REVIEW OF RELATED LITERATURE
Socioeconomic factors and social class are fundamental determinants of human functioning across the life span, including development, well-being, and physical and mental health.These are all primary concerns for psychological research, practice, education, policy, and advocacy. In other fields such as public health, epidemiology, and sociology, there has been exponential growth in work on socioeconomic conditions and these outcomes, as well as increasing funding from both governmental and foundation initiatives (e.g., the National Institutes of Health [NIH] agenda on health disparities; the MacArthur Foundation Research Network on socioeconomic conditions and Health; the Robert Wood Johnson proposal for a commission on health disparities in the Nigeria; and the World Health Organization Commission on Social Determinants of Health). Simultaneously, inequalities are increasing within the Nigeria and globally.We are concerned that psychology as a field and psychologists as individuals are underrepresented in participating in these initiatives and in addressing disparities resulting from the growing inequality. Much of the work on socioeconomic conditions is interdisciplinary. Psychology provides an important component, but there are many lost opportunities for including this perspective.There is often discomfort about focusing on the individual level within a multilevel approach, since this is seen as distracting from the social determinants that may be more amenable to large-scale social policy.To play an important role in this work, psychologists need not only to articulate the unique contribution that psychological theory and research can make but also to be more willing to link these to social– contextual and institutional factors that are inherent to SES/social class. For example, a growing body of scholarship documents the need for a psychology that is conscious of social class—calling for researchers, practitioners, and educators to attend more fully to the impact of socioeconomic position on psychological processes and outcomes, the subjective experiences of social class status, and psychosocial processes related to the social and political implications of class inequities (Adler et al., 1994; Carr & Sloan, 2003; Lott, 2002; Ostrove& Cole, 2003; Reid, 1993; Rice, 2001; Saris & Johnston-Robledo, 2000; L. Smith, 2005). In recognition of the need within psychology to address these issues and in an effort to determine how the Nigerian Psychological Association (NPA) might most effectively address them, the Task Force on Socioeconomic Status was formed.Nigerian Psychological Association (NPA’s) (2000) Resolution on Poverty and Socioeconomic Status and the creation of a task force charged with developing an agenda centered on social class are evidence of an increasing commitment to understanding the significance of social class and to challenging injustices, including socioeconomic disparities.This report is one step toward fulfilling these goals, but as the recommendations indicate, many more steps need to be taken. We believe that all areas of psychology will benefit from more disciplinary attention to social class and economic disparities in well-being. The report explores many of the arguments and evidence for the importance of SES and social class in the study and practice of psychology. The scope of this report is broad, and, consequently, some areas cannot be covered adequately. For example, while recognizing the importance of SES worldwide, the task force charge was to look at issues in the Nigeria. We were therefore unable to address the international population, and we recommend that future reports address the issue more globally. Additionally, although the task force charge was to address SES, the task force decided to place most of its focus on poverty. Most available research addresses poverty, and little data on other SES categories, such as the effects of affluence, are available.
CONCEPTUALIZING SOCIOECONOMIC STATUS
In this report, we compare three understandings of SES and social class–related inequalities in three critical domains of life: health (Belle &Doucet, 2003; Kawachi& Kennedy, 1999), education (Phillips & Chin, 2004), and human welfare (Lott & Bullock, 2007).We analyze the tensions among them and the need to consider all approaches as they intersect with other axes of privilege, power, and access to resources. These approaches include (a) models of SES that focus on material and structural factors; (b) gradient approaches, which focus on the effects of relative status and inequality; and (c) class models, which emphasize the persistent reproduction of hierarchies of power and privilege. In comparing these frameworks, we highlight how material conceptualizations of SES contribute to advocacy for improved access to resources; how research framed in terms of social inequality enhances our understanding of the psychosocial dimensions of inequality; and how class-based conceptualizations, with their overt focus on power, prestige, and privilege, address the persistent structural forces that maintain these hierarchies. All of these approaches call for psychology to pay greater attention to material and social context. The first two frameworks place greater emphasis on individual attributes and proximal causes in understanding and decreasing inequality than do social class–based approaches, which address cultural, structural, and institutional causes and solutions. The more macro level analysis employed in the class perspective can help psychologists better situate the individual experience and effects of SES in institutional and societal processes. Psychologists in turn can increase understanding of how individual processes affect and sometimes mediate social class. We highlight the significance of intersections of social class with race, ethnicity, gender, age, sexual orientation, and (dis)ability and argue for movement toward more contextualized, multilevel understandings of social class status. The multiple positions of these intersectional ties call into question psychological definitions of “normative” development and psychological health, as well as practices and policies based on these assumptions.
