The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness

Seth J Prins; Sarah McKetta; Jonathan Platt; Carles Muntaner; Katherine M Keyes; Lisa M Bates

doi:10.1097/EDE.0000000000001304

Back

The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness

Journal article

Peer reviewed

The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness

Seth J Prins, Sarah McKetta, Jonathan Platt, Carles Muntaner, Katherine M Keyes and Lisa M Bates

Epidemiology (Cambridge, Mass.), Vol.32(2), pp.303-309

03/01/2021

DOI: 10.1097/EDE.0000000000001304

PMCID: PMC7872213

PMID: 33252438

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/7872213View

Open Access

Abstract

Social stratification is a well-documented determinant of mental health. Traditional measures of stratification (e.g., socioeconomic status) reduce dynamic social processes to individual attributes downstream of mechanisms that generate stratification. In this study, we measure one process theorized to generate and reproduce social stratification-economic exploitation-and explore its association with mental health. Data are from the 1983 to 2017 waves of the Panel Study of Income Dynamics, a nationally representative cohort study (baseline N = 3059). We operationalized "unconcealed exploitation" as the percentage of individuals' labor income they were hypothetically not paid for productive hours. We ascertained psychologic distress and mental illness with the Kessler-6 (K6) scale. We fit inverse probability-weighted marginal structural models and found that for each unit increase in unconcealed exploitation, psychologic distress increased by 1.6 points (95% confidence interval = 0.71, 2.5) on the K6 scale and the odds of mental illness tripled (odds ratio = 3.0, 95% confidence interval = 1.5, 6.1). Results were not driven entirely by overwork and were robust to different inverse probability-weighted estimation strategies and sensitivity analyses. Exploitation is associated with mental illness. Focusing on exploitation rather than its consequences (e.g., socioeconomic status), shifts attention to a structural process that may be a more appropriate explanatory mechanism, and a more pragmatic intervention target, for mental illness.

Details

Title: Subtitle: The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness
Creators: Seth J Prins - Department of Sociomedical Sciences, Columbia University, New York, NY
Sarah McKetta - Department of Epidemiology, Columbia University, New York, NY
Jonathan Platt - Department of Epidemiology, Columbia University, New York, NY
Carles Muntaner - Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Katherine M Keyes - Department of Epidemiology, Columbia University, New York, NY
Lisa M Bates - Department of Epidemiology, Columbia University, New York, NY
Resource Type: Journal article
Publication Details: Epidemiology (Cambridge, Mass.), Vol.32(2), pp.303-309
DOI: 10.1097/EDE.0000000000001304
PMID: 33252438
PMCID: PMC7872213
NLM abbreviation: Epidemiology
ISSN: 1044-3983
eISSN: 1531-5487
Grant note: R01 DA048853 / NIDA NIH HHS
Language: English
Date published: 03/01/2021
Academic Unit: Epidemiology; Injury Prevention Research Center
Record Identifier: 9984214794402771

Metrics

16 Record Views

23 Times Cited - Web of Science