Psychologische Mechansimen im Zusammenhang zwischen sozialer Ungleichheit und Gesundheit - Relevanz des subjektiven sozialen Status

Der Zusammenhang von niedrigem sozialem Status und verschiedenen Gesundheitsfaktoren wurde schon vielfach belegt. Wohingegen in ärmeren Regionen Umweltfaktoren und die medizinische Grundversorgung von hoher Bedeutung sind, scheinen in moderneren Industriegesellschaften zunehmend psychologische Proze...

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Bibliographic Details
Main Author: Neubert, Marie
Contributors: Euteneuer, Frank (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2020
Online Access:PDF Full Text
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The relationship between low social status and several health indicators is well established. Whereas environmental factors and basic medical services affect health in low-income countries, potential psychological mechanisms seem to mediate the effect of social status on health in higher-income countries. Research suggests, that perceived social inequality – also referred to as subjective social status – might be such a psychological factor mediating the association between social status and health outcomes. Subjective social status (SSS) represents ones’ perceived social position in a specific hierarchy. Low SSS is associated with several mental and physical health impairments and these associations normally persist even after adjusting for objective socioeconomic measures such as income, education, and occupation. Unemployment has been identified as an important factor influencing mental health, but the mediating processes and mechanisms by which unemployment influences mental health are not well known. This study aimed to examine if unemployed individuals report lower SSS as well as lower mental health than employed individuals. Based on conceptual path models, we further tested if SSS might play a mediating role in the relationship between unemployment and mental health. We found that unemployed individuals reported lower SSS as well as lower mental health than employed individuals. Path model analyses indicated that the negative effect of unemployment on mental health was partially explained via a reduction of SSS. Our findings suggest that SSS may be an important psychological mechanism influencing mental health in unemployed individuals. The second study of this thesis aimed to examine the effect of social status on pain thresholds by experimentally manipulating participants’ SSS in a healthy student sample. Participants’ perceived social standing in comparison to other people in Germany was either temporarily elevated or reduced. We assessed participants' pressure pain thresholds before and after the manipulation. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. Furthermore, participants in the low-status condition reported increased pain thresholds compared to participants in the high-status condition. The results of this study indicate that temporarily manipulated social status affects pain thresholds. The third study aimed to address the issue if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. SSS and 24h ambulatory blood pressure were assessed in a non-clinical community sample. Analyses revealed an association between lower SSS and reduced nocturnal blood pressure dipping even after adjusting for objective measures of social status (i.e. education, occupation, and income). Our findings suggest that reduced nocturnal blood pressure dipping might be a potentially mediating biological mechanism in the relationship between SSS and cardiovascular disease. The fourth study presents further examinations of the research group. This study aimed to test how the discrepancy between factual SSS and counterfactual SSS relates to psychological distress in socially deprived individuals (i.e. unemployed individuals and single mothers). Upward counterfactual thinking refers to the process of simulating better alternatives to a factual state. When socially disadvantaged individuals reflect on the negative outcomes regarding their social status, they may be thinking these may not have happened if they did not lose their job, or did not become a single parent. Participants of both samples reported higher counterfactual SSS than factual SSS. We found that a higher discrepancy between factual and counterfactual SSS was associated with elevated psychological distress. Thus, the discrepancy between counterfactual and factual SSS might be an additional psychological factor in the relationship between social inequality and mental health in socially disadvantaged individuals.