Social Structure, Stress, and Mental Health: Competing Conceptual and Analytic Models

Author(s): Carol S. Aneshensel, Carolyn M. Rutter and Peter A. Lachenbruch

Source: American Sociological Review, Vol. 56, No. 2 (Apr., 1991), pp. 166-178
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2095777
Accessed: 18-05-2016 17:55 UTC
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
http://about.jstor.org/terms

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted
digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about
JSTOR, please contact support@jstor.org.

Sage Publications, Inc., American Sociological Association are collaborating with JSTOR to digitize,
preserve and extend access to American Sociological Review

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

SOCIAL STRUCTURE, STRESS, AND MENTAL HEALTH:

COMPETING CONCEPTUAL AND ANALYTIC MODELS*

CAROL S. ANESHENSEL CAROLYN M. RUITTER
University of California, Los Angeles University of California, Los Angeles

PETER A. LACHENBRUCH
University of California, Los Angeles
A sociological model for the mental health consequences of social organization is distinguished from a sociomedical model for the social etiology of particular disorders. Both
models use stress to explain associations between social placement and disorder. These

models are not interchangeable, despite apparent similarities, but researchers frequently
apply the sociomedical model to sociological questions. Discrepancies between models are
illustrated with survey data collected from a community sample of adults. We demonstrate

that gender differences in the impact of stress are disorder-specific and do not indicate
general differences between women and men in susceptibility to stress.

Sociological interest in stressful life circum-

in the prevalence of disorder in terms of group

stances originated to explain associations

differences in exposure and/or vulnerability to life

between markers of social placement such as class,

gender, and minority group status and rates of

changes (Kessler 1979; Kessler and McLeod

1984; Kessler and Neighbors 1986; Newmann

mental and emotional disorder. Early social cau-

1986; Turner and Noh 1983; Ulbrich, Warheit,

sation perspectives reasoned that low-status social

and Zimmennan 1989). We submit that this body

groups evidenced high rates of disorder because

of stress research, although informative about the

members of these groups disproportionately en-

social etiology of particular disorders, provides a

countered difficult, harsh, or traumatic life conditions. Elevated rates of disorder also were attrib-

distorted view of the mental health consequences

uted to restricted group access to social, econom-

of various structural arrangements.

In interpreting this literature, we distinguish

ic, or personal resources - assets that combat

between sociological models that focus on the

difficult life circumstances and diminish their

mental health consequences of patterns of social

mental health consequences (Dohrenwend and

organization and sociomedical models that em-

Dohrenwend 1969; Pearlin and Johnson 1977).'

phasize the social antecedents of mental disor-

These perspectives are embodied in recent re-

ders. These two orientations may appear identi-

search that seeks to account for group differences

cal or complementary and are often interchanged,

Direct all correspondence to Carol S. Aneshensel,

21-245 Center for Health Sciences, School of Public

Health, UCLA, Los Angeles, CA 90024-1772. This

research was supported by a grant from the National
Institute of Mental Health (I ROl MH42816). Data
were collected under the Epidemiologic Catchment
Area program, a series of five epidemiologic studies
conducted by independent research teams in collaboration with NIMH. Data reported here are from the
Los Angeles site (UO1 MH 35865): Marvin Karno,
Richard L. Hough, Javier I. Escobar, M. Audrey Burnam, and Dianne Timbers, Principal Investigators.
The authors wish to thank Leonard I. Pearlin for providing valuable suggestions and Roberleigh H. Schuler
for conducting analyses. This paper was presented at
the International Conference on Social Stress Research, Regent's College, London, June, 1990.
i The major alternatives to these social causation

but this similarity is illusory and deceptive. The

questions posed and answers provided by these
models are qualitatively different and, at times,
incongruent. Sociological and sociomedical
models both incorporate social characteristics,

stress, and psychological dysfunction but differ

in their conceptualizations of the relationships
among these constructs.
hypotheses are the social drift and social selection
hypotheses which portray psychological disorder as
producing downward social mobility or selection out

of social roles such as being married or employed.

With the exception of severe disorder, such as schizophrenia, however, the empirical evidence lends more
support to social causation than social selection processes (Eaton 1986; Mirowsky and Ross 1989a).

166 American Sociological Review, 1991,Vol. 56 (April: 166-178)

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 167

Sociological inquiry begins with particular so-

and a wide array of physical and psychological

cial structural arrangements and looks forward

disorders (see Thoits 1983 and Kasl 1984 for re-

toward a broad range of potential consequences;

views). Ironically, while these disorder-specific

the sociomedical paradigm begins with a partic-

findings attest to the far-reaching and diverse

ular disorder and looks backward toward a broad

impacts of stressful life experiences, the disorder-

range of potential antecedents of that disorder.2

specific paradigm itself is inadequate for assess-

These vantage points shape the assumptions im-

ing these nonspecific effects.

plicit in each model. Sociological theory expli-

This anomaly arises because the presence or

cates how normative social arrangements gener-

absence of a particular disorder is implicitly and

ate conditions that damage the emotional interi-

inappropriately equated with whether the person

ors of people's lives (Pearlin and Lieberman

1978). High rates of disorder among some social

has been affected by stress (Pearlin 1989). That

is, status with regard to a single disorder is treat-

groups are seen as the inevitable by-product of

ed as a proxy for status with regard to all stress-

ordinary facets of social life, facets that are often

related disorders. Only persons displaying

advantageous to other social groups. In contrast,

symptoms of the disorder being investigated are

treated as potentially having been affected by
stress. Persons having other stress-related condi-

the sociomedical paradigm portrays disorder as

atypical and looks for unusual elements of individuals' lives that account for this disorder. This
paradigm portrays stress as an independent variable and social characteristics as background or

tions are treated as not having been affected by

stress and are combined conceptually and analytically with persons who are unaffected by stress

confounding factors. The sociological paradigm,

in one "nondisordered" category.3 This classifi-

instead, conceptualizes stress as an orderly con-

cation is appropriate from an etiologic perspec-

sequence of social organization, i.e., as an interserved that the various structural arrangements

tive insofar as these persons do not have the disorder being investigated.4 This classification,
however, is misleading from the perspective of

in which individuals are embedded determine the

determining the consequences of exposure to so-

vening variable. For example, Pearlin (1989) ob-

stressors they encounter, the stress mediators they

cial stress because persons with other stress-re-

are able to mobilize, and their inner experiences

lated disorders are misclassified as unaffected by

of stress.

stress.

