Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

• Type of Material: Article
• Authors: Jithin Sam Varghese, Emory University; Rachel Waford Hall, Emory University; Ann DiGirolamo, Emory University; Reynaldo Martorell, Emory University; Manuel Ramirez-Zea, Institute of Nutrition of Central America and Panama (INCAP); Aryeh Stein, Emory University
• Language: English
• Date: 2021-07-22
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ssmph.2021.100880
• Title of Journal or Parent Work: SSM-POPULATION HEALTH
• Volume: 15
• Start Page: 100880
• End Page: 100880
• Keywords: Psychosocial framework; MacArthur ladder; COHORT; INCOME; Relative deprivation; SENSITIVITY; Perceived social status; DISORDERS; SYMPTOMS; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; Science & Technology; DEPRIVATION; AFRICAN-AMERICANS; Happiness; SELF-RATED HEALTH; HAPPINESS; Psychological distress; Subjective status; ASSOCIATIONS
• Research Categories: Health Sciences, Nutrition

Abstract

Objective: We study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes. Methods: We use data from participants of the INCAP Longitudinal Study 1969–2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m2), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS). Results: Median participant rating was 5 [IQR: 3–8] for the perceived community respect and 3 [IQR: 1–5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (−0.28, 95 % CI: −0.47, −0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator. Conclusions: Subjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways.