Section Learning Objectives

• Describe the sociocultural model.
• Clarify how socioeconomic factors affect psychological disorders.
• Clarify how gender can affect psychological disorders.
• Clarify how environmental factors affect psychological disorders.
• Clarify how multicultural factors (including racism) affect psychological disorders.
• Evaluate the sociocultural model.

Outside of biological and psychological factors, race, ethnicity, gender, religious orientation, socioeconomic status, sexual orientation, etc. also play a role in psychological disorders, and this is the basis of the sociocultural model. Next, we explore a few of these factors.

2.4.1. Socioeconomic Factors

Low socioeconomic status has been linked to higher rates of mental and physical illness (Ng, Muntaner, Chung, & Eaton, 2014) due to persistent concern over unemployment or under-employment, low wages, lack of health insurance, strained finances, and the inability to put food on the table, which can then lead to feeling hopeless, helpless, and dependent on others. This situation places considerable stress on an individual and can lead to higher rates of anxiety disorders and depression. Borderline personality disorder has also been found to have a higher prevalence in people in low-income brackets (Tomko et al., 2014).

2.4.2. Gender Factors

Gender plays an important, though at times, unclear role in psychological disorders. It is important to understand that gender is not the cause of psychological disorders, though differing demands placed on men and women by society and their culture can influence the development and course of disorders. Consider the following:

• Rates of eating disorders are higher among women than, men, though both genders are affected. In the case of men, muscle dysphoria is often of concern and is characterized by extreme concern over not being muscular enough.
• OCD has an earlier age of onset in boys than girls, with most people being diagnosed by age 19 or 20.
• Women are at greater risk for developing anxiety disorders than men.
• attention-deficit/hyperactivity disorder (ADHD) is more common in men than women, though women are more likely to have inattention issues.
• Boys are more likely to be diagnosed with autism spectrum disorder.
• Depression occurs with greater frequency in women than men.
• Women are more likely to develop post-traumatic stress disorder (PTSD) compared to men.
• Rates of major depressive disorder with seasonal pattern (Seasonal Affective Disorder) are four times greater in women than men.

2.4.3. Environmental Factors

Environmental factors also play a role in the development of psychological disorders. Here are some examples.

• In the case of borderline personality disorder (BPD), many people report experiencing traumatic life events such as abandonment, abuse, unstable relationships or hostility, and adversity during childhood.
• Cigarette smoking, alcohol use, and drug use during pregnancy are risk factors for attention-deficit/hyperactivity disorder (ADHD).
• Divorce or the death of a spouse can increase the risk of developing an anxiety disorder.
• Trauma, stress, and other extreme stressors are predictive of depression and many other disorders (e.g., PTSD).
• Malnutrition before birth, exposure to viruses, and other psychosocial factors are believed to contribute to the risk of developing schizophrenia.
• Major depressive disorder with seasonal pattern (Seasonal Affective Disorder; SAD) occurs with greater frequency for those living far north or south of the equator (Melrose, 2015). Horowitz (2008) found that rates of SAD are just 1% for those living in Florida while 9% of Alaskans are diagnosed with the disorder. This is due to differences in exposure to sunlight in these regions (exposure to sunlight suppresses melatonin which is a hormone that can increase vulnerability to SAD).

Source: https://www.nimh.nih.gov/health/topics/index.shtml

2.4.4. Multicultural Factors, Racism, and Discrimination

Racial, ethnic, and cultural factors are also relevant to understanding the development and course of psychological disorders. First, it is imperative to note that race is a social, not a biological construct, that is used to divide people into groups based on superficial physical traits, typically skin color. While there is no biological basis for the construct of race, discriminatory practices based on race can have profound effects on mental health and multicultural psychologists assert that both normal and dysfunctional behavior need to be understood in relation to the individual’s unique culture and the group’s value system.

Racially and ethnically minoritized people must contend with prejudice, discrimination, racism, economic hardships, etc. as part of their daily life and these stressors can increase vulnerability to some psychological disorders (Lo & Cheng, 2014; Jones, Cross, & DeFour, 2007; Satcher, 2001). Racism exists at personal, interpersonal, institutional, and social structural levels. At the personal level, racism can promote internalized stereotypes that affect individuals’ health and well-being. Racism at the interpersonal level includes explicit behaviors (e.g., racial slurs) as well as microaggressions (i.e., everyday slights and offenses that communicate negative attitudes toward specific groups). Institutional racism refers to discrimination embedded in everyday practices of institutions or organizations, including health care and psychiatry. Individuals in such institutions can participate in and contribute to systemic racism without consciously endorsing racist ideas. Finally, social structural racism refers to racism and discrimination that are embedded in the norms of society and public policy (e.g., inequities in economic resources, power, and privilege).

Racism is an important social determinant of health that contributes to a wide variety of adverse health outcomes, including suicidal behavior, and post-traumatic stress disorder, and racism can predispose individuals to substance use, mood disorders, and other psychological disorders. Other adverse consequences of discrimination include unequal access to care, clinician bias, misdiagnosis, and treatment. Examples include misdiagnosis of schizophrenia among Black people presenting with mood disorders and other conditions, more coercive pathways to care, less time in outpatient treatment, and more frequent use of physical restraints and suboptimal treatments.

As such, clinicians should make active efforts to recognize and address all forms of racism, bias, and stereotyping in clinical assessment, diagnosis, and treatment. Further, to address this unique factor, culture-sensitive therapies have been developed and include increasing the therapist’s awareness of cultural values, hardships, stressors, and/or discrimination and prejudices faced by their client; the identification of suppressed anger and pain; and raising the client’s self-worth (Prochaska & Norcross, 2013). Moreover, the culture of the client is carefully considered in determining whether a behavior is atypical and not culturally expected.

 2.4.5. Evaluation of the Model

The sociocultural model has contributed greatly to our understanding of the nuances of diagnosis, prognosis, and treatment of mental disorders for other races, ethnicities, cultures, and genders. In Chapter 3 we will discuss diagnosing and classifying psychological disorders from the perspective of the DSM 5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition text revision). Important here is that specific culture- and gender-related diagnostic issues are discussed for each disorder, demonstrating increased awareness of the impact of these factors. Still, the sociocultural model suffers from issues with the findings being difficult to interpret and not allowing for the establishment of causal relationships due to a reliance on more qualitative data gathered from case studies and ethnographic analyses (one such example is Zafra, 2016).

Chapter Recap

In Chapter 2, we first distinguished uni- and multi-dimensional models of psychological disorders and made a case that the latter was superior. We then discussed biological, psychological, and sociocultural models of psychological disorders. In terms of the biological model, neurotransmitters, brain structures, hormones, genes, and viral infections were discussed as potential causes of mental disorders, and several treatment options were described. In terms of psychological perspectives, behavioral, cognitive, humanistic and existential perspectives were discussed. Finally, the sociocultural model indicated the roles that socioeconomic status, gender, environmental, and multicultural factors can play in psychological disorders.