Mental health and occupational mobility in a group of immigrants

Soc. Sci. & Med.. Vol. [2. pp, 53 to 58. Pergamon Press 1978. Printed in Great Britain.

M E N T A L HEALTH A N D O C C U P A T I O N A L MOBILITY IN A G R O U P OF I M M I G R A N T S WILLIAM W. EATON Department of Psychiatry, Jewish General Hospital, and Department of Sociology, McGill University and JEAN-CLAUDE LASRY Department of Psychiatry, Jewish General Hospital, and Department of Psychology, University of Montreal Abstrac~Studies on occupational mobility and mental disorders are reviewed. Failure to study homogeneous types of mental disorder, to include adequate status controls and to provide supporting theoretical and empirical evidence are frequent methodologic errors. Evidence that schizophrenia is linked to downward mobility appears to be fairly consistent; on the other hand, mild psychiatric disorder seems to be linked to upward mobility. For the present study, a sample of North African Jewish immigrants to Montreal was interviewed in 1972. With appropriate status controls, the presence of mild psychiatric symptoms was also weakly associated with upward mobility. However, the correlation increased in strength for those who had changed jobs more recently. A similar pattern was obtained for a measure of job satisfaction. The results indicate that job stresses involved in upward mobility can lead to mild psychiatric symptoms.

In Table 1 we have divided the 18 studies by diagnosis. The type of mobility is important too. Studies of intergenerational mobility involve groups which are compared as to their pattern of mobility from their parental social class. 1ntragenerational mobility involves the career pattern of individuals over part of their own life span. In almost all studies, mobility between social classes is measured by comparing occupational statuses at two points in time. Studies of status incongruence often create scores measuring the difference between educational and occupational status. Since educational status is usually acquired early in the occupational career, we have categorized the studies of status incongruence as intragenerational. The presence of status controls is an important aspect of studies of social mobility. Without these controls, a researcher may attribute to mobility an effect which should be attributed to the individual's social class status. Since social class status is usually strongly related to mental disorder, a study without status controls is incomplete. In our definition of status controls, we have included statistical control of one or both statuses, as well as control by a group of "normals" matched to patients for class status. Although not identical, both control methods serve the same theoretic purpose. In this column, a "yes" indicates the presence of some sort of control and a blank space, its absence. The presence of supportive evidence helps to evaluate research results. It indicates that a relatively broad pattern of relationships in the study of mobility supports the conclusions drawn. The broad pattern makes idiosyncratic and irrelevant causes of the empirical result less likely (e.g. sampling error or a methodologic artifact). Often the supportive evidence takes the form of association with variables that mediate or specify the effect of social mobility. We have also

INTRODUCTION

Social mobility has been defined as the process by which individuals move from one position in the status hierarchy of society to another [1]. It has been widely hypothesized by a variety of societal analysts from Durkheim [2] to Toffler [3], that excessive social mobility is harmful for one's mental health. In western societies, mobility between social classes is the most important type of social mobility, although other types (e.g. cultural or geographic) have been studied. It involves changes in life style and culture [4, 5]. The socially mobile individual may have it/appropriate expectations for his own and others' behavior, and be unable to respond appropriately to others' expectations regarding his own behavior. Mobility of this sort disrupts interpersonal relations [-6, 7] and also involves life events which may be stressful [8]. It seems clear that social mobility produces stress with various consequences. Table 1 presents a summary of 18 studies of social class mobility and mental health, excluding studies relating mobility to physical health problems [9, 10], as well as studies of mental health and social class that did not deal with class mobility as such [11 13]. It is difficult to draw conclusions from such a diversity of research, each study having its own idiosyncrasies of theoretical approach and methodology. Several criteria describing these studies have been included to permit evaluation of this body of research. The type of instrument or the diagnosis used is of prime importance. Most studies have utilized diagnosis by a psychiatrist. Several others have used a symptom checklist like the Gurin items, the Cornell Medical Index, or the Langner scale, and others asked for self-ratings of happiness. These measures differ considerably, especially in the severity of the mental disorder they evaluate, and variation in results could depend on differences in diagnosis or instrument used. 53

54

WILLIAM W. EATON and JEAN-CLAUDE LASRY

Table l. Review of studies presenting data on social mobility and mental disorder

