Abstract
Mental health researchers have identified a number of social factors that may be associated with the prevalence of functional psychiatric illness. Some of the empirical findings are contradictory among studies using different methodologies or conducted in different times and places (Mishler and Scotch 1965; Turner 1972; and Dohrenwend 1975). It is recognized, however, that two of the highly consistent findings are the relationships of psychiatric illness to sex roles and social class. In general, the overall rates of psychiatric illness are higher among women than men (e.g., Davis 1962; Langner and Michael 1963; Phillips 1966; Phillips and Segal 1969; Gove and Tudor 1973; and Clancy and Gove 1974), and higher among members of lower socioeconomic groups (Faris and Dunham 1939; Hollingshead and Redlich 1958; Langner and Michael 1963; Leighton, et al. 1963;Kohn 1968; Dunham 1970; and Hodge 1970).
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Notes
Both surveys were conducted by the same research team, using an identical research technique and similar diagnostic criteria (Lin, et al. 1969: 67-68).
In Mitchell’s study, emotional illness was indicated by 11 questions on symptoms, including shortness of breath, heart beating hard, spells of dizziness, nightmares, losing weight, hands sweat, can’t get going, trouble getting to sleep, headaches, nervous, and loss of appetite. Those with four or more of these symptoms were labelled emotionally ill.
It should be recognized that the use of Langner’s scale has recently been criticized on both conceptual and methodological ground. See, for instance, Seiler (1973) and Dohrenwend and Dohrenwend (1976).
It needs to be underscored that the present study measures psychiatric morbidity as defined by Langner’s 22 items. In effect, we look for “universals” for the purpose of making a comparison between Hong Kong and the West. A study of this kind has its own significance, as it provides a cross-cultural validation of professional psychiatric constructs. However, as Kleinman (1977) has argued, the study may have committed a “category fallacy”. That is, we may have superimposed the Western psychiatric categories on the mental states of the Chinese population in Hong Kong. Since somatization exists to a greater extent in Chinese culture than in the West (Wong 1976; Kleinman 1977), the use of Langner’s scale in this study may have missed some stress symptoms which are important to the Chinese people, such as the feeling of having insufficient blood and “ch’ i” (vital essence), of excessive heat and “fire” inside the body, and of over-accumulation of “gas” in the chest. Furthermore, some of the items (e.g., fainting, loss of appetite, heart beating, and acid stomach) in Langner’s scale may be defined by the local population as indications of physical instead of mental sickness, thus creating a gap between the Western professional judgement and the indigenous definition of psychiatric morbidity. We agree with Kleinman (1977) that there is a need for detailed phenomenological descriptions in Hong Kong, and believe that such accounts of cultural specifics would supplement studies (like the present one) which emphasize cultural universals.
However, it should be pointed out that the cut off point is essentially arbitary. In their validity studies of the scale, for instance, Mannis (1963) argued that the scale is valid only for scores of 10 or higher, whereas Haese and Meile (1967) concluded that the best cut off point is between 6 and 7 symptoms.
It should be made explicit here that this paper adopts the social causation approach, which assumes that the formation of psychiatric symptoms is a consequence of sociallyinduced stress on the individual (for discussions see, for instance, Dunham 1964; Dohrenwend 1966; and Lee 1976). With the present data, we were unable to provide an adequate test of this assumption. Readers should bear in mind that there are alternative hypotheses. It may be, for instance, that the sex-differences in symptoms are due to physiological factors rather than social roles, and that instead of social causation the social class differences are due to the social selection of individuals with symptoms into lower class status. Further studies are needed to examine these alternative propositions (for some suggestions, see Dohrenwend 1975; and Lee 1976).
Gaitz and Scott (1972) also found very little relationship between age and symptoms. Their measurement of psychiatric symptoms is identical to ours, although the age-categories are not the same.
An issue of concern is that since life dissatisfaction could be a result, or a component, of psychiatric morbidity, the life satisfaction finding in this study may be an artifact. We would like, however, to remind the readers of an important assumption underlying this study, i.e., the questionnaire item on life satisfaction is used as an indicator of achievement-aspiration discrepancies. Analytically, therefore, life satisfaction (as an indicator of the concept of discrepancies) is distinct from the concept of psychiatric symptoms, and it can be conceived as a determinant of psychiatric symptoms.
As an alternative proposition, it may be argued that relative to their male counterparts, the low SES females tend to suffer from greater deprivation than the higher SES females. Consequently, the sex-differences in psychiatric symptoms were greater in the low than the higher SES groups. This argument, however, does not seem to be in line with our data. In a further analysis, we found that females were significantly more satisfied with life than males in all SES groups, and that the magnitudes of sex-differences in life satisfaction were also about the same in these various SES groups.
