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Conceptualizing & Measuring Distress Sociology 3MH3 The Sociology of Stress and Mental Health McMaster University Wednesday, January 22, 2025 Dr. Diana Singh  Agenda 1 2 3 4 5 Trends in Stre...

Conceptualizing & Measuring Distress Sociology 3MH3 The Sociology of Stress and Mental Health McMaster University Wednesday, January 22, 2025 Dr. Diana Singh  Agenda 1 2 3 4 5 Trends in Stress Measuring Debates about the Group Case Study Test 1 Details & Research Psychological Measurement of Quiz Practice Well-Being and Mental Health Distress Outcomes Winter 2 Soc 3MH3 2024 The Stress Process Model 3  Social and Economic Statuses Neighborhood Stressors Primary Mental Health Stressors Secondary Outcomes Stressors Mediating and Moderating Resources SOC 3MH3 Winter 2023 4 Quick Revisit: Mediating & Moderating Resources  Weak Correlation The “Weak” Stressor-Distress Link Distress Research tends to find a modest Stress Exposure or weak correlation between Strong Positive Correlation exposure to stressors and distress; Why? Distress Several reasons…. Stress Exposure SOC 3MH3 Winter 2023 6  Social and Economic Statuses Neighborhood Stressors Primary Mental Health Stressors Secondary Outcomes Stressors Mediating and Moderating Resources SOC 3MH3 Winter 2023 7 Moderating Resources 1. The Differential Vulnerability Hypothesis 2. The Stress Buffering Hypothesis The “Weak” Stressor- Distress Link  Several reasons….  1)The “differential vulnerability” hypothesis:  The distress associated with some stressors is worse for some groups compared to others. SOC 3MH3 Winter 2023 9  Social and Economic Status Primary Mental Health Stressors Outcomes The Differential Vulnerability Hypothesis SOC 3MH3 Winter 2023 10  The Differential Vulnerability Hypothesis What is a theoretical narrative behind these predictions? (high) Low Education DISTRESS High Education (low) (low) STRESSOR (high) 11 Moderating Resources  Why else might there be a modest or weak correlation between exposure to stressors and distress.  2) Moderating resources  Some people have resources that help moderate the association. What are these resources and how do they “moderate”?  Coping, social support, and self-concepts  The buffering hypothesis o Resources buffer the effects of stressors; meaning they weaken or absorb the impact of stress For example: “The relationship between job insecurity and distress is weaker among those with a higher sense of control.” SOC 3MH3 Winter 2023 12 The Stress Process Model: Moderating Resources Primary Mental Health Stressors Secondary Outcomes Stressors Mediating and Moderating Resources SOC 3MH3 Winter 2023 13  The Buffering Hypothesis (i.e., moderation) (high) Low resources DISTRESS High resources (low) (low) STRESSOR (high) 14 Mediating Resources 1. Resource Erosion 2. Resource Mobilization The Stress Process Model: Mediating Resources Primary Mental Health Stressors Secondary Outcomes Stressors Mediating and Moderating Resources SOC 3MH3 Winter 2023 16 How can resources mediate in the stress process? Two ways social support could be a Job Loss mediating link? Resource erosion? The loss of a job decreases social support, which, in turn, elevates Social levels of distress. Support Resource mobilization? The loss of a job increases social support, which, in turn, reduces levels of psychological distress. Distress SOC 3MH3 Winter 2023 17  Recap Moderation Mediation Weak Stressor-Distress Link Explains when or for whom Explains how a stressor leads the stressor impacts distress to distress Why they are important: (e.g., stress → distress, (e.g., stress → financial Weak direct links between stronger with low sense of strain → distress). stressors and outcomes can control). often be explained by Mediation is NOT about the unmeasured mediators within It is NOT about the pathway strength of the relationship the process – The SPM Model (mediation) but about the (moderation), but about (Pearlin, 1999). strength of the relationship understanding the pathway (moderation). through which the effect occurs 18 Presentation title 20XX Trends in Stress Research SOC 3MH3 Winter 2023 19  Life change model  Good and bad?  Focus on chronic stress  Stress in other words.  Stress world moves with the larger world…  Traumatic events  Where to go next…  More contextual considerations – multilevel approaches in research  Stressors do not occur in isolation 20 SOC 3MH3 Winter 2023 SOC 3MH3 Conceptualizing & Measuring Distress A brief review of research methodology….  