Discontinuities Between Sociological and

order as a proxy for mental health status compromises the assessment of the consequences of stress

Treating status with regard to a particular dis-

Sociomedical Paradigms

We argue that the sociomedical paradigm is wellsuited for identifying etiologic factors for particular disorders, but is inherently inadequate for
identifying the mental health consequences of
social organization. Our central critique of the
empirical stress literature is that the impact of stress

for psychological functioning overall. Specifically, etiologic estimates for particular disorders
are biased estimates of the overall impact of stress.
Moreover, this misclassification is nonrandom:
the proportion misclassified as not disordered
increases as stress exposure increases precisely
because these are stress-related disorders. Con-

for a particular disorder is often mistaken for the

sequently, the direction of the bias is unknown.

impact of stress on mental health in general. This

confusion arises because stress research, irrespective of disciplinary orientation, typically
considers only one disorder as an outcome, e.g.,
depression. A basic premise of social stress theory, however, is that the effects of stress are nonspecific, not limited to any particular disorder.
This premise rests on empirical research demonstrating an association between exposure to stress

That is, the impact of exposure to stress on psy-

2 "Forward" and "backward" refer to conceptual

orientations toward social characteristics and stres-

chological dysfunction overall may be overestimated or underestimated by using etiologic

models for specific disorders. We submit that
I This issue is presented in terms of diagnostic categories for simplicity, but the same problem exists
when disorder is defined by symptom counts of par-

ticular types of disorder because persons with symptoms of other types of stress-related disorder are classified as asymptomatic, i.e., unaffected by exposure
to stress.

sors and not research design. Previous research con-

4 Schwartz and Link (1989) argue that the appro-

ducted within each of these paradigms has employed

priate control group for etiologic estimates are per-

prospective, retrospective, and cross-sectional meth-

sons without the disorder under study rather than those

ods of data collection.

without any disorder.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

168 AMERICAN SOCIOLOGICAL REVIEW

such bias occurs unless the disorder being considered is a reasonable proxy for the universe of
all stress-related disorders.
Equally important, group differences in the
impact of stress for a particular disorder may not
reflect the extent to which stress exerts a more
harmful psychological effect among some social
groups than others. This observation is an exten-

sion of the misclassification issue, with the added complication that subgroups of the population
may vary in the rate of occurrence of the various
stress-related disorders included in the "nondisordered" category. Group comparisons of stressreactivity for a single disorder are predicated on

Wheaton (1990) observed, the operationalization

of stress as an inventory of life events has contributed to the progressive disengagement of the
concept from social structural conditions.
Thus, the sociomedical paradigm is inherently
inadequate for examining the mental health consequences of social organization not only because
it ignores numerous potential mental health consequences, but also because it excludes numerous potential stressors.
The Case of Gender

der relationship is a reasonable proxy for all stress-

The slippage between the two paradigms is illustrated by the case of gender. Sex role theory attributes higher rates of disorder among women

disorder relationships for each of the groups. This

than men to the gender stratification of social roles,

assumption is untested and, as we shall illustrate

empirically, untenable. Disorder-specific findings
on group differences in stress-reactivity will
misrepresent overall group differences in the
mental health impact of stress to the extent that
members of these groups differ in the dominant

positing that the social roles typically occupied by

women disproportionately expose women to stress

the assumption that this particular stress-disor-

modes of expressing psychological reactions to

stressful life experiences. We submit that such
bias occurs unless the stress-disorder relationships being examined are a representative sample
of the universe of all stress-disorder relationships
for every group in the population.

The universe of such relationships, however,

is defined by stressors as well as disorders. The

widespread adoption of the sociomedical para-

digm in stress research has limited conceptualizations of stressful life experience. The treatment of stress as an independent variable has
produced a measurement strategy designed to
purge any potential contamination by disorder
from the assessment of stress. First, research has
concentrated on acute events because chronic
difficulties are likely to be influenced by the individual's psychological state insofar as the person is an active participant in those difficulties

(e.g., ongoing marital conflict). Second, research

has concentrated on acute events that are presumably independent of the person's pre-existing state (e.g., bereavement) rather than events
that may be a result of pre-existing disorder (e.g.,
divorce). This measurement solution is consistent with the conceptualization of stress as an
independent variable, but is inconsistent with the
conceptualization of stress as an intervening
variable that links social position with psychological dysfunction because this strategy effectively removes the individual and his or her characteristics from models of stress processes. As

(Gove 1972; Gove and Tudor 1973; Aneshensel,

Frerichs, and Clark 1981). Recently, higher rates
of disorder among women have been attributed to
their greater exposure and vulnerability to events
occurring to individuals in the person's social
network, labeled the high cost of caring hypothesis (Kessler and McLeod 1984). Both theories are
general ratherthan disorder-specific: They concern

connections between gender and stress that produce more disorder among women than among
men. Applied research, however, implicitly has
adopted the sociomedical, disorder-specific paradigm, and focused upon symptoms of depression and/or anxiety, commonly referred to as
nonspecific psychological distress (Dohrenwend,
Shrout, Egri, and Mendelsohn 1980). The label of
nonspecific psychological distress, however, is a
misnomer because numerous possible manifestations ofdistress, e.g., substance abuse/dependence,
are omitted.

Dohrenwend and Dohrenwend (1976) have

criticized such global theories for failing to consider adequately gender differences in the prevalence of different types of disorder. Recent epidemiologic surveys demonstrate that lifetime and
recent prevalence rates for overall mental disorder are comparable for women and men, with
depressive and some anxiety disorders more
common among women than among men, and
antisocial personality and alcohol abuse-dependence more common among men than among

women (Robins et al. 1984; Karno et al. 1987;

Myers et al. 1984; Burnam et al. 1987). These
findings challenge the basic premise of theory
and research in this area that women have higher
rates of disorder than men.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 169

While recent research on gender tends to state

(Bumam et al. 1987; Karno et al. 1987). Briefly,

explicitly that findings pertain to a particular dis-

the characteristics of the sample approximate

order, such caveats do not resolve the theoretical

those of the target population, displaying consid-

dilemma posed by the sociomedical paradigm.

erable diversity in terms of ethnicity (39.7 per-

Stress may be a more important etiologic factor

cent Mexican American, 41.8 percent non-His-

for women than men for some disorders, but such

panic white, 18.4 percent other), annual family

findings do not necessarily mean that women are

income (mean = $23,440, s.d. = $19,220), gen-

more vulnerable to stress than are men.

der (52.7 percent female), age in years (mean =

We illustrate this point with an empirical ex-

40.5, s.d. = 16.6), employment status (65.5 per-

ample. Our example is not intended as an ex-

cent employed), and marital status (47.0 percent

haustive treatment of gender and mental health.

married or living with someone).

