1
|
Rinn R, Whittal A, Kremeti E, Lippke S. The social class of orthopedic rehabilitation patients: Are there differences in subjective health, return to work motivation, and participation in aftercare interventions? Soc Sci Med 2024; 356:117152. [PMID: 39047522 DOI: 10.1016/j.socscimed.2024.117152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/14/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
This longitudinal quasi-experimental study examines the relationship between social class, subjective health, motivation to return to work (RTW) following medical rehabilitation, and participation in aftercare interventions, utilizing the Social Cognitive Theory of Social Class. To do so, a prospective multicentric study was conducted. The analysis was based on data from N = 1044 orthopedic rehabilitation patients in three clinics in Germany. Latent growth curve models, fixed-effect linear regression models, and multilevel binomial logistic regression were employed for data analysis. As hypothesized, the findings demonstrate that lower social class is associated with poorer subjective health, while higher social class is linked to increased solipsistic motives, characterized by pursuing personal goals in the context of RTW. Conversely, individuals from lower social classes exhibit contextualist motives, which indicate a focus on social and environmental threats influencing their motivation to RTW. Surprisingly, social class does not significantly impact participation in aftercare interventions, probably due to low variance and potentially the successful inclusion within the German healthcare system. These findings emphasize the importance of considering diverse motivation profiles derived from the Social Cognitive Theory of Social Class. The study contributes to our understanding of the social determinants of health and has implications for reducing health disparities by highlighting the motivational aspects, including solipsistic and contextualist motives, associated with social class.
Collapse
Affiliation(s)
- Robin Rinn
- Constructor University Bremen gGmbH, Campus Ring 1, 28759, Bremen, Germany.
| | - Amanda Whittal
- Constructor University Bremen gGmbH, Campus Ring 1, 28759, Bremen, Germany.
| | - Eleni Kremeti
- Institute for Social Work and Social Pedagogy e. V., Zeilweg 42, 60439, Frankfurt am Main, Germany.
| | - Sonia Lippke
- Constructor University Bremen gGmbH, Campus Ring 1, 28759, Bremen, Germany.
| |
Collapse
|
2
|
Bryan BT, Thompson KN, Goldman-Mellor S, Moffitt TE, Odgers CL, So SLS, Uddin Rahman M, Wertz J, Matthews T, Arseneault L. The socioeconomic consequences of loneliness: Evidence from a nationally representative longitudinal study of young adults. Soc Sci Med 2024; 345:116697. [PMID: 38490911 DOI: 10.1016/j.socscimed.2024.116697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/24/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
The negative health consequences of loneliness have led to increasing concern about the economic cost of loneliness in recent years. Loneliness may also incur an economic burden more directly, by impacting socioeconomic position. Much of the research to date has focused on employment status which may not fully capture socioeconomic position and has relied on cross-sectional data, leaving questions around the robustness of the association and reverse causation. The present study used longitudinal data to test prospective associations between loneliness and multiple indicators of social position in young adulthood, specifically, whether participants who were lonelier at age 12 were more likely to be out of employment, education and training (NEET) and lower on employability and subjective social status as young adults. The data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 individuals born in England and Wales during 1994-1995. Loneliness and subjective social status were measured at ages 12, 18 and 26. Employability and NEET status were assessed at age 18. Findings indicate that greater loneliness at age 12 was prospectively associated with reduced employability and lower social status in young adulthood. The association between loneliness and lower social status in young adulthood was robust when controlling for a range of confounders using a sibling-control design. Results also indicate that loneliness is unidirectionally associated with reduced subjective social status across adolescence and young adulthood. Overall, our findings suggest that loneliness may have direct costs to the economy resulting from reduced employability and social position, underlining the importance of addressing loneliness early in life.