Author and reference Hollingshead et al. [14] LaPouse [15] Lystad [16] Hollingshead and Redlich [17] Clausen and Kohn [18] Goldberg and Morrisson [19] Turner and Wagenfeld [20] Hare et al. [21] Langner and Michael [22] Birtchnell [23] Dalgard [24] Parker and Kleiner [25] Birtchnell [23] Jackson [26] Jackson and Burke [27] Abramson [28] Parker and Kleiner [25] Kasl and Cobb [29] Robins [30] Birtchnell [23] Hollingshead et al. [14] Langner and Michael [22] Birtchnell [23] Hare et al. [21] Ellis [3 l]

Date

N

Diagnosis or instrument

1954 1956 1957 1958 1959 1963

25 Schizophrenia 114 Schizophrenia 94 Schizophrenia 847 Schizophrenia 124 Schizophrenia 509 Schizophrenia 94 Schizophrenia 1967 198 Schizophrenia 1972 119 Schizophrenia 1963 138 Psychotic type 1971 370 Non-depress. psy. 1971 325 Psychosis 1966 1 2 4 0 Patients* 1971 775 Depression 1962 609 Gurin 1965 1668 Gurin 1966 970 C.M.I.t 1966 1349 C.M.I. t 1971 324 Gurin 1966 624 Anti-social 1971 369 Pers. disorder 1954 25 Neurosis 1963 706 Neurotic type 197l 361 Non-depress. neur. 1972 111 Neurosis 1952 60 Happiness

Type of mobility

Status control

Supportive evidence

Intra Intra Intra Intra Intra Inter Intra Inter Inter Inter Inter Inter Inter Inter Intra~c Intra$ Intra$ Inter Intra~ lntra Inter Inter Inter Inter Inter Intra

yes yes

yes yes yes

yes

yes

Finding ~$ 0 $ 0 0

yes yes yes yes yes yes yes

1; 0

yes yes yes

?; 1;

yes yes yes

yes yes

yes yes

yes yes

1 1 0 0 T

* Patients--Ambulatory and hospitalized t C.M.I.--Cornell Medical Index $ lntra--Status inconsistency

included here as supportive evidence intensive longitudinal study over a period of years. The last column in Table 1 indicates the research finding. An upward arrow "1" means that there was as association of upward mobility with mental disorder. A downward arrow "~" indicates that mental disorder was connected to downward mobility. A "0" indicates no association of mental disorder and mobility in either direction. It seems clear from Table 1 that the association of mobility and mental disorder depends on the disorder studied. For severe disorders such as the psychoses, and especially schizophrenia, the disorder is connected to downward mobility. Seven out of eleven relevant studies observed this result [16, 19-23]. The only marked exception is the study of Dalgard [24], who found that upward and downward mobility were linked to disorder. It is worthy of note that he included all psychotics in sample, whereas most other studies focussed on schizophrenics only. The presence of affective psychoses in his sample may have influenced the result. Hollingshead et al. [14], with a very small sample, found that schizophrenics from one class level were more likely than normals to be upwardly mobile. In the other class level they studied, schizophrenics were downwardly mobile. In three other studies, disorder was not linked to mobility in either direction [15, 17, 18]. In one of these studies [19] the downward mobility was shown to follow the onset of schizophrenia. These results are consonant with the so-called "drift" and "selection" hypothesis,

namely that "pre-existing psychological disorder leads to low social status" [11]. For the milder disorders the results are more ambiguous. Here it is doubly important to examine the methodologic qualities of the studies carefully. Several studies include mixtures of mild and severe disorders. Two studies clearly include psychotics and milder disorders in their populations (Parker and Kleiner's patient group, [25]; and Birtchnell's depressive patients, [-23]). In both cases the disorder was linked to downward mobility, Five other studies used a selfreport symptom scale: either the Gurin items or the Cornell Medical Index. These techniques are used to indicate overall psychopathology, and it is quite possible that the group with high symptomatology could include psychotics. At any rate, the findings are ambiguous: Jackson's early study [26] yields no relationship of mobility with disorder, and Parker and Kleiner's high symptom group is downwardly mobile [25]; the other three studies show a relationship of disorder with upward and downward mobility [27-29]. Curiously, these three latter studies are all of status incongruence; it may be that the statistical technique accompanying this approach tends to draw out the dual finding artifactually [32]. There are two studies of personality disorder, by Birtchnell [23] and Robins (who focussed on the subtype of anti-social personality [30]) indicating a relationship of the disorder with downward mobility. The lack of other studies on personality disorder is disap-

Health and mobility in a group of immigrants pointing, in view of its strong relationship to social class status [11]. There are five studies on the milder end of the spectrum of mental disorder; four of neurosis and one of self-ratings of happiness. Three of these show upward mobility to be related to the disorder, and two show no relationship. Although two of these studies with positive findings are strong methodologically, they have very small sample sizes [14, 31,]. Other studies with larger samples are weaker in terms of method, and all have at "least one major flaw [21-23]. At this point, a tentative conclusion might be that upward mobility is associated with mild psychiatric symptoms. In the light of this evidence, we decided to study the association of occupational mobility and mental disorder in a population of Jewish immigrants from North Africa to Montreal. Our tentative hypothesis was that upward mobility would be associated with mild psychiatric symptoms.* In addition to studying the association itself, we wanted to be able to specify the direction of causation, if possible. While it seems clear that severe disorders may lead to downward mobility, it is unclear whether propensity for neurosis precedes mobility or whether the stresses associated with upward mobility cause an increase in symptoms.

METHODOLOGY

Procedure The data were collected by a sample survey. A master list of 2300 North African immigrant families was constructed from lists of a community association, a socio-recreational agency, the records of an immigrant agency, and the telephone directory. This master list represents virtually all the Jewish North African immigrants to Quebec. F r o m the list, 199 married couples and 82 single persons (a total of 480) were randomly sampled, stratifying for year of immigration. This paper concerns the 166 adult males who reported having an occupation in North Africa and a job in Montreal at the time of the interview. Since it has been shown that the racial or ethnic match of the interviewers and interviewees influences answers, interviewers were all North African immi* There have been few attempts to reify the concept of mobility or its potential effects on mental health. For instance, one might suspect that upward mobility has different effects than downward mobility. Upward mobility involves acquiring new, demanding roles that may be beyond the individual's capacities. Symptoms of anxiety could be the likely result. Downward mobility involves loss of roles and is degrading, which could suggest depression as a result. Our data were not adequate to address these questions, but they are, nevertheless, important. t In a recent review of the literature on the methodology involved in studies of social mobility, Hope [53] has reinterpreted some of the criticisms by Blalock, Bereiter, Bohrnstedt, and others. He shows that adequate status control is not impossible, as they imply. Implicit in his argument is the idea that one status control may actually be partially effective, and is substantially better than none. We have analyzed our results following his method (constructing one vertical status index based on occupation in North Africa, education, and present occupation) and results are very similar.

55

grants themselves [33]. The survey procedure and sample have been described previously [34, 35]. Since the sample was stratified for year of immigration, the immigrants had resided in Montreal for varied lengths of time. The earliest arrivals had been in Montreal 15 years at the time of the interview, while the later ones had been resident for only two years. Seventy per cent were in Montreal for 4 or more years at the time of the survey.

Measures The concept of occupational mobility seems to be simple enough, and its operationalization straightforward. It denotes a change in status, and if the statuses can be ordered along an interval-scale continuum, the operationalization involves the differences between scores at two points in time. However, several methodologists have shown [ 3 6 3 8 ] that it usually makes little sense to correlate variables with a difference score--in this case a mobility s c o r ~ w i t h o u t controlling statistically for the two components of the score. Otherwise, one may falsely ascribe to the mobility score a causal affect resulting only from an association with one component and the artifactual regression to the mean. Paradoxically, however, such control is difficult because of the problem of multicollinearity.] Our solution to this problem is accomplished in two ways. First, we create a difference score based on the occupational prestige rating of the individual's job in North Africa and his present job in Montreal. When we correlate this score with the individual's mental health, we control for present job status and educational attainment. By controlling for education we equalize to some extent, the starting point of the occupational career and avoid the problem of multicollinearity. However, this method is not perfect because of the chance that association with early job (independent of educational level) and regression to the mean have inflated the correlation, leading us to attribute casuality to the wrong concept. Secondly, we attempt to strengthen our findings with supportive evidence that demonstrates that the measure of the concept we are using behaves as the concept should. The occupations of the respondents were coded into 71 categories, then assigned the prestige scores of Blishen [39]. Hodge and his colleagues have shown that occupational prestige ratings correlate very highly between many nations [40]. The difference between the score for present job and score for job in North Africa is our measure of occupational mobility. Positive scores indicate upward mobility, and negative scores indicate downward mobility. Consistent with the 18 studies reviewed in Table 1, a horizontal move within the same occupational rank is defined as no change or absence of mobility. As our measure of mental health we used the 22-item scale of Langner [41]. The scale deals with a variety of symptoms connected with neurosis and psychophysiologic disorder. Recent criticism of the Langner scale has underscored the need for caution in interpreting results based on it [42, 43] but it has been used with some success in many studies. Differences between normal and psychiatric patient groups

