S&P Unit VIII Article Review

Outcomes in the Sociology of Mental Health and Illness: Where Have We Been and Where Are We Going?

Author(s): Allan V. Horwitz

Source: Journal of Health and Social Behavior , Jun., 2002, Vol. 43, No. 2, Selecting Outcomes for the Sociology of Mental Health: Issues of Measurement and Dimensionality (Jun., 2002), pp. 143-151

Published by: American Sociological Association

Stable URL: https://www.jstor.org/stable/3090193

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Outcomes in the Sociology of Mental Health and Illness:

Where Have We Been and Where are We Going?*

ALLAN V HORWITZ

Rutgers University

Journal of Health and Social Behavior 2002, Vol 43 (June): 143-151

Sociologists of mental health and illness have traditionally used outcome mea- sures that they have obtainedfrom other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrange- ments affect mental health might require the development of explicitly sociolog- ical outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social-level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues.

Throughout the history of the sociology of ticular mental health outcomes. Their limita- mental health and illness, other disciplines tions stemmed from using treated cases as have usually provided the outcome measures measures of outcome variables. for sociological studies. The earliest research, The reliance on official statistics continued which began during the 19th century, used until the 1950's when the Midtown Manhattan official statistics as measures of mental illness and Sterling County studies initiated the sec- (Grob 1985). The constraints of formal institu- ond major era of sociological studies of com- tions and bureaucratic management, not socio- munity mental health (Srole et al. 1962; logical concerns, determined what cases came Leighton et al. 1963). This research was to official attention and thus came to serve as groundbreaking because it moved the center of outcomes. For example, the most renowned interest from institutionalized, treated cases of study from this era, Durkheim's Suicide, devel- mental illness to untreated but distressed com- oped a brilliant theory of how social integra- munity members. In addition, these studies tion and group meaning systems affected paid careful attention to sociologically mean- social pathology (Durkheim [1897] 1951). ingful processes such as social class, social Durkheim, however, used official records to mobility, and social integration that have con- obtain his measures of suicide, and so his con- sequences for mental health. These studies, tribution to the study of outcomes was limited, however, used outcome measures developed by The best subsequent studies in this tradition- military psychiatrists in World War II to quick- Faris and Dunham's (1939) Mental Disorders ly and efficiently screen millions of draftees in Urban Areas and Hollingshead and for common psychophysiological and psy- Redlich's (1958) Social Class and Mental chopathological symptoms (Grob 1990). Illness-made major contributions in under- Symptom scales were designed to predict standing the social processes that lead to par- which soldiers might suffer breakdowns in

*1 am grateful to Jill Kiecolt, David Mechanic, and combat. As a result, they contained many Robin Simon for their comments on an earlier ver- symptoms of anxiety, but were arguably not as sion of this paper. Direct correspondence to useful for measuring distress in community avhorwgrci.rutgers.edu. populations.

143

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144 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

Community studies quickly adopted these those reported in official statistics to symptom self-reported symptom scales, which summed scales and then to diagnostic measures.2 What into continuous scales, measured general vul- has not changed is the reliance on measures nerabilities to stressors, and could be used to developed for the purposes of other disci- study distress in untreated community sam- plines, whether of hospital administrators, mil- ples. The Langner 22-item scale of distress and itary psychiatrists, or the mental health profes- similar scales such as the Health Opinion sions.

Survey and, later, the CES-D dominated socio- But do these kinds of outcome variables best logical research about mental health and ill- serve sociologists' purposes? As Schwartz ness until the mid-1980's and still maintain a (2002) observes in this symposium, sociolo- strong presence in the field (Langner 1962; gists of mental health and illness have tradi- Macmillan 1957; Radloff 1977). They also tionally relied on individual-level, subjective came to serve as the central outcome measure states, and not on macro-level, social out- in the stress paradigm, which has guided most comes, as measures of the dysfunctional con- research in the sociology of mental health and sequences of social life. illness since the late 1960's (Pearlin et al. This symposium directs sociological atten- 1981). However, while sociologists of stress tion toward mental health outcomes as a criti- developed sophisticated theories of stressors cal yet neglected aspect of the sociology of and mediators of stress (e.g., Thoits 1983; mental health and illness. It focuses on three Pearlin 1989; Turner, Wheaton, and Lloyd major issues (1) When are discrete disease 1995; Dohrenwend 2000), they gave less atten- entities or continuous symptom scales the most

tion to the outcomes they used. appropriate measures for sociological study? The Epidemiologic Catchment Area (ECA) (2) Do single outcome variables suffice, or

studies inaugurated the third stage of studies in must sociologists use multiple outcomes in the sociology of mental illness in the early their research? (3) How much attention should 1980s (Robins and Regier 1990; see also sociologists pay to the positive, as well as the Dohrenwend and Dohrenwend 1982). 1 These negative, aspects of psychological conditions? studies sought to measure mental health in ' .

comuniy tudesusig dagostc ntiie Unfortunately, space limitations preclude commuy s s uextensive discussion of other critical issues

that the psychiatric profession established in about outcomes, including using macro-social the DSM-III in 1980 (APA 1980; Horwitz a s i dlutm e and dciding 2002). The sociologist Lee Robins led the as well as individual outcomes and deciding development of the ECA's measurement when symptoms indicate mental disorders or instrument, the Diagnostic Interview Schedule result from normal responses to stressful envi- (DIS). The DIS translated the disease-specific ronments. entities that the psychiatric profession had cre- How to best answer each of these questions ated into symptom-based diagnostic entities depends on the way one views the primary suitable for use in community populations goals of the sociological study of mental health (Robins 1986). These diagnoses were dichoto- and illness. I assume that the most fundamen- mous, disease-specific, and served clinical, tal question for sociologists who want to pre- and not sociological, purposes. The largest dict states of mental health is: "what are the recent study in psychiatric epidemiology, the psychological consequences of particular National Comorbidity Study (Kessler et al. social arrangements?" (Pearlin 1989; 1994), adopts the same diagnostic model as the Aneshensel, Rutter, and Lachenbruch 1991; ECA. Diagnoses have not replaced symptom Schwartz 2002).3 Sociologists are primarily scales, which still serve as outcome measures interested in understanding how social struc- for most mental health research published in tures, stressful life events, social integration, JHSB (Schwartz 2002). Nevertheless, dichoto- social roles, social relationships, cultural sys- mous diagnostic measures have dominated tems of meaning, and the like influence mental large-scale community and national studies in health. Social structure and culture are not psychiatric epidemiology for the past twenty properties of particular individuals, but are years (Dohrenwend and Dohrenwend 1982; aspects of social systems. Sociologists assume Kessler 2002). that these systems have fundamental effects on

The outcomes in the sociology of mental the psychological well-being of the individuals health and illness have thus changed from who comprise them. How, then, should we

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OUTCOMES IN THE SOCIOLOGY OF MENTAL HEALTH AND ILLNESS 145

conceptualize the impacts of social arrange- its joints" because they capture the essential ments on mental health and illness? nature of mental diseases (Frances et al. 1990).

For example, the symptoms of schizophrenia may not lie on a continuum, but in most cases

CONCEPTUALIZATION AND are either present or not present. Thus, diag- MEASUREMENT ISSUES noses are believed to better capture the inher-

ent nature of mental disease to a greater extent Diagnoses or Continua? than continuous scales.

Second, the empirical distribution of symp- Medically-minded thinking emphasizes toms in a population also can dictate the use of

dichotomies (Luhrmann 2000). Physicians, dichotomies. Even when researchers use con- including psychiatrists, are trained to recog- tinuous measures as outcomes, most respon- nize and diagnose pathology. While diagnoses dents often report either no or few symptoms; are often uncertain and ambiguous, most dis- only a small minority report many symptoms eases are distinct from-not continuous (e.g., Sweeney and Horwitz 2001). In such with-normalcy. Even such continuous condi- cases, it is often necessary to dichotomize out- tions as blood pressure or cholesterol levels are come variables, regardless of the researcher's divided at cut-points that indicate pathology or theoretical preferences. normalcy. As Kessler (2002) notes in this sym- Third, sociologists also might use diagnoses posium, even when a condition is continuous, to align their work with research in the mental physicians must decide to treat or not to treat. health professions, especially psychiatry Therefore, the constraints of medical practice (Klerman 1989). Regardless of their adequacy, lead physicians to think in dichotomous cate- diagnostic models dominate clinical and epi- gories. demiological research. For sociological studies Following medical logic, contemporary psy- to be comparable to work in psychiatry, psy-

chiatric diagnoses in community studies rely chology, biology, and genetics, they must use on sharp cut points between health and dis- diagnostic measures. Otherwise, they risk mar- ease. For example, if five symptoms are neces- ginalization. Another practical reason for using sary for making a diagnosis of major depres- diagnoses is that the major source of funds for sion, then people who report four depressed research on mental illness, the National symptoms are viewed as more similar to those Institute of Mental Health, is unlikely to sup- with no symptoms than to those with five port projects that do not use particular DSM symptoms (Mirowsky and Ross 2002). entities as outcome measures. Likewise, different disorders are considered to Despite their possible theoretical and practi- be discrete entities that do not overlap with cal advantages, using dichotomous outcomes other disorders. Hence, diagnoses split condi- also entails costs. As Mirowsky and Ross tions into, for example, anxiety disorders, (2002) vigorously argue in this symposium, depressive disorders, and substance abuse and creating dichotomies from continuous data dependence disorders. These categories are restricts the amount of information available to further split into subcategories such as social researchers. In particular, the use of cut-points anxiety, generalized anxiety, or specific pho- can underestimate the stressful consequences bias. Whatever overlap occurs between differ- of social arrangements by disregarding the dis- ent disorders is seen as indicating "comorbidi- tress of individuals who barely fail to meet the ty"-the presence of more than one discrete criteria for a particular diagnosis.4 Further- disorder-rather than the inherent overlap of more, unlike clinicians, sociologists should be common symptoms that comprise a single, interested in psychological states on all points nonspecific dimension of psychological dis- of the mental health continuum, not only those tress. at the negative extreme. Diagnoses, however, Grouping symptoms into diagnoses has sev- inherently ignore the conditions of persons

eral advantages. Many psychiatrists believe who fail to meet criteria for "caseness." that mental illnesses consist of constellations Sociologists must also ask what the conse- of symptoms that cluster together and whose quences of stressful social arrangements are co-occurrence is not coincidental but indica- likely to be. Are they dichotomous clinical tive of an underlying disorder (Mechanic conditions such as schizophrenia, bipolar dis- 1999). Therefore, diagnoses "carve nature at order, and major depression? Alternatively, are

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146 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

these consequences more likely to be degrees (Dohrenwend and Dohrenwend 1982). During of distress whose severity ranges from very the second stage, sociologists measured gener- small to very large? If so, the psychological alized distress using continuous symptom consequences of social arrangements would be scales. Finally, while diagnostic studies in the inherently continuous rather than dichotomous third stage of research obtain information (Wheaton 2001). Finally, sociologists who are about multiple psychiatric disorders, they treat trained to think in terms of regression models each disorder as a discrete entity (e.g., Blazer often find that continuous data are easier to et al. 1994; Magee et al. 1996). Even more so conceptualize and model than dichotomous than sociologists, mental health researchers outcomes. focus almost exclusively on single, discrete

Sociologists might use continua for some conditions. Indeed, most researchers in psychi- conditions and diagnoses for others. Some atry or psychology build careers around the mental disorders, such as schizophrenia and study of single entities such as depression, bipolar conditions, might be seen as discrete alcohol abuse, or anorexia (Wilson 1993). conditions that parallel serious medical dis- Studying single outcomes can be a serious eases. In contrast, the most common conse- liability to sociologists, who often compare the quences of stressful social conditions-e.g., psychological consequences of social arrange- depression, generalized anxiety, psychophysi- ments among different groups. Diverse ethnic, ological symptoms, heavy substance use-are social class, age, and gender groups, among more likely to be continuous and generalized others, might respond to stressors through dif- rather than discrete and specific. ferent types of outcomes (Aneshensel et al.

Optimally, as Kessler (2002) suggests, stud- 1991; Horwitz, White, and Howell-White ies should explicitly compare findings that 1996). To the extent that different groups have result from diagnoses and continua. Practical different psychological responses to social considerations, however, often dictate the use arrangements, studying single outcomes dis- of either continua or diagnoses. Most sociolo- torts comparisons of group responses to stres- gists must use short, continuous symptom sors. scales because of the time and cost that diag- A good early example of the benefits of nostic instruments entail. Other sociologists, using multiple outcomes is Andrew Henry's who are involved in large, interdisciplinary, and James Short's Suicide and Homicide epidemiological studies, usually find diagnos- (1954). Henry and Short found that downturns tic scales more practical than continua. in the business cycle increased rates of sui-

Ultimately, which instrument is used cides among whites but not blacks. depends on the researcher's goal. Continuous Comparable downturns increased rates of symptom scales are usually more appropriate homicide among blacks but not whites. A for understanding the stressful consequences study of suicide alone would mistakenly con- of social arrangements. Dichotomous diag- dude that bad economic conditions harmed noses typically better fit the needs of policy- whites more than blacks; conversely, a study of makers, public health officials, and clinicians homicide alone would reach the opposite con- (Kessler 2002). These diagnoses, however, clusion. Only a study that uses both outcomes should not stem from simple symptom counts can adequately assess the comparative impact but from sophisticated models of disease of economic stressors for both blacks and processes. Whatever the researcher's purpose whites. might be, outcome measures must be adapted At present, only studies of gender and men- to particular situations in flexible ways. tal health typically use multiple outcomes.

Studies that compare the mental health of males and females now routinely use not only

Single or Multiple Outcomes? a measure of internalized distress such as the CES-D, but also male-related mental health

Sociologists of mental health and illness outcomes such as alcohol problems (e.g., have usually relied on single outcomes to Aneshensel et al. 1991; Horwitz et al. 1996; assess the psychological consequences of Simon 1998). These studies have considerably social arrangements. In the first stage of added to our understanding of how social research, agency records reported particular arrangements affect the mental health of dif- outcomes such as schizophrenia or suicide ferent social groups. For example, before the

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OUTCOMES IN THE SOCIOLOGY OF MENTAL HEALTH AND ILLNESS 147

use of multiple outcomes became widespread, ity as stress outcomes that are responsive to it was commonly thought that marriage stressful social arrangements.5 How can soci- enhanced men's mental health but diminished ologists choose which outcomes best reflect women's mental health (Bernard 1972; Gove stress outcomes when such a wide range of and Tudor 1973). When sociologists examined possibilities is available? A possible guide is alcohol problems as well as distress, they that a single outcome reflecting how each found that marriage had beneficial psycholog- group in a comparison responds to stressors ical consequences for both men and women will suffice. A second issue is whether an out- (Horwitz et al. 1996; Simon 2002). come in one group is the functional equivalent Conversely, the initial studies of how divorce of a different outcome in another group. For affects the mental health of children, which example, researchers often view rates of heavy used behavioral problems as their outcome alcohol use among men as comparable to dis- measures, indicated that divorce had worse tress among women (Horwitz and Davies effects for boys than girls (see Zaslow 1989). 1994). Yet heavy alcohol use could indicate When studies of divorce included internalized conformity to cultural norms or hedonistic measures of distress as well as problem behav- motives as well a stress response. Likewise, as iors, they found that girls suffered as serious Umberson et al. (2002) indicate, violent consequences of parental divorce as boys behavior sometimes can be a response to (Doherty and Needle 1991). Adequate compar- stressful social arrangements. At other times, isons of the psychological impact of any social however, the same behavior can stem from condition should encompass outcomes that efforts to uphold social norms (Black 1983). characterize the likely responses of all groups Sociologists must develop theories and meth- under consideration. This dictum holds not ods that can divide outcomes that are stress only for men and women but also for social responses from those that indicate other kinds class, ethnic, age, and any other social charac- of social processes. The notion that a mental teristic that influences how people respond to health outcome in one group is comparable to social stressors. a different outcome in another group must be

Umberson, Williams, and Anderson (2002) empirically established and not assumed. Yet, in this symposium expand the range of mental at present, sociologists have not developed health outcomes to include violent behavior. strong methods that can show when different They argue that impulsive violence is a behav- outcomes across social groups are functionally ioral expression of emotional distress that equivalent. characterizes how members of some social In addition, practical problems sometimes groups respond to frustration and stress. The mandate the use of single outcomes. Many sec- implication of their study is that the violent ondary data sets that sociologists of mental behavior of persons who might score low on health often rely on only contain adequate traditional symptom scales that measure inter- measures of single outcomes. In such cases, nalized distress can sometimes reflect alterna- using multiple outcome measures is not feasi- tive styles of reacting to stressful social ble. Moreover, the use of multiple outcomes arrangements. If so, externalized actions and sometimes produces the same results as single emotions such as domestic violence or anger outcomes, so that multiple measures are redun- that sociologists of mental health have tradi- dant.6 While sociologists should always be tionally ignored might be ways that some types cautious in reaching conclusions about the of individuals express stressful emotions that psychological consequences of social arrange- others respond to through internalized mani- ments from single outcome measures, they festations of distress (Ross and Mirowsky should not reject such studies out of hand. 1995; Schieman 2000). Accurate comparisons Finally, Schwartz' (2002) contribution raises of how men and women respond to stressors another critical issue. The stress paradigm that require measures of externalized as well as of has dominated the sociological literature about internalized outcomes. mental health has almost exclusively focused