Rather, it demonstrates the intrinsic flaws in the

sociomedical paradigm for addressing certain

Personal interviews in English and/or Spanish

were conducted by lay interviewers at the re-

sociological questions. These flaws could be il-

spondent's home. The diagnostic portion of the

lustrated for other types of disorders and for oth-

Spanish version demonstrates adequate test-re-

er indicators of social placement. The central

test reliability among monolingual respondents

principle is that single-outcome models provide

and fair to good diagnostic agreement with the

biased estimates of the global effects of stress,

English version among bilingual respondents

particularly group differences in stress-reactivi-

(Karno, Burnam, Escobar, Hough, and Eaton

ty, unless the stress-disorder relationships exam-

1983; Burnam, Karno, Hough, Escobar, and

ined are adequate samples of the universe of all

Forsythe 1983).

stress-disorder relationships for all groups in the

population.

Measures

Information on psychiatric disorders was collectMETHOD

ed with the Diagnostic Interview Schedule (DIS),

Sample and Procedures

a highly structured instrument designed for administration by lay interviewers (Robins, Helzer,

The data were collected as part of the multisite

Croughan, and Ratcliff 1981). This information

Epidemiologic Catchment Area (ECA) program

was converted by computer algorithm to pseudo-

(Eaton and Kessler 1985). Only data from the Los

diagnoses using DSM-III criteria (American Psy-

Angeles site are reported here because informa-

chiatric Association 1980). Although questions

tion concerning the occurrence of stressful events

concerning the reliability and validity of DIS-

and circumstances is part of the site-specific por-

generated diagnoses persist, the DIS is currently

tion of the survey and is not duplicated at the other

the most widely accepted method for lay, com-

four sites.

munity-based diagnostic surveys. Diagnoses were

The household sample was selected from two

made on a lifetime basis, but only disorders oc-

mental health catchment areas in metropolitan

curring within the past six months are analyzed

Los Angeles, one predominantly Hispanic (83

here because most of the information concerning

percent), primarily of Mexican origin or descent,

stress pertains to this time interval.

and one predominantly non-Hispanic white (63

The low prevalence of most specific disorders

percent). Within each catchment area, respon-

made the use of models for discrete disorders

dents were selected with a two-stage probability

infeasible. Consequently, disorders were grouped

design (census blocks and households), with random selection of adults (18 years or older) within
households. A 68 percent response rate yielded a

into two composite categories: affective or anxi-

total sample of 3,131 adults; sample sizes for

analyses reported here vary due to missing data.
The data were weighted to adjust for differential
selection probabilities associated with catchment

ety disorders (major depressive episode, manic

episode, panic disorder, phobia, obsessive-compulsive, somatization) and substance-use disorders (alcohol abuse/dependence and drug abuse/
dependence).5 These categories are used for several reasons: Research on nonspecific psycho-

area and household size, and for nonresponse

(weighted to stratified 1980 census counts). De-

tailed descriptions of the sampling procedures

and characteristics of the sample appear elsewhere

5 Detailed descriptions of the measurement and

scoring procedures are available upon request from
the senior author.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

170

AMERICAN

SOCIOLOGICAL

REVIEW

logical distress generally taps depression and

of symptoms across all disorders is dispropor-

anxiety; nonspecific psychological distress and

substance-use disorders typically are studied

tionately influenced by the affective or anxiety

separately; and these disorders usually show

anxiety vs. substance-use symptomatology only.

symptoms, results are compared for affective or

strong gender differences.

The absence of a composite symptom count,

Generalized anxiety disorder, while not included in the version of the DIS used in this

however, does not detract from our argument

because we need only demonstrate that the mod-

survey, was assessed separately and scored ac-

el for symptoms of one type of disorder does not

cording to DSM-III criteria; it was included in

generalize to symptoms of other disorders. Be-

the affective and anxiety disorder category. Dys-

cause symptom counts are highly skewed with a

thymia was excluded because no recency infor-

mode of zero, symptom counts are transformed

mation was available. Persons with scores of 13

by taking the log of the count plus one.

or more errors on the Mini-Mental State Exami-

The conceptualization and operationalization

nation (Folstein, Folstein, and McHugh 1975),

indicative of severe organic dementia, were ex-

of psychological disorder are subjects of intense

cluded because of doubts about the reliability of

data provided by these persons. Finally, a third
category of other disorders included schizophre-

debate among sociologists, psychiatrists, and epidemiologists. These measurement issues, however, are extraneous to the issue of model mis-

personality. While our procedures do not en-

specification addressed here. Disorder-specific

stress models, whether operationalized as discrete disorders or as symptom counts, provide

compass all psychiatric disorders, the assessment

biased estimates of the overall impact of stress. It

is considerably more comprehensive than is typ-

is the condition of sampling the entire domain of

nia, schizophreniform disorder, and antisocial

ically the case in research of this type.

Although other groupings of disorders are

possible and perhaps even preferable, the precise

configuration of these analytic categories is immaterial to the central issues examined here. Any
categorization that falls short of adequately representing all stress-related disorders would suffice to illustrate the slippage between theoretical
and empirical models.
We define disorder using both diagnostic criteria (presence/absence of disorder) and symptom counts. This dual approach is used because
the recent emphasis in psychiatric epidemiology
is on diagnosable disorders, while most previous
stress research concerned symptomatology.
Moreover, debate continues about whether diagnosable disorders or symptoms are the most appropriate object of inquiry (Mirowsky and Ross
1989b). The two operationalizations are similar

stress-disorder relationships for the entire popu-

lation that is at issue here, not whether disorder is

a discrete or continuous entity.

We employ three measures of stress: negative

life events occurring to the respondent; negative

life events occurring to someone important to the

respondent; and financial strain. We focus on

negative events because undesirable events are
more stressful than other events (Thoits 1983).
While prior research has emphasized events oc-

curring to the individual, recent research suggests that events occurring to significant others
may be especially important to women (Kessler

and McLeod 1984). Financial strain is an indicator of chronic life strains.