References
Abramson, J. H. 1966 Emotional disorder, status inconsistency and migration. Milbank Fund Quarterly 44 (January): 23–48.
Bradburn, N. M. 1969 The Structure of Psychological Weil-Being. Chicago: Aldine.
Chen, John T. S. 1973 1001 Chinese Sayings. Hong Kong: Chung Chi College Press.
Cheng, T. Y. 1977 The Economy of Hong Kong. Hong Kong: Far East.
Cheung, Fanny Forthcoming Self perception, cultural norm and development: Case studies of 36 Chinese women. To be published in the Journal of The Chinese University of Hong Kong.
Clancy, K., and Walter Gove 1974 Sex differences in mental illness: An analysis of response bias in self-reports. American Journal of Sociology 80 (July): 205–16.
Cooperstock, Ruth 1971 Sex differences in the use of mood-modifying drugs: An explanatory model. Journal of Health and Social Behavior 12 (September): 238–44.
Cronbach, Lee J. 1951 Coefficient alpha and the internal structure of tests. Psychometrika 16 (September): 297–334.
Davis, James A. 1962 Stipends and Spouses. Chicago: University of Chicago Press.
Davis, James A. 1971 Elementary Survey Analysis. N. J.: Prentice-Hall.
Dohrenwend, Bruce P. 1966 Social status and psychiatric disorder: An issue of substance and an issue of method. American Sociological Review 31 (February): 14–34.
Dohrenwend, Bruce P. 1975 Sociocultural and social-psychological factors in the genesis of mental disorders. Journal of Health & Social Behavior 16 (December): 365–92.
Dohrenwend, Bruce P., and Dewitt L. Crandell 1970 Psychiatric symptoms in community, clinic, and mental hospital groups. American Journal of Psychiatry 126 (May): 1611–21.
Dohrenwend, Bruce P., and Barbara S. Dohrenwend 1976 Sex differences and psychiatric disorders. American Journal of Sociology 81 (May): 1447–54.
Dunham, H.W. 1964 Anomie and mental disorder. In Anomie and Deviant Behavior. B. Clinard, ed. N.Y.: Free Press; pp. 128–157.
Dunham, H.W. 1970 Social class & mental disorder. British Journal of Social Psychiatry and Community Health 4:76–83.
Faris, R. E., and H. W. Dunham 1939 Mental Disorders in Urban Areas. Chicago: University of Chicago Press.
Gaitz, C.M. and J. Scott 1972 Age and the measurement of mental health. Journal of Health & Social Behavior 13 (March): 55–67.
Gove, W. R., and K. Clancy 1976 Response bias, sex differences, and mental illness: A reply. American Journal of Sociology 81 (May): 1463–70.
Gove, W. R., and J. F. Tudor 1973 Adult sex roles and mental illness. American Journal of Sociology 76 (January): 812–35.
Haese, Philip, and Richard Meile 1967 The Relative effectiveness of two models for scoring the mid-town psychological disorder index. Community Mental Health Journal 3 (Winter): 335–42.
Hodge, Robert W. 1970 Social integration, psychological well-being, and their socioeconomic correlates. In Social Stratification, Edward O. Laumann, ed. N.Y.: The Bobbs-Merrill; pp. 182–206.
Hollingshead, A. B., and F. C. Redlich 1958 Social Class and Mental Illness. N.Y.: John Willey & Sons.
Hollingshead, A. B., R. A. Ellis, and E. L. Kirby 1954 Social mobility and mental illness. American Sociological Review 19 (October): 511–20.
Hopkins, K., ed. 1971 Hong Kong: The Industrial Colony. London: Oxford University Press.
Kish, Leslie 1965 Survey Sampling. London: John Wiley & Sons.
Kleiner, Robert J., and Seymour Parker 1963 Goal-striving, social status, and mental disorder: A research review. American Sociological Review 28 (April): 162–203.
Kleinman, Arthur M. 1977 Depression, somatization and the new cross-cultural psychiatry. Social Science & Medicine 11: 3–10.
Kohn, M. L. 1968 Social class & schizophrenia: A critical review. In The Transmission of Schizophrenia, David Rosenthal and Seymour S. Kety, eds. London: Pergamon; pp. 155–173.
Langner, Thomas S. 1962 A twenty-two item screening score of psychiatric symptoms indicating impairment. Journal of Health & Social Behavior 3 (Winter): 269–76.
Langner, Thomas S. 1965 Psycho-physiological symptoms and status of women in two Mexican communities. In Approaches to Cross-Cultural Psychiatry, J. M. Murphy and A. H. Leighton, eds. Ithaca, N.Y.: Cornell University Press.
Langner, T., and S. T. Michael 1963 Life Stress and Mental Health. N.Y.: The Free Press.