Using multiple outcomes, however, also on subjective, individual-level outcomes. raises several issues. One is how far the range Sociologists of mental health, however, have of outcomes must extend. Schwartz (2002), for neglected macro-level, social consequences of example, wants sociologists to consider crime, stressors such as aggregate rates of homicide mortality, cardiovascular disease, and religios- and other violent crimes, lack of participation

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148 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

in social activities, and marital breakups. Many sium begins to develop some measures of unresolved issues arise when the range of out- these positive states. He argues that mental comes is extended to these processes. How can health is not simply the absence of mental ill- the stress paradigm incorporate macro-social ness but is a separate dimension of positive outcomes? How much distortion of true rates feelings and functioning. Building on the of disorder does the use of officially recorded work of Ryff (1989; see also Ryff and Keyes rates entail? How are societal outcomes related 1995), Keyes shows how flourishing, as much to individual outcomes? These and many other as languishing, should be a topic of concern difficult issues must be confronted if social as to sociologists, and he develops and tests well as psychological outcomes will be an some scales to measure mental health as well explicit focus of the sociology of mental as mental distress. Sociologists of mental health. health can do far more in following Keyes'

focus on all points of the mental health con- tinuum.

Negative or Positive Outcomes? Psychologists have paid far more attention to positive states of mental health than sociol-

Sociologists of mental health and illness ogists (e.g., Jahoda 1958; Bradburn 1969; have generally assumed that the only condi- Seligman 2000). They often assert that the tions worth studying are those that are prob- environment can only create short-term fluc- lematic and preventable (Mills 1943). tuations in happiness, which is a stable indi- Therefore, the overwhelming preoccupation of vidual or genetic trait (Myers and Diener sociologists of mental health and illness has 1995; Lykken and Tellegen 1996). It is time been to study the negative psychological con- that sociologists meet this challenge by exam- sequences of social arrangements. We study ining the social determinants of positive drug abuse, but not the pleasures of getting states of well-being (e.g., Hughes and high; depression, but not happiness; anxiety, Thomas 1998). Happiness, no less than dis- and not relaxation. The focus of funding agen- tress, ought to respond to changes in social cies on problematic instead of positive out- structure and culture. As with the study of comes certainly contributes to this one-side negative states of mental health, sociological emphasis. It is thus ironic that this journal is measures of positive mental health should called the Journal of Health and Social encompass societal, as well as individual, Behavior and that our ASA section is called level measures. Only after such studies are the Sociology of Mental Health. In fact, very conducted will we truly be able to say that we few sociological studies actually deal with are sociologists of mental health as well as of health or mental health. Yet, if sociologists are mental illness. interested in the full range of psychological impacts that social conditions have, they must pay far more attention to the positive as well as CONCLUSION negative effects of social conditions.

From a sociological point of view, the posi- The nature of their outcomes defines acade- tive consequences of social arrangements are mic subfields. The sociology of mental health as important as the negative ones. For example, and illness should pay far more attention to what sorts of social structures, roles, relation- what constitutes good sociological measures of ships, and meaning systems are conducive to mental health and illness than it has in its ini- happiness and positive well-being? When does tial three stages. We hope that the papers in this status attainment lead to fulfillment and when symposium will begin a dialogue about a pos- to frustration? Does immersion in coherent sible fourth stage of research. This stage might cultural belief systems lead to meaningful and rely less on other disciplines for its outcome purposeful lives? Such questions indicate that measures and develop sociologically sensitive sociologists should pay more attention to the indicators of the positive and negative conse- development of scales that measure fulfill- quences of social arrangements. Such mea- ment, purpose, meaningfulness, and happi- sures might include social-level as well as indi- ness, among other positive dimensions of men- vidual-level indicators, multiple as well as sin- tal health. gular outcomes, and positive as well as

Corey Keyes' (2002) paper in this sympo- negative psychological states. They will also

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OUTCOMES IN THE SOCIOLOGY OF MENTAL HEALTH AND ILLNESS 149

be continuous, generalized scales as well as dichotomous, specific diagnoses. If these papers result in an enhanced level of self-con- sciousness among sociologists about the out- come measures they use, this special sympo- sium will have served its purpose.