How to turn concepts into valid measurements Conceptualization Operationalization Measurement Levels of Concept Exhaustive Measurement Mutually Exclusive Validity/Reliability Dimension/Indicator Winter 23 SOC 3MH3 2024  What is Conceptualization? Constructs derived by mutual agreement from each Concept one’s mental images (conception) Conception Each one’s mental image of a set of social phenomena Winter 24 SOC 3MH3 2024  Conceptualization Process of coming to an agreement about what “fuzzy” and imprecise concepts mean for research purposes Involves describing: different dimensions of concepts indicator: observable measures of dimensions 25 SOC 3MH3 Winter 2024  What is Operationalization? Specifying precisely how the concept will be measures Specification The same concept can be operationalized in different ways For example: anxiety (self-report vs physiological) Clearly identify your variables Range of variation (relevant to your research) Identification Degree of precisions (variations b/w extremes) Level of measurement Winter 26 SOC 3MH3 2024 Measurement and Conceptualization of Mental Health  Measuring Well-Being and Distress  What is psychological distress? Two major forms  Depression is “feeling sad, demoralized, lonely, hopeless, or worthless, wishing you were dead, having trouble sleeping, crying, feeling everything is an effort, and being unable to get going. “  Anxiety “is being tense, restless, worried, irritable, and afraid.”  Distress embodies anxiety and depression symptoms reflecting affective impairment of functioning ranging from mild to severe, and indicative of the probability of disorder. Winter 28 SOC 3MH3 2024  Langner (1962) Twenty-Two items Centre for Epidemiologic Studies’ Depression Scale (CES-D; depression) Common Composite International Diagnostic Instrument (CIDI, WHO; depression) Measures Diagnostic Interview Schedule (DIS; anxiety) Examples of symptoms….  Depression Anxiety Blue, low spirits, sad, lonely, feel your life is Fearful, worried, anxious, irritable, a failure, feeling things never turn out, bothered by things that usually don’t bother tense Example Mood you, wish you were dead Items No appetite, trouble sleeping, trouble Cold sweats, heart beats hard, concentrating, trouble remembering, fainting, dizziness, shortness of Mailaise everything is an effort, can’t get breath, trembling hands, feel going, talk less hot all over Winter 30 SOC 3MH3 2024  Data and Method Canadian Work Stress and Health Study (CAN-WSH) (5 waves) PI Scott Schieman, University of Toronto N=6,004 (Wave 1; 2011) Some items from Canadian Work Stress & Health survey… 32  Defining Distress…. [Distress] can be interpreted to refer to the extent of anxiety and depression symptomatology…indicating an affectively based impairment in…social functioning capacities. The range of impairment is probably from none through…lower levels of severe; that range is sufficient to make…the [measurement scale] useful as a proxy indicator of variation in the probability of…a diagnosis in the realm of anxiety and depression disorders (qtd. Wheaton 2007, p 305-306) Winter 33 SOC 3MH3 2024  What it’s NOT Distress is NOT dissatisfaction Distress is NOT mental illness or alienation  Distress results from  Debate in this area deprivation; dissatisfaction is  According to M&R, not a perceived deprivation relative cognitive or personality to one’s expectation disorder  Alienation is a state of mind;  Category versus continua distress is a state of feeling. …(see next slide) Winter 34 SOC 3MH3 2024 Diagnosis: Superimposed Categories  Not discrete entities (one or the other)  Not entirely present or absent, rather some variation. Continuous type measures capture the variation in mental health outcomes better than discrete measures  Three reasons why discrete measures are arbitrary 1. Reification of mental disorder  Reification: to treat an abstraction as if it had material existence  Example: referring to the “diagnosis” of depression as though it were depression. 