Suicide and Depression among Low and Wealthy SES 12 month Prevalence of depression: 6.7% of U.S.

population Lifetime prevalence of depression: 16.5% Low SES is associated with Psychologically: Higher rates of attempted suicide Higher levels of emotional and behavioral difficulties: anxiety, depression, adhd Higher levels of aggression, hostility Physically: Higher BMI index for adolescents Higher physiological markers of chronic stress Higher rates of cardiovascular disease for adults Depression Overview of accumulation of literature in the past few years: Rates of psychopathology and mental disorders are higher among individuals of lower SES than individuals of high SES. It has been found for MDD, APD, Anxiety disorders, and substance abuse disorders. People from lowest SES groups were 2.6 times more likely to meet diagnostic criteria for psychiatric disorders than were people from highest SES groups adjusting for variables (age, gender, marital status, ethnicity, data collection site) Debate: It is unclear whether having a low socioeconomic status (SES) leads to depression or whether depression leads a person into poverty (bc of all the symptoms related with the illness). 2 primary hypothesis emerged in the literature: Social selection/downward drift hypothesis adults with psychological problems drift down the SES ladder bc of their psychopathology and their resultant inability to fulfill expected role obligations. Pathology is initially caused by genetics. Supported by studies on schizophrenia and ADHD Social causation/differential incidence hypothesis people with low SES develop psychological problems as a result of living with adversity (poverty,

stress). High levels of environmental stress can produce psychopathologies such as PTSD, depression and anxiety. First study to examine social causation in a nationally representative U.S. sample of children and adolescent. Longitudinal 9 year study. For 3 SES levels (low, medium & high), compared new cause incidence rates of 7 forms of psychopathology at 4 times of assessment every 3 years testing the following hypothesis A greater incidence of new cases would be found for the low-SES group than for the middle and high SES groups for symptoms: withdrawn, anxious/depressed, somatic complaints, delinquent behavior, and aggressive behavior Higher cumulative prevalence would be found for the low SES group than middle and high SES group on all symptoms Despite more new cases with many syndromes in the low SES group, mental health service rates would not be elevated for this group low SES have less access to health care Results Results strongly support SES effects on somatic complaints, anxious/depressed, thought problems, delinquent behavior, and aggressive behavior. Accumulation of clinically elevated scores for individuals from low SES group. Results correspond with the 3rd hypothesis that despite more new cases of elevated scores in the low SES group, there was no concurrent increase in mental health services for low SES individuals. Low SES contributes to more new cases of psychopathology, yet limited access to mental health care for those who need it Results strong argue for social causation effects on variety of syndromes but it does not imply causation of psychopathology!! It just implies contribution to variation in levels of psychopathology. consistent with diathesis-stress model of psychopathology which states economic adversity is a stressor that activates propensity for developing a disorder. A study tried to answer this question by examining a database of 34,000 patients w/ 2 or more psychiatric hospitalizations in Mass from 1994-2000. They found that unemployment, poverty and housing unaffordability were correlated with risk of mental illness.

 The results of this study suggest that SES impacts the development of mental illness directly, as well as indirectly through its association with adverse economic stressful conditions among lower income groups. Author Christopher G. Hudson, Ph.D., is quoted in an APA release as stating that "The poorer one's socioeconomic conditions are, the higher one's risk is for mental disability and psychiatric hospitalization," .This was found regardless of what economic hardship or type of mental illness the person suffered. Suicide Shaped by many social forces Lots of literature on low SES and suicide, not much on wealthy and suicide Low SES and suicide Research shows areas with less poverty, unemployment and family disruption have lower rates of suicide. Higher SES may reduce suicide risk: Higher incomes mean more access to health care. Employment provides income and also fosters social interaction in organizations Education provides individuals with greater sense of self-control and improved social capital The Richard Cory Phenomenon: Suicide and Wealthy in Kansas City, Missouri Journal of Forensic Science Richard Cory Poem mythical man of wealth, the envy of everyone in town. In the end, the man who had everything went home and put a bullet through his head Unexpected, but really is it? Case controlled study to see if suicide occurs more or less frequently among those with more of lifes finer things Used all cases of suicide reported to the Medical Examiner from 1998-2002. 426 suicides Compared appraisals of houses lived in by the suicide victims and appraisals for personal property owned by each victim, the victims spouse or parents were compared to a control group. Each non suicide control victim was matched by age, gender, race, and year of death with each suicide victim Identified stressors for suicidal intent:

 Financial strain, loss of a loved one, relationship difficulties, health difficulties, mental health problems or drug problems for each suicide from reports. Results Suicide victims were 77% more likely than controls to have lived in houses rather than apartments, trailers, or other dwellings Houses lived in by suicide group had significantly higher mean and median appraisal values than the control group. Suicide group: $50,000-100,000; Control group: <$50,000, suicide group more likely to live in expensive houses Analysis of stressors for the suicide group identified mental health and relationship issues as the predominant stressor, financial strain was identified in 8% of victims In summary, there is a positive correlation of suicide and SES in this study May seem counterintuitive, but possible explanation for this association include: Disappointment with life many people who become more wealthy expect more from life. But when expectations arent met (reversal of fortune or problems persist), they ultimately become disappointed. Diminished endurance kinda like how resilient the person is. People with wealth and comfort do not endure hardship as well as those without the finer things. Suicide results from a breakdown of endurance Increased complexity wealth brings complexity to life. Theres additional responsibilities and complications that leads to additional problems. Ex: a person who is poor does not have $ to gamble or take risks Ex: Japans economic downturn in 1999, record # of suicides Conclusion: FACT: Suicide is neither the rich man's disease nor the poor man's curse. Suicide is very "democratic" and is represented proportionately among all levels of society.