STATUS AND THE PSYCHE: HOW MENTAL HEALTH PARADOXES CHALLENGE THEORIES OF INEQUALITY

Abstract

Social scientists have documented a set of unexpected sociodemographic patterns they call health paradoxes or epidemiological paradoxes. Like all paradoxes, such findings compel scholars to reconsider their assumptions about the social world—findings are only “paradoxical” when viewed from a certain perspective. This dissertation centers on mental health paradoxes, cases in which persons deemed low-status (less educated individuals, racial minorities, immigrants) report better mental health despite greater marginalization. I examine three paradoxes: (1) elevated rates of self-injurious thoughts and behaviors (SITB) in socioeconomically advantaged college students, (2) greater risk of psychiatric disorders in White vs. Black Americans (the Black-White mental health paradox), and (3) higher rates of mental health problems among the native-born (the healthy immigrant paradox). For each paradox, I test a range of potential mechanisms including social support, stressors, and identity measures. I leverage data from two national studies: the Healthy Minds Study (HMS) of college and university students (2009–2019) and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC–III, 2012–2013). Findings challenge the distributive paradigm inherent in dominant approaches such as the stress process model and fundamental cause theory, both of which are limited by a similar focus on material and psychosocial “resources.” Taken together, my results highlight the resilience of groups deemed low-status and suggest that structural and cultural arrangements imposed by high-status groups (including an individualist focus on success and self-advancement) may harm well-being.