2. Ignores variation of severity; unreliable  One can be diagnosed, the other not despite small differences 3. A person should not be diagnosed to be helped Winter 35 SOC 3MH3 2024  Anti-Diagnosis: Patterns of Symptoms Which symptoms belong to which index (i.e., Depression? Anxiety?) Do they occur together or separate? Three hypotheses: 1) Galaxy hypothesis: symptoms are segregated based on similarity type 2) Nebula: symptoms are randomly distributed 3) Spectrum: symptoms of each type cluster together; however, the clusters overlap May have symptoms of depression and anxiety; no clear distinction between these boundaries. 36 Presentation title 20XX  The Galaxies Galaxies Spectrum Nebula ooo x x x x x x x x xxx ooo xxxxxoooooo x o +x x xxx o ooo oooo ooo o+ o+x x +++ o ooo o+++ + x o x o o o +++ ++ +++++ +++ + + xo o ++ ++++ Winter 37 SOC 3MH3 2024  Mapping Correlation Among Symptoms Ross & Mirowsky, 2003 38 Presentation title 2025  Additional consequences of thinking categorically about overlapping symptoms…  1) Proliferation of categories  efforts to define distinctive combinations of emotional, cognitive, and behavioural problems → more diagnostic categories  compare versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)  2) Social construction of prevalence and unmet need  aimed at intervention not the social cause; does not consider that some may not seek help (i.e., coping skills, variations in stressors)  3) Prevalence of comorbidity  comorbidity: the likelihood that someone who fits one category also fits another  more varieties in diagnoses lead to multiple diagnoses Winter 39 SOC 3MH3 2024  Distinguishing Distress from Disorder  Despite the advantages of using continuous measures of distress to assess mental health outcomes, are there disadvantages?  And, despite the disadvantages of using more discrete categories of disorder to define mental health, are there advantages?  Horwitz and Wheaton outline the debate, while presenting counterpoints and supportive evidence in defence of their position  Horwitz: Distinguishing disorder from distress is a good thing  Wheaton: Categories of disorder are arbitrary and insufficient Winter 40 SOC 3MH3 2024 The Main Argument Horwitz vs Wheaton (ROUND 1)  Distinguishing Distress from Disorder  Horwitz (2007)  Important to distinguish the two, but stress researchers do not  “The typical outcomes of the sorts of stressful social arrangements that sociologists usually study…are not internal psychological dysfunction but instead are natural responses that non-disordered people make to stressful conditions”  Distress is the normal, natural, expected response to stressful life circumstances, and should be distinguished from disorder, which signals something is wrong with the internal functioning of the individual.  Why no distinction today? Early military psychiatry, community studies, the DSM I, and CES-D scales conflated disordered with non-disordered conditions Winter 42 SOC 3MH3 2024  Distinguishing Distress from Disorder  Wheaton’s (2007) counter argument….  Why we don’t distinguish disorder and distress….  Disorder favours biological over social causes (i.e., internal dysfunction points to biology).  Considerable overlap between distress and disorder; despite other definitions. Distress is “not non-specific” and instead, is tied to the probability of anxiety and depression disorders (p. 305-6)  Why distress is not a “normal” reaction to stressors  Heterogeneity and variability in people’s responses  Socially and culturally defined  Differential vulnerability  Mediating and moderating resources Winter 43 SOC 3MH3 2024 The Reasons…. Horwitz vs Wheaton (ROUND 2)  Distinguishing Distress from Disorder Horwitz’s (2007) argument Distress is distinct from disorder because: 1) Instable, transient, short term symptoms and reaction; 2) would subside if the stressor was removed. “Distress is a normal human emotion, not a disorder, when it both emerges and persists in proportion with external stressful situations” (p. 275) Soldiers’ experiences, WWII Adolescents CES-D at four time points (Larson et al. 1999) Poverty among Native Americans (Costello et al. 2003) Key: Distress is a “normal” reaction to a typical life stressor Winter 45 SOC 3MH3 2024  Distinguishing Distress from Disorder Wheaton’s (2007) counter argument…. 