Interviewers asked whether specific events had

occurred during the previous six months to the
respondent ( 12 events) or to someone important
to the respondent (10 events). They also asked

in that one diagnostic criterion specifies the min-

whether "anything else happened that affected

imum number of symptoms necessary for a positive diagnostic status. Diagnostic ascertainment

your life a lot" (Golding, Potts, and Aneshensel

forthcoming). Multiple open-ended responses

also specifies additional criteria, however, such

were coded, compensating somewhat for the short

as symptom configurations, severity, duration,

list of specific events. Respondent events were:

and absence of exclusionary criteria such as

work or money-related (e.g., fired, business loss,

physical illness. Thus, individuals with the mini-

negative change in financial situation); family or

mum number of symptoms may be negative on

relationship-related (e.g., divorce, break-up with

diagnostic status because they do not meet these

partner, someone moved out of household); legal

other diagnostic criteria.

problems (e.g., arrest, trouble with the law, de-

Counts of symptoms present during the past

six months have the following possible and observed ranges: affective or anxiety, 0-108 vs. 053; substance-use, 0-22 vs. 0-14. Because a count

portation); crime victimization (e.g., burglarized,

robbed, mugged, assaulted); and deaths. Events
occurring to others were: work or money-related;

legal; crime victimization; and illness of another

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 171

person (e.g., physical illness or injury, nervous or
mental problems, drug or alcohol problems). Re-

spondent events range from zero to seven events

with a mean of .68 and a standard deviation of
1.03, while events occurring to others range from
zero to nine events with a mean of 1.21 and a
standard deviation of 1.52. Financial strain is

Table 1. Percentages: Males and Females to Whom Each

Disorder Occurred in the Preceding Six Months
Type of Disordera Males Females
Any affective, anxiety, or substance- 14.2 14.6
use disorder (.9) (1.0)

Any affective or anxiety disorder: 5.9 13.0

(.6) (.9)

measured by the presence or absence of five con-

ditions -having difficulty affording food, clothing, medical care, and furniture and paying bills
(Pearlin, Lieberman, Menaghan, and Mullan
1981). This count ranges from zero to five with a
mean of 1.40, a standard deviation of 1.67, and
internal consistency reliability of .81. Because
comprehensive assessment of psychiatric disorder

Major depressive episode 2.2 3.4

(.4) (.5)
Mania

episode

(.2) (.2)
Panic

disorder

.1

.5

(.1) (.2)
Phobia

2.6

8.4

(.4) (.7)
Obsessive-compulsive .5 .3

sample of the universe of stress. Conclusions

pertaining to these measures should be regarded
as exploratory.

.1

Generalized anxiety disorder .6 .7

was a primary objective of the ECA program, little

time was devoted to potential psychosocial antecedents of disorder. Consequently, our stress
measures are not ideal and are not an extensive

.0

(.0) (.1)

(.2) (.2)
Somatization

.0

.0

(.0) (.0)
Any substance-use disorder: 9.2 2.4

(.8) (.5)

Analysis

We compare disorder-specific models with models for all types of disorder combined. The disorder-specific models are: the presence/ absence of
any affective or anxiety disorder and the presence/absence of any substance-use disorder; the
combined model considers the presence/ absence
of any disorder. Parallel disorder-specific models
are estimated for symptom counts.

For each type of disorder, the multivariate

analysis proceeds in two stages. First, the disorder is regressed on gender, other social characteristics and their interactions, and the three stress
measures. For purposes of comparability, sociodemographic interactions are retained in models
for all disorder types whenever these terms are
significant for any disorder type. Second, interaction terms between gender and the three stress
measures are added, representing effects of stress
that vary by gender. Regressions are estimated
separately by gender to confirm interactions from
the combined analysis. Two types of statistical
models are used: logistic regression for the presence/absence of disorder and multiple linear regression for the log-transformed symptom counts.
Statistical adjustments for design effects associated with the complex sample are made using
Taylor series linear approximation with SESUDAAN (Shah 1981), RTILOGIT (Shah, Folsom, Harrell and Dillard 1984) and SURREGER
(Holt 1977).

Alcohol abuse/dependence 8.0 1.9

(.7) (.4)
Drug abuse/dependence 1.8 .7

(.4) (.2)
Other disordersb .3 .2
(.1) (.1)
All

disorders

14.3

14.7

(.9) (1.0)
Maximum weighted number of cases 1,472 1,632
a Multiple diagnoses are possible.
b "Other disorders" refers to schizophrenia, schizophreniform disorder, and antisocial personality.
Note: Standard errors in parentheses.

RESULTS

Gender Differences in Disorder

Men and women are about equally likely to have

experienced a recent psychiatric disorder, as displayed in Table 1. This overall similarity, however, masks strong gender differences in specific
types of disorders. Alcohol abuse/dependence and
drug abuse/dependence are substantially more
common among men than among women. The
female-to-male odds ratio for the substance-use
category is .25 (p <.001), indicating a substantially greater male risk. In contrast, the female-to-

male odds ratio for the affective or anxiety disor-

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

172 AMERICAN SOCIOLOGICAL REVIEW

Table 2. Adjusted Odds Ratios: Presence/Absence of Disorder by Selected Personal Characteristics and Stressors
Affective or Anxiety Disorder Substance-Use Disorder All Disorders

Independent Variables Model I Model H Model I Model II Model I Model II

Female

1.55*

1.86*

.23***

.17***

.71*

.79

Ethnicity:a

Mexican-American .49** *5o** 1.03 1.02 .64 .64

Other .46** .45** 1.35 1.34 .66 .66
Age

(years)

Income

.99

(000)

Employed

Married

.99

.98**
.86

.50*

.98***

.98**
.86

.50*

.98***

.99
.97

.72

.99

.99**

.99**

.99**

.99**

.98

.73

.91

.58**

.92

.59**

Female x married 2.49* 2.47* .78 .72 1.98** 1.93**

Ethnicity x income:a

Mexican-American

Other

1.02*

Events-self

1.16*

1.02

1.02*
1.13

1.02

.99

.99

.99

1.13

1.22*

.99

1.01

1.02

1.19***

1.01

1.02
1.25**

Events-other 1.22*** 1.37*** 1.25*** 1.20** 1.27*** 1.32***

Financial strain 1. 18** 1.14 1.09 1.05 1.16** 1.11

Female
Female
Female

x
x
x

events-self

1.05

events-other
financial

Intercept

.11

strain

.09

.21

-.71**

.83*
1.05

.91

1.19
1.16

.23

.30

.92

1.08
.28

Number of cases 2,907 2,907 2,903 2,903 2,924 2,924

*p?. ** p <.01 *** p <.001

a Reference category is non-Hispanic white.

Note: Model II differs from Model I by the inclusion of gender-by-stressor interaction terms.

der is 2.32 (p < .001), indicating a substantially

greater female risk. This gender difference is due
primarily to the greater prevalence of major de-

pressive disorder episodes and phobia among females. Recent affective or anxiety disorders and

substance-use disorders tend to occur separately

rather than together: only 1.0 percent (s.e. = .3) of

the men and 0.6 percent (s.e. = .2) of the women

experienced both types of disorder during the past
six months.