NOTES

1. The movement toward diagnostic studies in the United States drew upon earlier devel- opments in the United Kingdom, especially the creation of the Present State Examination by the psychiatrist John Wing (1967).

2. Sociologists, including Thomas Langner during the second stage, and Lee Robins and Ronald Kessler during the third stage, were heavily involved in developing out- come measures. Nevertheless, their mea- sures were more suited for the purposes of psychiatric researchers, clinicians, epidemi- ologists, and policy-makers than those of sociologists.

3. For the purposes of this paper, I limit the concerns of the sociology of mental health and illness to studies that deal with the eti- ology of psychological conditions. My sug- gestions are not relevant for other types of research such as labeling or social construc- tionist studies that explain social definitions of mental health and illness and not psy- chological states (see Horwitz 1999).

4. This situation is not unique to mental health but also applies to some physical condi- tions. For example, blood pressure levels that are close to, but not beyond, cut-off points for hypertension are risk factors for cardiovascular disease (Vasan et al. 2001).

5. A different, although related, issue regards using stressful life circumstances and psy- chological distress as predictors of subse- quent levels of educational and occupation- al achievement. The impact of stress expo- sure and emotional states on status attainment is a promising, relatively unex- plored avenue for future research in the sociology of mental health (cf. Wheaton 2001).

6. The finding that different outcome mea- sures produce the same results is still of interest because it indicates that stressors can have multiple consequences. Nevertheless, issues of parsimony and

space can mandate presenting results for only one outcome.

REFERENCES

American Psychiatric Association. 1980. Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association.

Aneshensel, Carol S., Carolyn M. Rutter, and Peter A. Lachenbruch. 1991. "Competing Conceptual and Analytic Models: Social Structure, Stress, and Mental Health." American Sociological Review 56:166-78.

Bernard, Jessie. 1972. The Future of Marriage. New Haven, CT: Yale University Press.

Black, Donald. 1983. "Crime as Social Control." American Sociological Review 48:34-45.

Blazer, Donald G., Ronald C. Kessler, Kathryn A. McGonagle, and Marvin S. Swartz. 1994. "The Prevalence and Distribution of Major Depression in a National Community Sample: The National Comorbidity Survey." American Journal of Psychiatry 151:979-86.

Bradburn, Norman M. 1969. The Structure of Psychological Well-Being. Chicago: Aldine.

Doherty, William J. and Richard H. Needle. 1991. "Psychological Adjustment and Substance Use among Adolescents before and after a Parental Divorce." Child Development 62:328-37.

Dohrenwend, Bruce P. 2000. "The Role of Adversity and Stress in Psychopathology: Some Evidence and its Implications for Theory and Research." Journal of Health and Social Behavior 41:1-19.

Dohrenwend, Bruce P. and Barbara S. Dohrenwend. 1982. "Perspectives on the Past and Future of Pswychiatric Epidemiology." American Journal of Public Health 72:1271-1279

Durkheim, Emile. [1897] 1951. Suicide: A Study in Sociology. New York: Free Press.

Faris, Robert E.L. and Warren H. Dunham. 1939. Mental Disorders in Urban Areas. Chicago: University of Chicago Press.

Frances, Allen J., Harold A. Pincus, Thomas A. Widiger, WW Davis, and M.B. First. 1990. "DSM-IV: Work in Progress." American Journal of Psychiatry 147:1419-48.

Gove, Walter R. and Jeanette Tudor. 1973. "Adult Sex Roles and Mental Illness." American Journal of Sociology 78:812-35.

Grob, Gerald. 1985. "The Origins of American Psychiatric Epidemiology." The American Journal of Public Health 75: 229-36.

1990. "World War II and American Psychiatry." The Psychohistory Review 19:41-69.