THE CONCEPT OF MENTAL ILLLNESS
Mental illness is associated with many contributing and/or causative factors. Genetics and other biological variables (e.g., abnormal balances of neurotransmitters and brain defects and injury) and psychological issues (e.g., trauma and neglect) are examples of such factors that have been significantly linked to mental health. Additionally, numerous environmental factors are associated with mental illness. Examples of the environmental factors associated with mental illness include: stressors such as the death of a loved one, separation/divorce, changing schools, job loss, and financial hardships; cultural and social variables; prenatal exposure to viruses, toxins, alcohol and/or drugs; nutritional deficiencies; chronic medical disorders; autoimmune diseases and infections; tobacco use and excessive alcohol intake; air pollution and toxicant exposure; high weather temperatures; seasonal patterns; natural disasters; and rural geographical location. Mental disorders tend to result from various combinations of the contributing/causative factors, and so all of these factors and mental health issues must be considered in context. Certain environmental factors related to mental illness are modifiable. Awareness of the numerous environmental factors that contribute to mental illness could help individuals, family members, friends, teachers, employers, coworkers, and health care providers utilize and/or develop preventative interventions, early identification and screening services, and immediate treatment strategies for mental health problems. Mental illness has a major impact on the economy and is associated with significant costs. These total costs are comprised of both direct and indirect costs. Examples of the direct costs include the costs of medication, clinical visits, and hospitalization; examples of the indirect costs include the costs of reduced labor supply, increased physical health care, public income support payments, educational underachievement, homelessness, and incarceration. SAMHSA reports that although mental health expenditures have increased in the past two decades, they have decreased as a share of all health expenditures. A substantial proportion of individuals with mental illness do not receive the mental health care they need, even though reliable and cost-effective evidence-based services exist for all mental disorders. Funding for the mental health system is insufficient. The study, prevention, early recognition, and treatment of mental illness are not only economical, but importantly, essential to the overall well-being of society.
Mental illness is a prevalent condition in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2013, approximately 43.8 million adults aged 18 or older in the U.S., 18.5% of all adults in this country, had any mental illness (AMI) in the past year and approximately 10.0 million adults aged 18 or older in the U.S., 4.2% of all adults in this country, had serious mental illness (SMI) in the past year.1 Additionally, mental illness is a condition that is associated with serious and widespread consequences, ranging from physical to social detriments. It is thus important to understand the causation and development of various mental disorders to better prevent, detect, and treat mental illness and to alleviate such consequences. Mental illness is associated with many contributing and/or causative factors. Genetics and other biological variables are examples of such factors that have been significantly linked to mental health. Hereditary, familial, and twin studies in particular have long supported the possibility of genetic predispositions to mental illness. Advances in genetic mapping have allowed for increased study within this field. Genetic risk factors have been indicated as important in the causation of many mental disorders, including schizophrenia, bipolar disorder, major depressive disorder, generalized anxiety disorder, and obsessive compulsive disorder (OCD). Abnormal functioning of nerve cell circuits/pathways, including abnormal balances of neurotransmitters, and brain defects and injury have likewise been noted as potential causative factors of mental illness. There are also various psychological factors that are associated with the causation of mental illness. For example, psychological trauma, frequently as a result of emotional, physical, or sexual abuse, is a critical etiological factor in the development of many mental disorders in childhood and adulthood. Neglect, particularly regarding symptoms of psychosis and schizophrenia, is another psychological factor that is strongly related to mental health problems within the framework of a causal relationshipFurthermore, numerous environmental factors have been indicated as contributing and/or causative factors of mental illness. For instance, life stressors such as death, divorce, changing schools, and financial problems have significant causal relationships with negative mental health outcomes. Cultural and social variables are other examples of these types of environmental factors, as are different external conditions, including: prenatal exposure to viruses, toxins, alcohol, and/or drugs; nutritional deficiencies; chronic medical disorders; presence of pollutants; high temperatures; and rural geographical location. All of this complex, and often times overlapping, contributing and/or causative factors must be considered in context; mental disorders tend to result from combinations of all of the aforementioned factors. Moreover, it is important to note that certain environmental factors related to mental illness are modifiable. The prevention and treatment of mental illness is not only important for individuals’ well-beings, since mental health is one of the biggest predictors of life satisfaction, but also to alleviate the intense, societal economic burden of mental illness. One of the major societal consequences of mental illness is a substantial impact on the economy. The costs resulting from mental illness are significant, though not well-documented. These total costs are comprised of both direct and indirect costs. Examples of the direct costs include the costs of medication, clinical visits, and hospitalization; examples of the indirect costs include the costs of reduced labor supply, increased physical health care, public income support payments, educational underachievement, homelessness, and incarceration. In 2002, the estimated SMI costs in the U.S. in total, excluding costs associated with comorbid conditions, incarceration,homelessness, and early mortality, was $317.6 billion.
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