A gender difference in stress-exposure or re-

activity is unlikely to account for the gender distributions of both affective or anxiety disorders
and substance-use disorders because these gen-

der differences are in opposite directions. The

fact that similar proportions of men and women
had some kind of disorder, however, does not
necessarily mean that men and women have similar levels of stress-exposure and/or reactivity.
For example, the impact of stress may be inversely related to exposure, i.e., the group with
the highest exposure has the lowest reactivity, an
"inoculation" effect.

Gender, Stress, and Diagnostic Categories

Of primary concern is whether gender differences in the impact of stress for one type of disorder
signify ubiquitous gender differences in the impact of stressful life experiences on mental health.
Table 2 presents models for the two categories of

disorder - affective or anxiety disorder and substance-use disorder - and for any psychiatric
disorder. The gender-by-stressor interaction terms

represent gender differences in the impact of stress

for particular disorders. These terms signify genderdifferences in overall stress-reactivity only for
the model for all disorders. Logistic regression

coefficients are presented as adjusted odds ratios.6

6 The odds ratio, el, is sometimes called a partial
odds ratio because it is the odds ratio comparing two
groups holding all other variables at the same level.
Thus, the female-to-male odds ratio is the effect of
being female net of the other variables included in the
model. The gender-by-stressor interaction term represents a multiplicative effect of events on the female-to-male odds ratio given a single event. For n
events, this effect is raised to the nth power.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 173

As can be seen, the models for the two diagnos-

Global gender differences in reactions to

tic categories differ from one another and from

the model for all psychiatric disorders with regard to gender contingencies in the effects of the
various stressors considered (Model II). Certain

stressful life experiences should produce similar

stressors are more important etiologically for men

or for women when only affective or anxiety dis-

orders or substance-use disorders are considered.

For all psychiatric disorders, all three stressors
exert independent effects on the odds of disorder,
effects that are similar for men and women.
For any affective or anxiety disorder, being

female continues to be associated with an increased risk of disorder when other characteristics and stress-exposure are held constant. This
gender difference is greater among the married
than the unmarried. Mexican-Americans and
those of other ethnic backgrounds are at lower
risk than non-Hispanic whites. Increased income
is associated with a decreased risk of affective or
anxiety disorder, except among those of other
ethnic backgrounds. All three stressors are independently associated with an increased risk of
affective or anxiety disorder (Model I). Adding
the three gender-by-stressor interactions (Model
II) alters these associations. Negative life events
occurring to someone important to the respondent

is the only stressor related to disorder, but this

effect is contingent upon gender. Specifically,
these events have less of an effect among women

gender-contingencies across different types of

disorder, but models for the presence/absence of
substance-use disorder produce markedly different results. Being male continues to be associated
with a greater risk of substance-use disorder in
the multivariate models. Increasing age is associated with decreased risk. In the main effects
model (Model I), negative life events occurring
to someone important to the respondent is the
only stressor associated with increased substanceuse disorder. When gender-by-stressor interactions are added (Model II), a different pattern
emerges. Events occurring to others continue to
be associated with increased risk, but the genderby-stressor interaction term, suggesting a greater
impact among women than men, approaches sta-

tistical significance (p < .06). Negative life events

occurring to the respondent slightly decrease the
risk of substance-use disorder among women,
but increase this risk among men. For substanceuse disorder, events-self increase risk among men
only, while events-other increase risk among men
and women, possibly more so among women.
Separate logistic regressions by gender for
substance-use disorder clarify these interactions.
These analyses reveal that events-self nonsignificantly decrease the odds of disorder for women

Logistic regressions conducted separately by

gender confirm the somewhat greater impact
among men of events occurring to someone else.
For women, all three stressors are related significantly to affective or anxiety disorders: events-

(eB = .87;p > .05) and significantly increase these

odds for men (el = 1.20; p < .05), meaning these
events are etiologically important for men only.
Events-other are related to increased odds of
substance-use disorder among both women (eB =
1.39; p < .001) and men (el = 1.22; p < .005),
being somewhat stronger among women. The

self (el = 1. 18; p < .05), events-other (el = 1.13; p

< .05), and financial strain (el = 1.20; p < .005).

financial strain stressor attains statistical significance for women (el = 1.23; p < .05), but not men

than among men.

For men, events occurring to someone else is the

(el = 1.04; p > .05), but because the interaction

only stressor significantly related to these disor-

term and main effect for this stressor were not

significant in the pooled analysis, skepticism is
warranted regarding this gender contingency.

ders: events-self (el = 1.14; p > .05), events-other (el = 1.40; p < .001), and financial strain
(el = 1.14; p > .05). The financial strain and
events-self coefficients, however, are of similar
magnitude for women and men; the difference in

statistical significance levels may be due to the

somewhat greater sample size for women. Events

Considering the two types of disorder -affective

or anxiety disorder and substance-use disorder
- in conjunction with one another reveals that

the role of gender in general and with regard to

the impact of stress varies across different types
of disorder. Specifically, the zero-order effect of
gender is strong for these two categories of disorder, but in the opposite direction. Interaction

occurring to someone else, however, appear to

increase the odds of affective or anxiety disorder
to a substantially greater degree among men than
women. Also, being married decreases the odds

terms representing gender differences in the im-

of affective or anxiety disorder among men

pact of stressful events are disorder-specific.

(el=.51; p<.05) but not women (el= 1.24;

Events occurring to others appear to be more

etiologically important for men than women for

p> .05).

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

174 AMERICAN SOCIOLOGICAL REVIEW

Table 3. Unstandardized Regression Coefficients: Symp-

affective or anxiety disorder, but more etiologi-

tom Counts (Log) on Selected Personal Charac-

cally important for women than men for substance-use disorder.

teristics and Stressors

Affective or Substance-Use

Independent Anxiety Disorder Disorder

Variables Model I Model II Model I Model II

Female .311 .081 -.423*** -.305***

Ethnicity:a

Mexican- -.364** -.334** -.108 -.109

American

Other -.086 -.096 -.159* -.151*

Age (years) -.007 -.008* -.009*** -.009***

Income (000) -.004 -.004 -.005 -.005**

Employed .123 .084 -.089 -.070
Married -.298** -.286** -.035 -.045
Female x ethnicity:a

Mexican- .007 -.037 -.064 -.071

American

Other -.212* I.199* -.023 -.043

Female x age .000 .001 .005*** .004**

Female x -.036 .032 .109** .082*

employed

Age x ethnicity:a

Mexican- .006* .006* .002* .002*

American

Other .001 .001 .003** .003**

Age x income .000 .000 .0001* .0001*

Age x -.005* -.005* -.001 -.001

employed

Age x married .005* .005* .000 .000

Income x .002 .002 .001 .001
employed

Events-self .085*** .064* .036*** .059***

Events-other .123*** .116*** .026*** .038**

Financial strain .065*** .030 .010 .012

Female

.048

-.049**

events-self

The disorder-specific results differ as well from

the results for all psychiatric disorders. The im-

pact of gender is muted considerably. Being female slightly decreases the risk of a disorder, a
gender difference that is smaller among the married than among the unmarried. Increasing age

and income are associated with decreased risk of

disorder. In the main effects model (Model I), all
three stressors are associated independently with
an increased risk of any disorder. When gender-

by-stressor interaction terms are added (Model

II), the event stressors remain significantly related to the risk of any disorder, but the effect of
financial strain is just short of statistical significance (p < .08). None of the gender-by-stressor
interactions, however, approaches statistical significance.