Lau, S. K. 1977 Utilitarianistic Familism: An Inquiry into the Basis of Political Stability in Hong Kong. Research Report of the Social Research Centre, The Chinese University of Hong Kong.
Ranee P. L. 1976 The causal priority between socioeconomic status and psychiatric disorder: A prospective study. The International Journal of Social Psychiatry 22 (Spring): 1–8.
Leighton D. C., J. S. Harding, D. B. Macklin, A. M. Macmillan, and A. H. Leighton 1963 The Charter of Danger. N.Y.: Basic Books.
Lin, T. Y. 1953 A study of incidence of mental disorders in Chinese and other cultures. Psychiatry 16:313–36.
Lin, T. Y., H. Rin, E. K. Yeh, C. C. Hsu, and H. M. Chu 1969 Mental disorders in Taiwan, fifteen years later: A preliminary report.” In Mental Health Research in Asia and the Pacific, W. Caudill and T. Y. Lin, eds. Honolulu: East-West Center; pp. 67–91.
Manis, J., M. Brawer, C. Hunt, and L. Kercher 1963 Validating a mental health scale. American Sociological Review 28 (February): 108–16.
Meile, Richard, and Philip N. Haese 1969 Social status, status incongruence, and symptoms of stress. Journal of Health & Social Behavior 10 (September): 237–44.
Merton, Robert 1959 Social Theory and Social Structure, Revised and Enlarged Edition. Glencoe: Free Press.
Mishler, Elliot G., and Norman A. Scotch 1965 Sociocultural factors in the epidemiology of schizophrenia: A review. International Journal of Psychiatry 1 (April): 258–305.
Mitchell, R. E. 1969 Levels of Emotional Strain in Southeast Asian Cities, Vols. I & II. A Project of the Urban Family Life Survey, The Chinese University of Hong Kong, Hong Kong.
Nathanson, C. A. 1975 Illness and the feminine role: A theoretical review. Social Science & Medicine 9:57–62.
Phillips, D. L. 1966 The “true” prevalence of mental illness in a New England state. Community Mental Health Journal 2 (Spring): 35–40.
Phillips, Derek, and Kevin Clancy 1970 “Response biases in field studies of mental illness.” American Sociological Review 35 (June): 503–15.
Phillips, D. L., and B. F. Segal 1969 Sexual status and psychiatric symptoms. American Sociological Review 34 (February): 58–72.
Porritt, D., and S. Millar 1976 Psychometrics of the dependent variables. Unpublished manuscript, Australian National University.
Rin, H., et al. 1966 Psychophysiological reactions of a rural and suburban population in Taiwan. Acta Psychiatrica Scandinavica 42:410–473.
Rinehart, James W. 1968 Mobility aspiration-achievement discrepancies and mental illness. Social Problems 15 (Spring): 478–88.
Rosenberg, Morris 1968 The Logic of Survey Analysis. N.Y.: Basic Books.
Schader R., M. Ebert, and J. Harmatz 1971 Langner’s psychiatric impairment scale: A short screening device. American Journal of Psychiatry 128 (November): 569–601.
Seiler, Lauren H. 1973 The 22-item scale used in field studies of mental illness: A question of method, a question of substance, and a question of theory. Journal of Health & Social Behavior 14 (September): 252–64.
Shively, A. M. 1972 Kwun Tong Life Quality Study: Data Book. Unpublished document of the Social Research Centre, The Chinese University of Hong Kong.
Shively, A. M., and Stanley Shively 1972 Value changes during a period of modernization: The case of Hong Kong. Occasional paper of the Social Research Centre, The Chinese University of Hong Kong.
Suits, D. B. 1954 Use of dummy variables in regression equations. Journal of American Statistical Association 52: 548–51.
Turner, R. Jay 1972 The epidemiological study of schizophrenia: A current appraisal. Journal of Health & Social Behavior 13 (December): 360–69.
Wong, Aline 1975 Women in Modern Singapore. Singapore: University Education Press.
Wong, C. L. 1976 An appraisal of psychiatric symptoms, with special reference to psychiatric private Practice in Hong Kong. Hong Kong Journal of Mental Health 5 (December): 5–7.
Yap, P. M. 1965 Phenomenology of affective disorder in Chinese and other cultures. In Transcultural Psychiatry, A. V. S. DeReuck and R. Porter, eds. Boston: Little, Brown; pp. 84–114.
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Lee, R.P.L. (1981). Sex Roles, Social Status, and Psychiatric Symptoms in Urban Hong Kong. In: Kleinman, A., Lin, TY. (eds) Normal and Abnormal Behavior in Chinese Culture. Culture, Illness, and Healing, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-4986-2_14
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