Psychosomatic Medicine 18:449-456 (1956)
© 1956 American Psychosomatic Society

Social Class Prevalence and Distribution of Psychosomatic Conditions in an Urban Population

(Special Article)

¹ Cornell University Medical College
² Department of Psychiatry, Cornell University Medical College

By way of summary, the present paper reports partial results of an epidemiological investigation of eleven somatic disorders in terms of their lifetime prevalence among a large sample of adults in the age range of 20-59. This investigation is one phase of a larger epidemiological study of mental health in a central residential area of New York City.

One focus of this paper was on the relationships of these somatic ailments, taken separately and collectively, to one of the primary forms of social differentiation in the American community, namely, socioeconomic status. It was found that:

Ten of the somatic disorders covered in the study manifest four different and clearly delineated patterns of distribution on the status scale.

With the number of such disorders a person has had as a criterion, the rates of multiple ailments do not vary with socioeconomic status, except for the groups at the two extremes of the scale, where the rates are higher. Thus, the status distribution of multiple ailments takes the form of a shallow U-shaped curve.

If two or more somatic disorders in a person raises the probability that at least one of the disorders has a psychogenic basis, then the lifetime prevalence of psychosomatic ailments is at a high level of frequency in our population.

The second focus of this paper was on the psychological dimension of tension-anxiety as measured by a questionnaire method appropriate to mass interviewing. With this focus it was found that:

While all other psychological dimensions covered in our questionnaire are highly correlated with socioeconomic status, tension-anxiety is not so related. It therefore appears to be a generalized phenomenon in the study population, and also a frequent phenomenon.

Tension-anxiety is correlated with nine of the eleven somatic disorders covered. It is not correlated with asthma and hypertension.

Tension-anxiety is highly correlated with multiple somatic ailments, especially in the very top and bottom status groups.

From the social-status focus and the tension-anxiety focus in combination we have in no small measure found confirmation that in most of the large series of somatic conditions covered, both sociological and psychological variables are vitally involved.

As to the specific hypotheses tested here, to some the data gave full support, to some the data lent only the partial support that compels modification, and to others the data offered no support whatever.

But even for the hypotheses that did not suffer rejection, the findings pose many questions that are as yet unanswered. It is hoped that our continuing analysis of still unmined data will generate answers, or at least new hypotheses that will point the directions in which possible answers may be found.

We would close with the observation that when an epidemiological investigation has completed its work and rendered its final report, any discoveries of differential distribution patterns of a disease serve to narrow the search for specific etiological conditions that underlie and account for such differences. The paths of such simultaneous search are two. First, further epidemiological investigation that takes off from but pushes out with better methods toward farther frontiers than its predecessor. Second, clinical research that seeks to disentangle the dynamic processes that lie between the discovered social covariables and the disease end product.

Our incomplete findings to date give us grounds for the hope of advancing such developments on the crucial scientific fronts of the psychosomatic and mental disorders.

This article has been cited by other articles:

				D. Schubert and S. I. Miller Social Class and Psychiatric Diagnosis: Differential Findings in a Lower-Class Sample International Journal of Social Psychiatry, June 1, 1978; 24(2): 117 - 124. [PDF]