Separate logistic regressions by gender reveal

a slightly weaker effect of events-other among

women (el = 1.21; p < .001) than men (el = 1.35;

p < .001). The effect of events-self is also slightly weaker among women (e5 = 1.13; p < .08) than
among men (el = 1.25; p < .005). The effect of
financial strain, however, is somewhat stronger

among women (el = 1.21; p < .001) than among

men (eB = 1.10; p > .05). These gender patterns

are consistent with the gender-by-stressor inter-

action terms in the combined analysis, but must

be viewed with caution since the formal tests in
the combined analysis were not significant. Also,
being married reduces the risk of disorder among
men (el = .59; p < .01), but not among women
(el = 1.16; p > .05), a result that is consistent with
the interaction term in the combined analysis.

In sum, gender differences in the impact of

stress for either specific type of disorder do not

Intercept .658 .779 .682 .618

generalize to the other type of disorder or to

overall disorder. Men and women appear to be
similarly affected by the types of stressful events
and circumstances considered here, but these effects are manifest as different types of disorder.
Thus, neither affective or anxiety disorders nor
substance-use disorders constitute a reasonable

R 2 .146*** .151*** .144*** .151***

proxy for disorder in general.

Female

.012

-.020

events-other

Female

.064*

-.004

financial
strain

N 2,924 2,924 2,924 2,924

p?<.05 **p<.01 ***p<.001

a Reference category is non-Hispanic white.
Note: Dependent variable is the log of the symptom count

plus one. Model II differs from Model I by the inclusion of

gender-by-stressor interaction terms.

Gender, Stress, and Symptoms of Psychological

Disorder

Most previous stress research, especially work

addressing gender differences in stress-reactivity, has dealt with symptoms of psychological dis-

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 175

tress. Table 3 presents results of multiple linear

in-gender analysis, therefore, confirms the gen-

regressions using log-transformed symptom

erally similar impact of events occurring to oth-

counts as the dependent variables. The gender-

ers among men and women, and the greater im-

by-stressor interactions represent gender differ-

pact of financial strain among women for symp-

ences in the impact of stress for specific types of

toms of affective or anxiety disorder.

symptoms.7 Gender differences in the impact of

stress on symptoms of one type of disorder do not

A markedly different pattern emerges for

symptoms of substance-use disorder. Symptom

generalize to symptoms of the other type of disor-

levels continue to be higher among men than

der. Financial strain appears more damaging to

women than men when the outcome is symptoms

women in the multivariate models (simple B =

of affective or anxiety disorder but not symptoms

among employed women. The decline in symp-

-. 175; p < .001), although somewhat less so

of substance use disorder. Events occurring to the

tomatology associated with increasing age,

respondent appear more damaging to men than

however, is less marked among women than

women for substance-use symptoms but not for

affective-anxiety symptoms.

among men, and among persons other than non-

Females report more symptoms of affective or

Hispanic whites. Conversely, the decline in

symptoms associated with increasing income is

anxiety disorder than males (simple B = .277; p

somewhat less marked with increasing age.

< .001), but this gender difference is not signifi-

Negative life events occurring to the respondent

cant in the multivariate models - except for the

and to someone important to the respondent are

consistently low level of symptoms among

related to higher levels of symptoms in the main

women of other ethnic backgrounds. Being

effects model (Model I). The gender-by-stressor

Mexican-American or married is associated with

interaction model (Model II), however, reveals

lower levels of symptoms. Age is associated with

that negative life events occurring to the respon-

lower symptomatology, but only for some groups;

dent are associated with increased symptoms of

the negative age effect is offset by interactions

substance-use disorder only among men. Events

among Mexican-Americans and the married, but

occurring to others are related to increased

is intensified among the employed. In the main

symptoms similarly among men and women.

effects model (Model I), all three stressors are

Financial strains appear to have little impact on

associated with higher symptom levels. When

these symptoms for either men or women.

gender-by-stressor interactions are considered

Separate regressions by gender of substance-

(Model II), both event stressors continue to be

use symptoms reveal similar results, with one

significantly related to higher symptom levels;

exception. The similar impact of negative life

these associations are similar for men and wom-

events occurring to someone else among women

en since the interaction terms are not statistically

(B = .016; p <.01) and among men (B =.038; p <

significant. Financial strain, however, is associ-

.005), and the impact of negative events occur-

ated with greater symptomatology among wom-

ring to the respondent among men (B = .057; p <

en only.

.001) but not among women (B = .010; p > .05)

Separate regressions by gender are consistent

with the combined analysis with one exception.

are replicated. Financial strain, however, is significantly related to symptoms among women
(B =.01l;p <.01), but not among men (B = .010;

The negative impact of financial strain among

women (B = .095; p < .001), but not among men
(B = .030; p > .05) is confirmed, as is the similar

p > .05). These coefficients are of approximately

the same magnitude, however, and the differ-

impact of events occurring to others among

women (B = .129; p < .001) and men (B = .1 17;

ence in significance levels may be due to the

p < .001). Events occurring to the respondent,

neither the main effect of financial strain nor the

however, are associated with symptoms among

women (B = 1 16;p< .001) but not men (B = .055;
p > .05); the formal test of this interaction in the

gender-by-stressor interaction attained statistical

combined analysis was not significant. The with-

somewhat larger sample size for women. Since

significance in the combined analysis, this gender difference must be viewed with skepticism.
These separate analyses, then, demonstrate that
events to others exert similar effects for women

7 The coefficients for the gender-by-stressor inter-

actions represent a difference in the stressor slopes

between women and men.

and men, while negative events occurring to the

self are associated with greater substance-use
symptomatology only among men.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