Henry, Andrew J. and James F. Short, Jr. 1954. Suicide and Homicide: Some Economic,

This content downloaded from ������������132.174.250.124 on Sun, 11 Jul 2021 23:53:31 UTC������������

All use subject to https://about.jstor.org/terms

150 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

Sociological, and Psychological Aspects of Aggression. New York: Free Press.

Hollingshead, August B. and Frederick C. Redlich. 1958. Social Class and Mental Illness. New York: John Wiley and Sons.

Horwitz, Allan V 1999. "The Sociological Study of Mental Illness: A Critique and Synthesis of Four Perspectives." Pp. 57-78 In Handbook of the Sociology of Mental Health, edited by Carol S. Aneschensel and Jo C. Phelan. New York: Plenum.

. 2002. Creating Mental Illness. Chicago: University of Chicago Press.

Horwitz, Allan V, and Lorraine Davies. 1994. "Are Emotional Distress and Alcohol Problems Differential Outcomes to Stress? An Exploratory Test." Social Science Quarterly 75:607-21.

Horwitz, Allan V, Helene R. White, and Sandra Howell-White. 1996. "The Use of Multiple Outcomes in Stress Research: A Case Study of Gender Differences in Responses to Marital Dissolution." Journal of Health and Social Behavior 37:278-91.

Hughes, Michael D. and Melvin E. Thomas. 1998. "The Continuing Significance of Race Revisited: A Study of Race, Class, and Quality of Life in America, 1972 to 1996." American Sociological Review 63:785-95.

Jahoda, Marie. 1958. Current Concepts of Positive Mental Health. New York: Basic Books.

Kessler, Ronald C. 2002. "The Categorical versus Dimensional Assessment Controversy in the Sociology of Mental Illness." Journal of Health and Social Behavior 43:171-188

Kessler, Ronald C., Katherine A. McGonagle, Shanyang Zhao, Christopher B. Nelson, Michael Hughes, Suzanne Eshelman, Hans-Ulrich Wittchen, and Kenneth S. Kendler. 1994. "Lifetime and 12-Month Prevalence of DSM-III- R Psychiatric Disorders in the United States." Archives of General Psychiatry 51:8-19.

Keyes, Corey L. M. 2002. "The Mental Health Continuum: From Languishing to Flourishing in Life." Journal of Health and Social Behavior 43:207-222

Klerman, Gerard L. 1989. "Comment on Mirowsky and Ross." Journal of Health and Social Behavior 30:26-33.

Langner, Tholmas S. 1962. "A Twenty-Two Item Screening Score of Psychiatric Symptoms Indicating Impairment." Journal of Health and Social Behavior 3:269-76.

Leighton, Dorothea C., J.S. Harding, D.B. Macklin, Alexander M. Macmillan, Alexander H. Leighton. 1963. The Character of Danger. New York: Basic Books.

Luhrmann, T.M. 2000. Of 2 Minds: The Growing Disorder in American Psychiatry. New York: Alfred A. Knopf.

Lykken, David and Auke Tellegen. 1996.

"Happiness is a Stochastic Phenomenon." Psychological Science 7:186-189.

Macmillan, Alexander M. 1957. "The Health Opinion Survey: Technique for Estimating Prevalence of Psychoneurotic and Related Types

of Disorder in the Community." Psychological Reports 3:325-29.

Magee, William J., William W Eaton, Hans J. Witchen, Kathryn A. McGonagle, and Ronald C. Kessler. 1996. "Agoraphobia, Simple Phobia,

and Social Phobia in the National Comorbidity Survey." Archives of General Psychiatry 53:159-68.

Mechanic, David. 1999. "Mental Health and Mental Illness: Definitions and Perspectives." Pp. 12-28 in A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems edited by A.V. Horwitz and T.L. Scheid. New York: Cambridge University Press.

Mills, C. Wright. 1943. "The Professional Ideology of Social Pathologists." American Journal of Sociology 2:165-80.

Mirowsky, John and Catherine E. Ross. 2002. "Measurement for a Human Science." Journal of Health and Social Behavior 43:152-170

Myers, David G. and Ed Diener. 1995. "Who Is Happy?" Psychological Science 6:10-19.

Pearlin, Leonard I. 1989. "The Sociological Study of Stress." Journal of Health and Social Behavior 30:241-57.

Pearlin, Leonard I., Morton A. Lieberman, Elizabeth G. Menaghan, and Joseph T. Mullan. 1981. "The Stress Process." Journal of Health and Social Behavior 22:337-56.