1) Distress is actually more stable than Horwitz presumes evidence from 7 studies stability remains over short and long lags (i.e., one to ten years) “distress cannot be interpreted as a measure of short-term, transient and self-limiting problems that are … distinct from the … problems tapped by clinical disorder” (p. 310) 2) Distress does not necessarily subside when stressor is removed, and instead, can have major consequences There are not “special stressors” that cause disorders NSFH: effects of divorce persist after 2 years Distress associated with reduced income, marital instability, high school dropout Winter 46 SOC 3MH3 2024 The Benefits…. Horwitz vs Wheaton (ROUND 3)  The Benefits of Distinguishing Distress from Disorder  Horwitz (2007)  Reference to accurate concepts and processes important  we study normal responses to social circumstances, not mental disorders  would help distinguish the severity of the stressor (i.e., relationship breakup compared to sexual abuse in childhood)  Distinguishing causal order  Distress is more likely to be the consequence of circumstance, while disorder more likely to determine circumstance.  Reducing the medicalization of “normal” human emotions  i.e., explosive growth of pharmaceutical companies (Pfizer; “Prozac Nation”, etc.) Winter 48 SOC 3MH3 2024  The Benefits of Distinguishing Distress from Disorder Wheaton (2007) Distress captures the probability of disorder, without arbitrarily distinguishing symptoms as normal or abnormal refer to the definition of distress provided earlier If we dismiss distress as a “normal” reaction, we’re dismissing real world misery people react to stressors differentially; there are no “special” stressors that specifically lead to disorder, just as there are no mild stressors that specifically lead to distress. Further, it would be more logical to transform categories into continuums, rather than the other way around because of issues of measurement. Easier to talk about levels rather than probabilities. Winter 49 SOC 3MH3 2024 Who Wins?…. Horwitz vs Wheaton  Let’s Take a vote www.menti.com Code: 4484 1716 51 Presentation title 20XX  Break for 10mins Winter 52 SOC 3MH3 2024 Mid-Term Exam Next week: January 29, 2025 54 Presentation title 2025  The Details  During class time, 2:30pm-5:20pm, please bring a pencil and pen @ Canadian Martyrs School (see A2L)  Multiple choice (15% of grade)  Covers the following  Main components of the stress process model (Pearlin 1999)  primary, secondary stressors; proliferation; mediating and moderating resources.  Definitions and examples of “stressors” (Wheaton et al. 2012)  life change, trauma, daily hassles, etc.; two-way classification  Application of terms (e.g. be prepared to identify examples of stress proliferation or moderating resources)  Defining psychological distress and symptoms (Mirowsky and Ross)  galaxy, nebula and spectrum hypotheses; drawbacks of categorization  The debate about measurement; advantages, disadvantaged, points and counter points (Horwitz; Wheaton)  don’t worry about all the details in these articles  FOLLOW FROM LECTURE SLIDES AND SUPPLEMENT WITH READING MATERIALS Winter 55 SOC 3MH3 2024  Examples of MC Qestions Suppose that a researcher found that, on Which of the following statements best average, men are more likely than women to represents the concept of stress proliferation? report higher levels of anger and anxiety after experiencing a job loss. Which of the following  a. involuntary job loss increases the concepts best describes this scenario? likelihood of economic hardship.  a. varied exposure  b. economic hardship increases anxiety more for women compared to  b. the trait hypothesis men.  c. ecological stressor  c. the loss of social networks increases  d. differential vulnerability the risk of depression more for men  e. stress proliferation compared to women.  f. none of the above  d. economic hardship increases the risk of antisocial personality disorder among men more than women.  e. a and b only 56 Presentation title 20XX  Examples of MC Qestions According to Mirowsky and Ross, what is a key Which of the following is an example of a limitation of focusing on discrete measures of chronic meso-level stressor? psychological distress?  a. Long-term, ongoing stress related to systemic inequalities, such as discrimination.  a. They fail to capture variations in severity.  b. Stress from individual life events, such as divorce or job loss.  b. They are subject to diagnostic inflation.  c. Persistent stress arising from intermediate social structures, such as  c. They are influenced by social workplace environments or community desirability bias. dynamics.  d. They ignore biological underpinnings  d. Widespread stress caused by of distress. national or global crises, such as pandemics. 57 Presentation title 20XX