Mental Health Treatment Histories, Recovery, and Well-being

Epidemiological and sociological research on recovery from mental disorder is based on three rarely tested medical model assumptions: (1) recovery without treatment is the result of less severe illness, (2) treatment predicts recovery, and (3) recovery and well–being do not depend on individuals’ treatment histories. I challenge these assumptions using National Comorbidity Survey-Replication data for individuals with any disorder occurring prior to the current year ( N = 2,305). Results indicated that (1) untreated remissions were fully explained by less serious prior illness, (2) treated individuals were less likely to recover due to more serious illness, and (3) people who had past–only treatment were more likely to recover than the never–treated, while those in recurring and recently initiated care were less likely to recover. Treatment histories predicted greater well–being only if recovery had been attained. Histories of care help to explain recovery rates and suggest new directions for treatment–seeking theory and research.

Mental Health Stigma and Social Contact Revisited: The Role of Network Closeness and Negativity

Researchers and policymakers are increasingly interested in the extent to which mental health stigma can be mitigated through social contact with people who disclose mental health issues. Empirical research on contact and stigma, however, largely focuses on the presence of contact without fully examining the nature of relationships. Interpersonal ties, for example, can be enduring and supportive, enduring and stressful, or weak yet cooperative. Using a novel egocentric network survey, this study contributes by measuring contact with respect to both the presence of alters with perceived mental health issues and the nature of those connections. Results show that, compared to respondents without any contact, naming more mental health contacts is associated with a reduction in stigma only when those relations are characterized by closeness and a lack of negativity. Among individuals with contact, a higher proportion of relationships perceived as negative or “difficult” exacerbates stigma. Implications of these findings for stigma reduction are discussed.

The Disjuncture between Medication Adherence and Recovery-centered Principles in Early Psychosis Intervention: An Institutional Ethnography

To examine how recovery principles are enacted in an early psychosis intervention (EPI) clinic, we used an institutional ethnographic approach focused on how the ideology of medication adherence organizes young people’s experiences of EPI services. Methods included ethnographic observation, in-depth interviews with 27 participants (18 clinic staff, four young people, and five family members), and textual analysis of clinic documents (e.g., case files, administrative forms, policy reports). The disjuncture between service providers’ intent to provide recovery-principled care and the actual experiences of young people is actualized in institutionalized practices of informal coercion around medication adherence, which we identify as “enticing,”“negotiating,” and “taking responsibility.” We link these practices to institutional accountability, risk, and efficiencies, and discuss the need for a shift in medication management approaches in EPI settings.

Aspiring to Do All Things Through Him Who Strengthens? Quixotic Hope, Religiosity, and Mental Health in Emerging Adulthood

Beliefs about the probability of educational success tend to be very optimistic in the United States. However, scholars are beginning to uncover mental health consequences associated with quixotic hope—the unrealistic outstripping of expectation by aspiration. Using longitudinal data from Waves 1 and 3 of the National Study of Youth and Religion, this study asks, (1) does religiosity promote or diminish the likelihood of quixotic hope? and (2) does religious attendance and closeness to God mitigate long-term mental health consequences of quixotic hope? Results show that weekly religious attendance had a modest negative relationship with the likelihood of experiencing quixotic hope, while increasing religious attendance over time attenuated the negative mental health consequences of quixotic hope on increases in depression. Closeness to God neither predicted quixotic hope nor played a moderating role for depression. As educational expectations rise, regular religious practice may help protect the emotional well-being of youth.

Falling Behind and Feeling Bad: Unmet Expectations and Mental Health during the Transition to Adulthood

How do perceived expectations of what it means to be an adult affect mental health? We draw from life course and social psychological literature to argue that falling behind perceived expectations for reaching markers of adulthood is associated with depression and anxiety. We test predictions with data from an original sample of more than five hundred 18- to 29-year-olds in the United States. Consistent with predictions, we find a positive relationship between falling behind expectations and both anxiety and depression even while controlling for own expectations about the accomplishment of markers of adulthood. In particular, we find that falling behind perceived expectations of peers regarding markers of adulthood is associated with anxiety and that falling behind perceived expectations of parents and society regarding markers of adulthood is associated with depressive symptoms.

Treatment Network Typologies and the Working Alliance of Clients with Serious Mental Illness

The climate and culture of treatment for clients with serious mental illness (SMI) are complex. In this study, we aim to cultivate a deeper understanding of the treatment environment using a network typological approach to measure the local treatment context and assess its implications on the perceived quality of clients’ relationships with their care providers. We use in-depth egocentric network data from clients with SMI in community mental health centers and state psychiatric hospitals from the Indiana Mental Health Services and HIV Risk Study ( N = 417). Clustering analysis identifies five unique and distinct network types: supportive, sparse, diverse, clinical, and treatment-focused. Weighted least squares regressions reveal clients in networks with high amounts of support predict a more trusting working alliance, whereas care-oriented networks predict a less trusting alliance. Our findings underscore the need to consider the local network context in studies of the quality of care provided to people with SMI.

Perceived Distributive Unfairness and Mental Health: The Gender-contingent Buffering Effects of Religion

Prior research has established that perceived distributive unfairness is associated with poor mental health. The purpose of this study is to examine whether religion moderates this association and whether gender conditions the moderating effects of religion. Using data from the 2012 Korean General Social Survey ( N = 1,375), the current analyses show that perceived distributive unfairness is positively associated with depression. However, each of the two indicators of religion—religious attendance and salience—weakens the positive association between perceived distributive unfairness and depression among women, but not men. These observations suggest that religion provides a stress-buffering effect against perceived distributive unfairness only for women. Thus, the findings of this study highlight the gendered ways that religion shapes the association between perceived distributive unfairness and mental health. I discuss the theoretical implications of these findings for views about the complex interrelationships among stress, coping resources, gender, and mental health.

A Mixed-method Study of the Effects of Post-migration Economic Stressors on the Mental Health of Recently Resettled Refugees

After years of emphasis on pre-migration trauma as the major determinant of refugee mental health, researchers have begun to explore the effects of post-migration stressors on refugees’ distress. However, few studies have brought together refugees’ emic understandings of the effects of economic stressors on their mental health with quantitative data sets to further explore the salience of stress processes as an explanatory mechanism. In qualitative interviews, 41 percent of 290 recently resettled adult refugees noted that economic stressors were a major source of distress and described pathways through which these stressors negatively influenced their mental health by limiting their ability to learn English, obtain meaningful employment, access health care, maintain contact with their families, and integrate into their communities. In structural equation modeling of quantitative data, we tested several possible hypotheses that emerged from the qualitative findings. We find that post-migration economic stressors mediated the relationship between migration-related trauma and post-migration emotional distress and post-traumatic stress disorder (PTSD) symptoms. These findings provide empirical support for stress proliferation as a mechanism through which trauma exposure contributes to distress.

Does Relative Deprivation within Schools Influence Adolescent Depression?

Research on relative deprivation (RD) and health has focused primarily on adult populations. Using the National Longitudinal Study of Adolescent to Adult Health, this study examines the link between RD and adolescent depression and is the first to test the mechanisms that underlie this relationship. This study finds that controlling for school fixed effects, family income, and observed characteristics of students and their families, students with higher RD within schools exhibit more depressive symptoms. This study also considers how RD may influence adolescent depression. Sobel-Goodman mediation tests reveal that a combination of lowered self-esteem and future expectations (especially about educational attainment) explains nearly half of the association between RD and adolescent depression. Results of this study suggest that social inequality and stratification may implicate population health in the next generation through socioeconomic stratification within schools.