Radloff, Lenore S. 1977. "The CES-D Scale: A Self-Report Depression Scale for Research in the General Population." Applied Psychological Measurement 3:249-65.

Robins, Lee N. 1986. "The Development and Characteristics of the NIMH Diagnostic Interview Schedule." Pp. 403-28 in Community Surveys of Psychiatric Disorders edited by Myrna M. Weissman, Jerome K. Myers, and Catherine E. Ross. New Brunswick, N.J.: Rutgers University Press.

Robins, Lee N. and Darrell A. Regier, eds. 1990. Psychiatric Disorders in America: The Epidemiological Catchment Area Study. New York: Free Press.

Ross, Catherine E. and John Mirowsky. 1995. "Sex Differences in Distress." American Sociological Review 60:450-68.

Ryff, Carol D. 1989. "Happiness is Everything, or is it? Explorations on the Meaning of Psychological Well-Being." Journal of Personality and Social Psychology 57:1069-81.

Ryff, Carol D. and Corey L.M. Keyes. 1995. "The Structure of Psychological Well-Being Revisited." Journal of Personality and Social Psychology 69:719-27.

Schieman, Scott. 2000. "Education and the

This content downloaded from ������������132.174.250.124 on Sun, 11 Jul 2021 23:53:31 UTC������������

All use subject to https://about.jstor.org/terms

OUTCOMES IN THE SOCIOLOGY OF MENTAL HEALTH AND ILLNESS 151

Activation, Course, and Management of Anger."

Journal of Health and Social Behavior

41:20-39.

Schwartz, Sharon. 2002. "Outcomes for the

Sociology of Mental Health: Are We Meeting

Our Goals?" Journal of Health and Social Behavior 43:223-235

Seligman, Martin E.P. 2000. "Positive Psychology:

An Introduction." American Psychologist 55:5-14.

Simon, Robin W 1998. "Assessing Sex Differences

in Vulnerability among Employed Persons: The

Importance of Marital Status." Journal of Health

and Social Behavior 39:38-54. Forthcoming. "Revisiting the Relationships

Among Gender, Marital Status, and Mental Health." American Journal of Sociology.

Srole, Leon, Thomas S. Langner, S.T. Michael, Marvin K. Opler, and Thomas A.C. Rennie. 1962. Mental Health in the Metropolis. New

York: McGraw-Hill.

Sweeney, Megan and Allan V Horwitz. 2001.

"Infidelity, Initiation, and the Emotional Climate of Divorce: Are There Implications for Mental Health?" Journal of Health and Social Behavior 42:295-310.

Thoits, Peggy A. 1983. "Dimensions of Life Events That Influence Psychological Distress: An Evaluation and Synthesis of the Literature." Pp. 33-103 in Psychosocial Stress: Trends in Theory

and Research edited by Howard B. Kaplan. New York: Academic Press.

Turner, R. Jay, Blair Wheaton, and Donald Lloyd.

1995. "The Epidemiology of Social Stress." American Sociological Review 60:104-25.

Umberson, Debra, Kristi Williams, and Kristin Anderson. 2002. "Violent Behavior: An Expression of Emotional Upset." Journal of Health and Social Behavior 43:189-206

Vasan, Ramachandran S., Martin G. Larson, Eric P. Leip, Jane C. Evans, Christopher J. O'Donnell, William B. Kannel, and Daniel Levy. 2001. "Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease." The New England Journal of Medicine 345 (November 1):1291-97.

Wheaton, Blair. 2001. "The Role of Sociology in the Study of Mental Health ... and the Role of Mental Health in the Study of Sociology." Journal of Health and Social Behavior 42:221-234.

Wilson, Mitchell. 1993. "DSM-III and the Transformation of American Psychiatry." American Journal of Psychiatry 150:399-410.

Wing, John. 1967. "Reliability of a Procedure for Measuring and Classifying 'Present Psychiatric State."' The British Journal of Psychiatry 113:499-515.

Zaslow, M.J. 1989. "Sex Differences in Children's Response to Parental Divorce." American Journal of Orthopsychiatry 59:118-41.

Allan V. Horwitz is Professor of Sociology in the Department of Sociology and Institute of Health, Health

Care Policy, and Aging Research at Rutgers University. Most recently, he is the author of Creating Mental Illness, University of Chicago Press, 2002.

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