176 AMERICAN SOCIOLOGICAL REVIEW

DISCUSSION

Kessler (1979) observed that stress may not in-

Stress research that focuses on a single disorder

fluence typical and extreme patterns of symptoms in the same manner. We would add that

fails to portray accurately social variation in stress

social group differences in the impact of stress

processes and mental health outcomes. Discrep-

may vary according to the stage of the disorder,

ancies between sociomedical and sociological

i.e., elevating subsyndromal symptoms vs. in-

models arise to the extent that the mental health

creasing the risk of severe disorder. This possi-

impact of stress is nonspecific, i.e., not limited to

bility may explain the finding of a greater impact

a single type of disorder. The nonspecific stress

among men than women of events occurring to

model is supported by our results in that stress

others for affective or anxiety disorder. Previous

was associated positively with both affective or

research has reported a greater impact of such

anxiety disorder and substance-use disorder.

events among women, but this research examined

Models for these two types of disorder, however,

symptoms rather than diagnosable disorder

are quite dissimilar; neither disorder-specific

model provides a good approximation to the glo-

(Kessler and McLeod 1984). Alternative explanations for this unexpected finding include: the

bal model for overall psychiatric disorder. Dis-

unique composition of the study sample, which

crepancies across models are particularly pro-

contains a high proportion of Mexican-Americans; the specific nature of the types of events

nounced for gender-contingencies in the effects

of various stressors. Although illustrated only for

gender, these results establish a general conclusion: the etiologic role of social factors for particular psychological disorders cannot be equated
with the overall mental health impact of these
social factors.
Disorder-specific models substantially mis-

represent social group differences in the mental

health consequences of exposure to stress whenever the impact of stress differs across groups for

various disorders. We have shown bias of this

type for gender: None of the disorder-specific

gender differences in stress-reactivity were replicated for the composite category of all disorders. Indeed, events occurring to others appear to
be more important for men than women for affective or anxiety disorder, but more important
for women than men for substance-use disorder.
Gender contingencies also do not generalize from
one type of symptom count to the other. Gender
differences in the impact of stress are disorderspecific and do not indicate general differences
between men and women in stress-reactivity.

Gender-contingent effects vary depending on

whether disorder is operationalized as a diagnos-

tic category or as a count of symptoms, even

though symptoms are essential elements of diagnosis. The one exception to this generalization is
the greater impact among men than women of

occurring to others; the relatively high prevalence

of phobias, which are not typically studied in

stress research; and the statistical methods of
analysis. Nevertheless, our results underscore how
the conceptualization and operationalization of
mental health outcomes shape conclusions regarding social stress processes.
A focus on overall psychological disorder may
obscure important group differences in the impact of stress on specific disorders. At issue here
is the nature of the question being addressed.

Neither disorder-specific nor general approaches

to mental health are inherently correct. The issue
of whether social characteristics modify the
mental health impact of stress exposure requires
examination of the full range of potential psychological manifestations of stress. Given variability across disorders, however, it is preferable
to examine multiple types of specific disorders
rather than relying solely on composite measures

of any disorder. We do not mean that every study

must assess every possible disorder, because for
certain questions, a focus on a single disorder is

appropriate. Single outcome studies, however,

are clearly inadequate for identifying the impact
of social factors on overall psychological wellbeing across subgroups of the population.
Recent advances in the standardization of measures of psychiatric disorders may accelerate the

events to self for substance-use disorders and

shifting research emphasis toward discrete diag-

symptoms. Analyses using symptom counts

nosable disorders. A major emphasis in these

concern variation within the range of normal

measurement innovations has been the standard-

functioning, whereas analyses using diagnostic

ization of the criteria for designating a person as

categories concern transitions from subsyndro-

positive with regard to a specific disorder. The

mal symptom states to clusters of severe symp-

central problem with regard to general stress

toms that correspond to clinically defined entities, typically more severe forms of disorder.

of persons as negative on stress-related disorder.

models, however, concerns the misclassification

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

COMPETING SOCIAL STRESS MODELS 177

To the extent that research on the impact of social

characteristics on stress processes adopts the sociomedical orientation of examining specific

psychiatric disorders, results are likely to tell us
more about the etiology of specific disorders than
about the impact of social characteristics and processes. The delineation of specific types of disorder can be turned to the advantage of social stress
researchers who can consider numerous types of
disorders. Indeed, it is this broader perspective on
mental health outcomes that distinguishes sociological inquiry from medical inquiry.
CAROL S. ANESHENSEL is Professor in the Department
of Community Health Sciences, and Head of the Division of Population and Family Health, School of
Public Health, University of California, Los Angeles.

Her recent research focuses on family structure and

adolescent stress, caregiving stress, natural disasters,
and ethnic differences infertility-related behavior. She

is currently working on a theoretical elaboration of

structural sources of social stress.

CAROLYN M. RU-TER is a Ph.D. candidate in Biostatistics at the UCLA School of PublicHealth with a minor
in Psychiatric Epidemiology. Her research interests
include logistic and log-linear models; her dissertation is concerned with spatial statistics.
PETER A. LACHENBRUCH is Professor of Biostatistics,
UCLA School of Public Health. His recent work is
concerned with small sample properties, sample size
determination, and discriminant analysis.

REFERENCES

American Psychiatric Association. 1980. Diagnostic

and Statistical Manual of Mental Disorders (3rd
ed.). Washington, DC: American Psychiatric Association.

Aneshensel, Carol S., Ralph R. Frerichs, and Virginia

A. Clark. 1981. "Family Roles and Sex Differences in Depression." Journal of Health and Social
Behavior 22:379-93.

Breslow, Lester, Jonathan E. Fielding, and Lester B.

Lave (eds.). 1984. Annual Review of Public Health:
Vol. 5. Palo Alto: Annual Reviews, Inc.
Burnam, M. Audrey, Richard L. Hough, Javier I. Escobar, Marvin Karno, Dianne M. Timbers, Cynthia
A. Telles, and Ben Z. Locke. 1987. "Six-Month
Prevalence of Specific Psychiatric Disorders
Among Mexican Americans and Non-Hispanic
Whites in Los Angeles." Archives of General Psychiatry 44:687-94.

Burnam, M. Audrey, Marvin Karno, Richard L.

Hough, Javier I. Escobar, and Alan B. Forsythe.

1983. "The Spanish Diagnostic Interview Scale:

Reliability and Comparison with Clinical Diagnoses."Archives of General Psychiatry 40:1189-96.

Dohrenwend, Bruce P. and Barbara S. Dohrenwend.

1969. Social Status and Psychological Disorder: A
Causal Inquiry. New York: Wiley- Interscience.
. 1976. "Sex Differences and Psychiatric

Disorders." American Journal of Sociology

81:1447-54.