56

WILLIAM W. EATON and JEAN-CLAUDE LASRY

Table 2. Mental health, work satisfaction and occupational mobility, with status controls OCCUPATIONAL MOBILITY WITH Mental health Work score satisfaction N = 166 N = 166 Simple correlations First order correlations

0.02

0.13"

controlling for: Present job Job in North Africa Education Second order correlations

0.20t -0.09 0.08

-0.03 0.22t - 0.l 1

0.12

-0.01

controlling for: Present job and education *P<0.05;tP

<0.01

are measured reliably, and it has the advantage of being well-known and widely used [44-47]. A measure of satisfaction with work is included in this study because the mobility score itself is calculated from prestige scores of occupations. Several questions concerning appraisal of job conditions were summed to form an overall index of work satisfaction.* RESULTS Immigration is a fairly severe disruptor of the status attainment process. As we have shown previously, the overall pattern of mobility for this group is a significant decline just after immigration followed * A review of literature on work satisfaction is given in Strauss [54]. The questions and item-to-total correlations are as follows: Are you satisfied or dissatisfied with your present occupation? Would you say very satisfied, satisfied, so-so, dissatisfied, or very dissatisfied'? (r = 0.81); Are you satisfied or dissatisfied with your salary'? (r = 0.70); Are you satisfied or dissatisfied with your general working conditions'? (r = 0.76); Comparing your present job with the one you had before coming to Canada, would you say your present gives you more satisfaction, the same, or less'? (r = 0.66); Do you ever find at work that the day never seems to end? Would you say never, sometimes, often or always? {r = 0.56). t Where Y = (X1 - X2), the correlation of Y with XI would always be positive and the correlation of Y with X2 would always be negative.

by a gradual rise [48]. W h e n jobs are categorized into ten b r o a d categories, only about 345o of our subjects start with an initial j o b in Quebec similar to the one they had in N o r t h Africa. At the time of the survey, again only a b o u t 30~0 are in the same b r o a d category of occupation as in N o r t h Africa, but the average prestige score had then risen to about the pre-immigration level. The mean of our index of mobility from job in N o r t h Africa to present j o b was - 2 . 6 Blishen units. Occupation in Morocco and education were good predictors of occupational attainment here [48]. However, there is considerable variance in mobility; the variance of our mobility score was 94.9, with range from - 3 7 . 1 to 25.2. Thus, some immigrants were extremely upwardly mobile while others were very downwardly mobile. The disruption caused by immigration followed by large variance in occupational attainment introduces a substantial source of mobility which is missed in studies of non-migrated populations. Thus, we suspect that the consequences of mobility will be larger and more discernible than in the general population. Present j o b prestige is positively correlated with upward mobility (r = 0.54, P < 0.05) and job in Morocco negatively correlated with mobility (r = - 0 . 3 3 , P < 0.05).t Family income is positively associated with mobility, as one might suspect ( r = 0.25, P < 0.05). The gradual rise in occupational attainment following immigration (noted above) is partly a function of time, since the correlation of mobility with length of stay is mildly positive (r = 0.18, P < 0.05). Table 2 presents the correlation of occupational mobility and mental health with the appropriate controls. There is a zero correlation of mobility with the mental health score. But when present job is controlled, a fair correlation appears (r = 0.20, P < 0.01). This correlation could be interpreted as an effect of upward mobility, but also as an effect of prior job, since it is not controlled. Without further controls, it is impossible to choose between the two interpretations. The small correlation of mobility with mental health, controlling for job in N o r t h Africa, probably results from the strong influence of present j o b on mental health: no matter which j o b level the individual was at in N o r t h Africa, the lower his present status, the worse his mental health score. The appropriate controls are for present job score and educa-

