Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

Abstract

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower‐status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed‐care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low‐income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment‐seeking factors may help explain mental hospitalization rates.

Exploring the relationship between social class, mental illness stigma and mental health literacy using British national survey data

“…Two classic studies examining class, stigma and service use argued that those from higher class backgrounds were more able to research and seek out formal treatment options (Hollingshead and Redlich, 1958; Horwitz, 1982). Thoits and Evenson (2008) have found recent support for this idea in the US context using national survey data. Golberstein et al (2008) found that perceived stigma of mental health care was higher among students with lower socioeconomic status (SES), and Eisenberg et al (2009) found that personal stigma of mental health treatment was higher among those from ‘poorer’ backgrounds, but there was no association with perceived public stigma.…”

Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals

“…Although this concerns a small-scale qualitative study of the stigma experiences of inpatient service users, their accounts of stigmatizing encounters with care providers offer insights into how experiences are affected by social structure. The research builds on previous work that emphasizes the link between health literacy and socioeconomic status (Papen, 2009) and on research that considers the role of this status in stigma processes (e.g., Thoits & Evenson, 2008).…”

Societal Reactions to Deviance

“…Such strategies arise in the course of long-term organizational arrangements in which public defenders and prosecutors have a common interest in routinizing work. Emphasizing the ambiguity of definitions of deviance, the discretion of officials in assigning labels to behavior, and the organizational 6 One exception is recent work by Thoits (2005, Thoits & Evenson 2008, who explores the effects of social status on the likelihood of labeling and hospitalization of the mentally ill. Disconfirming the "differential labeling hypothesis," she found that lower-status individuals are not more likely to be hospitalized than high-status individuals (Thoits & Evenson 2008). contexts of enforcement, work by Cicourel, Kitsuse, and Sudnow has stimulated a sizeable research literature, so much so that this strand of societal reaction theory might be more aptly named "organizational reaction" perspective.…”