Chapter 6:

Mental Disorder:
Social
Epidemiology
 Overview*
• Major contribution by sociologists is to describe the most significant
sociodemographic factors in determining the social characteristics of people most
likely to become mentally ill
• Also to identify the type of mental disorder most prevalent in a particular social group
• Sociologists also estimate the prevalence of mental disorder in the general population

• Social epidemiology is the measurement and analysis of social patterns of mental

disorder*
 Epidemiological Methods*
• Focus of the epidemiologist is not on individuals but on the health problems of large
groups of people*
• Goal is to find the cause of the health problem- so we must find the source
• So the goal is to find the starting point and trace its progression and influences

• Important Concepts:
• Case = the actual number of or person having a disorder, illness, or injury
• Risk = exposure to a health problem*
• i.e. the population at risk could be the entire population of the U.S. and the number of cases would be
the number of people diagnosed with X, Y, or Z.
• By dividing case/risk we get a ratio that represents the crude rate, or the simplest ratio
• An example of a crude rate is birth or death rates or marriage rates
• To have age-specific rates we simply limit our population to number of people in a particular age
bracket
 Epidemiological Methods*
• Incidence = the number of NEW cases of a specific health disorder occurring within
a given population during a specific time period*
• New cases of X in 2022

• Prevalence = the TOTAL number of cases of a disorder that exists at any given time
(old and new cases)*
• Lifetime prevalence = the number of people who had the disorder at least once in
their lifetime*
• The incidence of schizophrenia in a community may be low because no new cases
have developed in a given time period. However, the prevalence may be high if there
are many people previously diagnosed.
 Social Epidemiological Methods*
• Social epidemiologists are most interested in indicators of social class, sex (gender),
marital status, race, sexuality, etc.*
• The primary method for gathering this data is through surveys*
• However, other secondary sources are used to fill in gaps and verify the information*
• This may include: health records, mental hospital admissions data, other people who know the
patient, etc.
Diagnostic & Statistical Manual of Mental Disorders*
• Major criticism of DSM III (1980) was that the categories were not precise enough*
• Categories were only tested on 600 patients to see if they were valid

• The DSM-III-R (1987) revised the DSM III to correct the inconsistencies in the DSM
III*
• When we do generational comparisons or hereditary tracking why does this matter so
much?
• Was grandma really depressed, suicidal, or schizophrenic?

• DSM-IV (1994), reviewed 6,000 subjects

• DSM-IV-TR (text revision) was published in 2000.
• This edition claimed more empirical evidence than ever before
• Included symptoms specific to certain cultures but only as a guideline

• DSM-5 was released in 2013, based on more research

Diagnostic & Statistical Manual of Mental Disorders*
• DSM-5 also controversial
• Tendency to create a mental disorder based on mild behavior
• This is the medicalization of emotional symptoms
• Link to psychiatry claiming ownership of this field and being medical doctors
• New disorders added:
• Hoarding Disorder, Oppositional Defiant Disorder, Binge Eating Disorder, & Cannabis Withdrawal
Disorder
• Are these really mental disorders? Are any of them? At what point?
• The Social Construction of Mental Disorders…

• John Mirowsky & Catherine Ross argue that if 5 symptoms are necessary for a
diagnosis, people who report only 4 are considered to be in the same category as
people with no symptoms
• They argue that sociological studies should consider both the type and the severity of
psychological problems*
• We do not have true and complete information if we only use the DSM
ECA, NCS, & CES-D*
• The Diagnostic Interview Schedule (DIS) is one the most effective survey
instruments used
• The DIS is a survey questionnaire used to review a person’s history of past mental symptoms. A
computer assigns a diagnosis for research purposes*

• Another widely used scale is the Center for Epidemiologic Studies Depression Scale
(CES-D)- developed in 1976, 20 item scale
• This is not a clinical tool but is a valid and reliable research tool used to assess depression rates*
The “true” prevalence of mental disorder*
• It is difficult, if not impossible, to know the actual extent of
mental disorder in a large society.*
• Many people go undetected in a variety of ways.
• Previous research indicates that only a small minority of cases actually got official
treatment
• Most go untreated*

• We often dismiss a mental disorder as a personality flaw or eccentricity

The “true” prevalence of mental disorder
• The validity of diagnoses are in question
• Psychiatrists are notoriously bad at predicting dangerous behavior in mental patients
• Predictive validity = predictions of a person’s behavior derived from their diagnosis
(typically pretty low)
• However, tests on the effects of psychoactive drugs on behavior has high rates of
predictive validity
• So we use mass epidemiology studies to get approximations but these are just
approximations not a reality or precise measure
The “true” prevalence of mental disorder*
• True Prevalence: focus on 80+ worldwide studies, these do show consistent findings
(patterns hold across time and place)
• There is a significant relationship between mental disorder and 3 key
sociodemographic variables
• 1. social class
• 2. urban vs. rural location
• 3. gender

• Prevalence of mental disorder across the globe, is greater among lower

socioeconomic groups, in cities, and major differences between men and women.*
(also the less educated)
• Women have higher rates of depressive and anxiety disorders
• Men have higher rates of substance-related and antisocial personality disorders*
On to Module 2 and Chapter 7