Table 3. Mental health, work satisfaction, and occupational mobility with status controls and job duration subsamples Controlling for present job and education, partial correlation of OCCUPATIONAL MOBILITY WITH Mental health score Work satisfaction

Job duration: Entire sample N = 166 Less than 2 years N = 45 Less than 1 year N=21

partial r 0.12

P < 0.66

partial r -0.01

P < 0.46

0.30

0.02

- 0.23

0.06

0.55

0.01

- 0.42

0.02

Health and mobility in a group of immigrants tion, which gives a correlation of upward mobility with psychiatric symptoms of 0.12 (in the predicted direction but not statistically significant). Work satisfaction is included in our analysis as part of our attempt to interpret and generalize our predicted correlations of mobility and mental health. As one might expect, work satisfaction is correlated with good mental health (r = 0.48, P < 0.001). Table 2 shows a small positive correlation of work satisfaction and upward mobility (r = 0.13, P < 0.05). However, with appropriate controls, this correlation drops to almost zero. There is some evidence, then (Tables 1 and 2) that upward mobility is mildly associated with psychological disorder• However, the direction of causation is not clear: does upward mobility cause psychological disorder or are disordered persons more likely to be upwardly mobile? In research on a similar problem, Hinkle et al. [491 study the recency of mobility. If mobility causes psychological disorder, then the correlations should be stronger for those who have shifted jobs (and moved upward) more recently. If psychological disorder causes mobility, then the associations should not depend on recency of upward job shifts. In Table 3 the sample is split into three subgroups by the length of time since acquiring the present job. The first row does not take into account job duration. It presents partial correlations of mobility with the mental health score and the index of work satisfaction, controlling for education and present job, for the entire sample. The second row contains the same correlations for a subsample of 45 men who had held their present job less than two years. The bottom row presents the same correlations for the smaller subsample of 21 men who held their present job for less than one year. The Langner score is mildly related to mobility in the total sample (r = 0.12), somewhat more strongly associated with mobility in the twoyear subsample (r = 0.30, P < 0.05), and strongly correlated in the subsample who had acquired their present job within the last year (r = 0.55, P < 0.01). Thus, upward mobility is causally related to psychiatric symptomatology.* It is important to note that the index of work satisfaction behaves as it should under this hypothesis. Recent upward mobility is associated with dissatisfaction in the job. For the upwardly mobile person, the new job taxes his ability to a degree to which he is not accustomed, causing stress. The result is dissatisfaction with working conditions and more psychiatric symptoms. The results in Table 3 do not agree with those presented by Hinkle et al. [49] in their study of mobility and heart disease. They found no increment in heart disease due to upward mobility, even when they broke out subsamples by recency of promotion. The difference may be due to the different symptoms studied. Further, their sample was not restricted to immigrants, for whom mobility may be a more potent influence. A most important difference, though, is that * We constructed a similar table with a mobility score built from present job and initial job in Quebec (instead of job in North Africa). The same pattern of results was obtained, although not quite as strong.

57

their categories of recency of promotion were broader than o u r s ~ h e i r "most recent" group could have been promoted as far back as five years, whereas our results suggest that the adaptation to a new job is most stressful during the first year. Both this research and that of Hinkle et al. suggest that the stressful period does not last more than five years. The addition of our research to the studies summarized in Table 1 strengthens the conclusions somewhat. Our study has a sufficient sample size, controls adequately for status, and presents a relatively broad pattern of supportive evidence. The general conclusion is that schizophrenia (and perhaps other severe mental disorders) tend to be followed by downward mobility; neurosis tends to be preceded by upward mobility.

These results indicate that changes in working conditions are important as mediators of the relationship between occupational mobility and mental health. It is clear that studies of mental health in the occupational setting [50-52] are relevant to the study of mobility and mental health, and closer integration of the two areas should be fruitful.

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