Collapse
Affiliation(s)
- Bridget T Bryan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Katherine N Thompson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Sociology, College of Liberal Arts, Purdue University, 700 Mitch Daniels Blvd, West Lafayette, Indiana 47907-2059, USA
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, 5200 North Lake Road, Merced, 95343, USA
| | - Terrie E Moffitt
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, 27708, USA
| | - Candice L Odgers
- Department of Psychological Science, University of California Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, 92617, USA
| | - Sincere Long Shin So
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK; Chinese University of Hong Kong, Central Ave, Hong Kong, China
| | - Momtahena Uddin Rahman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jasmin Wertz
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Timothy Matthews
- School of Human Sciences, University of Greenwich, Park Row, London, SE10 9LS, UK
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
3
|
Dougall I, Vasiljevic M, Wright JD, Weick M. How, when, and why is social class linked to mental health and wellbeing? A systematic meta-review. Soc Sci Med 2024; 343:116542. [PMID: 38290399 DOI: 10.1016/j.socscimed.2023.116542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
RATIONALE Meta-reviews synthesising research on social class and mental health and wellbeing are currently limited and focused on specific facets of social class (e.g., social capital) or mental health and wellbeing (e.g., mental health disorders), and none sought to identify mechanisms in this relationship. OBJECTIVES The present meta-review sought to (1) assess the overall relationship between social class and mental health and wellbeing, (2) determine the mechanisms that act in this relationship, and (3) evaluate the strength of evidence available. METHODS The protocol was prospectively registered on PROSPERO (CRD42021214731). We systematically searched twelve databases in September 2022 and identified 149 eligible reviews from 38,257 records screened. Quality of evidence was assessed with the JBI levels of evidence and risk of bias with the ROBIS tool. RESULTS A large but low-quality evidence base points to class-based inequalities in mental health and wellbeing, with the strongest available evidence linking lower social positions to an increased risk of depression. In terms of different facets of stratification, the best available evidence suggests that deprivation (e.g., poverty), socioeconomic status, income, and subjective social status are consequential for individuals' mental health and wellbeing. However, high-quality evidence for the roles of education, occupation, other economic resources (e.g., wealth), and social capital is currently limited. Most reviews employed individual-level measures (e.g., income), as opposed to interpersonal- (e.g., social capital) or community-level (e.g., neighbourhood deprivation) measures. Considering mechanisms, we found some evidence for mediation via subjective social status, sense of control, and experiences of stress and trauma. There was also some evidence that higher socioeconomic status can provide a buffer for neighbourhood deprivation, lower social capital, and lower subjective social status. CONCLUSIONS Future research employing experimental or quasi-experimental methods, and systematic reviews with a low risk of bias, are necessary to advance this area of research.
Collapse
Affiliation(s)
- Isla Dougall
- Department of Psychology, Durham University, South Rd, Durham, DH1 3LE, UK.
| | - Milica Vasiljevic
- Department of Psychology, Durham University, South Rd, Durham, DH1 3LE, UK
| | - Jack D Wright
- Department of Psychology, Durham University, South Rd, Durham, DH1 3LE, UK
| | - Mario Weick
- Department of Psychology, Durham University, South Rd, Durham, DH1 3LE, UK.
| |
Collapse
|
4
|
Timpson K, McCartney G, Walsh D, Chabanis B. What is missing from how we measure and understand the experience of poverty and deprivation in population health analyses? Eur J Public Health 2023; 33:974-980. [PMID: 37862435 PMCID: PMC10710332 DOI: 10.1093/eurpub/ckad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Explaining why some populations are healthier than others is a core task of epidemiology. Socioeconomic position (SEP), encompassing a broad range of exposures relating to economic circumstances, social class and deprivation, is an important explanation, but lacks a comprehensive framework for understanding the range of relevant exposures it encompasses. METHODS We reviewed existing literature on experiential accounts of poverty through database searching and the identification of relevant material by experts. We mapped relevant concepts into a complex systems diagram. We developed this diagram through a process of consultation with academic experts and experts with direct experience of poverty. Finally, we categorized concepts on the basis of whether they have previously been measured, their importance to the causal flow of the diagram, and their importance to those consulted, creating a list of priorities for future measurement. RESULTS There are a great many aspects of SEP which are not frequently measured or used in epidemiological research and, for some of these, work is needed to better conceptualize and develop measures. Potentially important missing aspects include stigma, social class processes, access to education, sense of lost potential, neighbourhoods, fairness and justice, emotional labour, masking poverty, being (in)visible, costs, and experiences of power. CONCLUSIONS Analyses seeking to understand the extent to which SEP exposures explain differences in the health of populations are likely to benefit from a comprehensive understanding of the range and inter-relationships between different aspects of SEP. More research to better conceptualize and measure these aspects is now needed.
Collapse
Affiliation(s)
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | | |
Collapse
|