Dohrenwend, Bruce P., Patrick E. Shrout, Gladys Egri,

and Frederick S. Mendelsohn. 1980. "Nonspecific
Psychological Distress and Other Dimensions of
Psychopathology." Archives of General Psychiatry 37:1229-36.

Eaton, William W. 1986. The Sociology of Mental

Disorders (2nded.). New York: PraegerPublishers.
Eaton, William W. and Larry G. Kessler. 1985. Epidemiologic Field Methods in Psychiatry: The NIMH

Epidemiologic Catchment Area Program. Orlando, FL: Academic Press.

Folstein, Marshal F., Susan E. Folstein, and Paul R.

McHugh. 1975. "Mini-Mental State: A Practical
Method for Grading the Cognitive State of Patients
for the Clinician." Journal of Psychiatric Research
12:189-98.

Golding, Jacqueline M., Marilyn K. Potts, and Carol

S. Aneshensel. Forthcoming. "Stress Exposure
Among Mexican Americans and Non-Hispanic
Whites." Journal of Community Psychology.
Gove, Walter R. 1972. "The Relationship between
Sex Roles, Marital Status, and Mental Illness."
Social Forces 51:34-44.

Gove, Walter R. and Jeanette F. Tudor. 1973. "Adult

Sex Roles and Mental Illness." American Journal
of Sociology 78:812-35.
Holt, Mary Margaret. 1977. "SURREGR: Standard
Errors of Regression Coefficients from Sample
Survey Data." Research Triangle Park, NC: Research Triangle Institute.
Kamo, Marvin, M. Audrey Burnam, Javier I. Escobar, Richard L. Hough, and William W. Eaton.
1983. "Development of the Spanish-Language
Version of the National Institute of Mental Health
Diagnostic Interview Schedule." Archives of General Psychiatry 40:1183-8.
Karno, Marvin, Richard L. Hough, M. Audrey Burnam, Javier I. Escobar, Dianne M. Timbers, Felipe
Santana, and Jeffrey H. Boyd. 1987. "Lifetime
Prevalence of Specific Psychiatric Disorders among
Mexican Americans and Non-Hispanic Whites in
Los Angeles." Archives of General Psychiatry
44:695-701.

Kasl, Stanislav V. 1984. "Stress and Health." Annual

Review of Public Health 5:319-41.

Kessler, Ronald C. 1979. "Stress, Social Status, and

Psychological Distress." Journal of Health and
Social Behavior 20:259-72.

Kessler, Ronald C. and Jane D. McLeod. 1984. "Sex

Differences in Vulnerability to Undesirable Life

Events." American Sociological Review 49:620-31.
Kessler, Ronald C. and Harold W. Neighbors. 1986.
"A New Perspective on the Relationships among
Race, Social Class, and Psychological Distress."

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms

178 AMERICAN SOCIOLOGICAL REVIEW

Journal of Health and Social Behavior 27:107-15.

General Psychiatry 38:381-89.

Mirowsky, John and Catherine E. Ross. 1989a. Social

Robins, Lee N., John E. HeIzer, Myrna M. Weiss-

Causes of Psychological Distress. New York: Al-

man, Helen Orvaschel, Ernest Gruenberg, Jack D.

dine de Gruyter.

_ . 1989b. "Psychiatric Diagnosis as Reified

Burke, and Darrel A. Regier. 1984. "Lifetime

Prevalence of Specific Psychiatric Disorders in

Measurement." Journal of Health and Social Be-

Three Sites." Archives of General Psychiatry

havior 30:11-25.

41:949-58.

Myers, Jerome K., Myrna M. Weissman, Gary L.

Tischler, Charles E. Holzer, Philip J. Leaf, Helen

Orvaschel, James C. Anthony, Jeffrey H. Boyd,
Jack D. Burke, Jr., Morton Kramer and Roger
Stoltzman. 1984. "Six-Month Prevalence of Psy-

chiatric Disorders in Three Communities." Archives

of General Psychiatry 41:959-67.

Newmann, Joy P. 1986. "Gender, Life Strains, and

Schwartz, Sharon and Bruce G. Link. 1989. "The 'Well

Control' Artifact in Case/Control Studies of Specific Disorders." Psychological Medicine 19:737-42.
Shah, B. V. 1981. SESUDAAN: Standard Errors
Program for Computing ofStandardized Ratesfrom
Sample Survey Data. Research Triangle Park, NC:
Research Triangle Institute.

Shah, B. V., R. E. Folsom, F. E. Harrell, and C. N.

Depression." Journal of Health and Social Behav-

Dillard. 1984. RTILOGIT: Procedure for Logistic

ior 27:161-78.

Regression on Survey Data. Research Triangle Park,

Pearlin, Leonard I. 1989. "The Sociological Study of

Stress." Journal of Health and Social Behavior

NC: Research Triangle Institute.

Thoits, Peggy A. 1983. "Dimensions of Life Events

that Influence Psychological Distress: An Evalua-

30:241-56.

Pearlin, Leonard I. and Joyce S. Johnson. 1977.

"Marital Status, Life Strains and Depression."

American Sociological Review 42:704-15.

Pearlin, Leonard I. and Morton A. Lieberman. 1978.
"Social Sources of Emotional Distress." Pp. 21748 in Research in Community and Mental Health,
vol. 1, edited by Roberta Simmons. Greenwich,
CT: JAI Press.

tion and Synthesis of the Literature." Pp. 33-87 in

Psychological Stress: Trends in Theory and Research, edited by Howard B. Kaplan. Orlando, FL:
Academic Press.

Turner, R. J. and Samuel Noh. 1983. "Class and Psychological Vulnerability Among Women: The Significance of Social Support and Personal Control."

Journal of Health and Social Behavior 24:2-15.

Pearlin, Leonard I., Morton A. Lieberman, Elizabeth

Ulbrich, Patricia M., George J. Warheit, and Rick S.

G. Menaghan, and Joseph T. Mullan. 1981. "The

Zimmerman. 1989. "Race, Socioeconomic Status,

Stress Process." Journal of Health and Social Be-

and Psychological Distress: An Examination of

havior 22:337-56.

Differential Vulnerability." Journal of Health and

Robins, Lee N., John E. Helzer, Jack Croughan, and

Kathryn S. Ratcliff. 1981. "National Institute of

Social Behavior 30:131-46.

Wheaton, Blair. 1990. "Life Transitions, Role Histo-

Mental Health Diagnostic Interview Schedule: Its

ries, and Mental Health." American Sociological

History, Characteristics, and Validity." Archives of

Review 55:209-23.

This content downloaded from 138.26.87.12 on Wed, 18 May 2016 17:55:11 UTC
All use subject to http://about.jstor.org/terms