By Nancy E. Adler, M.D., Elissa S. Espel, Ph.D., University of California, San Francisco;
Grace Castellazzo, B.S.N., and Jeannette R. Ickovics, Ph.D.

The American Psychological Association has announced research showing that the perception of stress can affect a white woman's overall health as much as already known stressors like poverty. "It is not simply the effects of income or education that are linked to better health, but also the perception that one is higher on the social hierarchy," said lead author Nancy Adler, M.D., and University of California at San Francisco professor of psychiatry.

Researchers found that women who placed themselves higher on the social ladder reported better physical health, took less time to fall asleep at night, had lower resting physiological arousal and less abdominal fat, a key indicator for stress adaptation, said Dr. Adler. Perceptions of lower social standing were also associated with likelihood of greater chronic stress, pessimism and lower perceived control of life.

The researchers studied a sample of nearly 160 healthy white women age 30-46. In addition to reporting on their income and education, the women completed a new measure of subjective status. They were shown a drawing of a ladder with ten rungs and told to think of the ladder as representing where people stand in society. At the top of the ladder are people who are best off - those who have the most money, education, and best jobs. At the bottom are people who are the worst off - who have the least money, least education and worst jobs. Participants were then asked to place an "X" on the rung which best represented where they think they stood on the ladder.

The women, who had varying socio-economic backgrounds, were evaluated for psychological indicators, including negative affectivity (how much they generally tend to feel negative emotions), pessimism, perceived control over life, coping style, self-defined stress levels, and chronic stress levels. Participants were also evaluated for sleep patterns, resting physiological response, and fat distribution. A sub-sample of 59 women took part in a laboratory stress study that examined their cortisol response to stress over a three day period. Cortisol is a stress hormone that may play a role in the accumulation of abdominal fat, explained Dr. Adler.

Fat deposit, in turn, is linked to metabolic and cardiovascular disease. "With repeated experiences of the stress, the body has greater exposure to cortisol. Abdominal fat has a relatively greater sensitivity to cortisol than peripheral fat, so individuals with higher cortisol reactivity, high resting levels of cortisol and /or great exposure to events that evoke stress response accumulate greater abdominal fat," said Dr. Adler. Researchers analyzed the accumulation of body fat by measuring body mass index (BMI) and waist-to-hip ratios.

"These findings suggest that women who perceive themselves to be lower on the SES ladder, regardless of their actual placement, had more stress than their SES peers who did not have low perceptions of their SES status," said Dr. Adler. In order to make this determination, the authors controlled for the effects of objective SES in their statistical analysis before looking at the additional effect of subjective status. Therefore, their finding that subjective SES status is linked to physical and mental health outcomes is shown to be occurring above and beyond the direct impact of socioeconomic status.

Low subjective SES may either increase stress directly or make women more vulnerable to the affects of stress," said Dr. Adler. Lower ladder rankings are linked to increased stress even when researchers controlled for an objective evaluation of SES (education, occupation, income) and how much participants say they tend to feel negative emotions, explained Adler.

This research serves as a human analog to studies of social ordering and health among , plained Dr. Adler. Subordinate primates have higher cortisol, higher blood pressure, and worse health than dominant animals in stable social environments, according to previous research. "The ladder rankings may reflect direct social comparisons of social rank that are more similar to dominance hierarchies than are traditional measures of SES (education, occupation, income)," she said.

"Relationship of Subjective and Objective Social Status With Psychological and Physiological Functioning: Preliminary Data in Healthy White Women," Nancy E. Adler, M.D., Elissa S. Espel, Ph.D., University of California, San Francisco; Grace Castellazzo, B.S.N., and Jeannette R. Ickovics, Ph.D., Yale University; Health Psychology, Vol. 19, No. 6


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