Research and publications
| DOI | https://doi.org/10.1108/17465729200400012 |
| Published date | 01 June 2004 |
| Pages | 42-48 |
| Date | 01 June 2004 |
| Subject Matter | Health & social care |
Book reviews
Social inequalities and the distribution of common
mental disorders
David Melzer, Tom Fryers, Rachel Jenkins (eds)
Maudsley Monograph 44. Psychology Press 2004
ISBN 1 84169 385 5
While the relationship between physical disease and
relative deprivation is widely accepted and understood,
there is an enduring perception that mental illness is a
random misfortune. In fact, as this latest monograph in
the Maudsley series shows, across the spectrum of
mental health problems, prevalence is strongly
associated with social position. Being unemployed or
economically inactive, poorer material circumstances,
less education, physical health problems and adverse life
events all predict increased risk of the most common
disorders: typically anxiety and/or depression. Based on
a systematic review of nine large-scale population
studies, Melzer and colleagues demonstrate that,
contrary to the Royal College of Psychiatrists’ slogan
‘Every family in the land’, it is the poorest and most
deprived families who bear the main burden of mental
distress. Lone parents, those with physical illnesses and
the unemployed make up 20% of the population, but
these three groups constitute 36% of all those with
neurotic disorders, 39% of those with limiting mental
disorders and 51% of those with disabling mental
disorders.
Common mental health problems among ethnic
minority populations in the UK have been little studied
and are sometimes considered to be less prevalent, so
the inclusion of a review on ethnicity is particularly
welcome. The authors found that prevalence is at least
similar for ethnic groups, while depression may be
higher in Caribbean and African groups and anxiety
more frequent in Irish born populations. The dramatic
differences in prevalence reported from clinical settings
are not evident in population surveys, confirming once
again the disparities in access to treatment and services.
This is a dense study, as valuable for its detailed
analysis of the problems inherent in defining mental
health problems as it is for the wealth of data from a
wide range of major surveys. The authors conclude that
measures of mental health (for example, resilience and
coping), mental illness (both symptoms and disorders)
and measures of socio-economic status and other
indicators of social inequality are not standardised. The
use of different instruments and measures produces
data sets that are incompatible and non-comparable.
The collection also includes studies that did not meet
the criteria for inclusion in the systematic review, making
this one of the most accessible sources of the
international evidence on inequalities and mental health.
The database of over 1000 studies identified in the initial
search is also available to researchers on request.
The book is a key resource for anyone concerned
that the inequalities agenda has largely omitted mental
health and makes a strong case for targeting those most
at risk. This means looking beyond geography and
social class, to more sensitive and meaningful indicators
of relative deprivation. As the authors observe, ‘the
excess of psychiatric symptoms and common mental
disorders found in most social inequalities research is
not only a product of a sub-class of severely
disadvantaged people. There is clear evidence that
prevalence of symptoms and disorders increases
progressively with socio-economic status, even in the
absence of overt poverty or obvious deprivation.
Inequality itself, not only deprivation, appears to be
important and this has given rise to explanations in
terms of relatively reduced social capital, sense of
belonging and control over one’s life.’
The benefits of learning: the impact of education on
health, family life and social capital
Tom Schuller, John Preston, Cathie Hammond,
Angela Brassett-Grundy, John Bynner
Routledge–Falmer 2004 ISBN 0 415 32801 12
Since its establishment in 1999, the Centre for
Research on the Wider Benefits of Learning, based at
the Institute of Education, University of London,
(www.learningbenefits.net) has been quietly producing
journal of mental health promotion •volume 3•issue 2 •june 2004 © Pavilion Publishing (Brighton) Ltd
42
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