Programs of Research
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PROGRAMS OF RESEARCH
Mental Health and Psychological Anthropology
Although stress and distress have been important topics in biological and
medical anthropology, respectively, mental health itself has not received
sufficient attention in either anthropology or public health. This issue
has assumed international importance with the emergence of marked
increases in psychiatric and behavioral problems, in tandem with
exponentially increasing numbers of refugees worldwide (see figure below;
data from World Mental Health, Desjarlais et al 1996) and escalating disruption of social structures such as family and local communities. Moreover, mental health and behavior problems are closely related to health problems of both an infectious and chronic nature. Therefore, unravelling the bases of mental and physical health risk, and extension of such research to developing effective treatment and, especially, preventive measures demands a combination of both biological and psychosocial approaches. We are compelled by these challenges and will devote increasing energy to them.
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Mental healh and psychiatric disorder have increasingly become foci of a
series of collaborative studies with Developmental Epidemiology in Psychiatry
at Duke. These studies have provided access to opportunities rare for an
anthropologist, as they represent large, truly population-based samples
(described in the above section on human development) that, while they oversample
for psychiatric risk, nonetheless contain a large majority of young people
without disorder. Thus, while such studies aim to uncover pathways to psychopathology,
they also reveal much about pathways of normal development. With major support
from the W.T. Grant Foundation, we have included biological measures of
pubertal transition and, latterly, of cortisol reactivity in the main GSMS
and added Cherokee study involving prevalence of disorder and the contextual
mediators and moderators of psychiatric risk. This work also represents
an unparalleled integration of measures of biological with those of psychiatric
well-being.
| A central finding, replicated across
multiple waves of data, identifies emergence of sex difference in
rates of depression during puberty as arising from developmental shifts
in both sexes. Our observation that the powerful prepubertal relationship
between negative circumstances and depressive symptoms strengthens
greatly in girls and disappears in boys in the mid-to-later stages
of puberty provides a possible explanation why depression is nearly
twice that in females than males by age 15 years. Nonetheless, this
observation raises the further question of why these changes occur.
Logically, they may arise from differential impact of experience (hypersensitivity
in girls, "androgen anaesthesia" in boys), or through canalization
of distress toward divergent psychobehavioral manifestations. Exhaustive
scrutiny of our symptom data did not support the latter possibility,
so we considered the former by adapting a reactivity model from our
existing blood spot collection protocol. Pilot analyses of a subsample
revealed that cortisol reactivity predicted conduct and anxiety disorder
one to two years into the future, in a context-specific manner. |
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These exciting findings are also congruent with a large and growing body of literature
on reactivity, and will be pursued in a proposal to analyze all GSMS and
Cherokee samples for cortisol. Meanwhile, the reactivity paradigm seems
to point toward issues of key anthropological interest concerning the regulation
of attentional systems and the role of context and experience in the socialization
of arousal systems. These theoretical concerns have been developed in three
papers. The North Carolina samples (GSMS, Cherokee, CCC) offer, moreover,
a tremendous opportunity to explore these issues across ethnic communities.
Additionally, the work on long-term effects of early abuse and neglect,
with Cathy Spatz Widom, will allow us to consider the possible organizational
effects of traumatic experience on later affect regulation in relation to
vulnerability to further trauma. Lastly, we hope to use cultural consensus
modelling as a way to explore individual variation in working cultural logic
and the role of that variation (e.g., status incongruity) in psychiatric
risk, although we have not as yet been successful at obtaining funding specifically
for this.
| Relevant Publications |
| submitted |
A. Angold, C.M. Worthman, and E.J. Costello, "Depression as diagnosis and scale score: capturing the development of the gender difference." Arch Gen Psychiat. |
| in press |
C.M. Worthman, "Emotion: you can feel the difference." In: Beyond 'Nature or Nurture': Biocultural Approaches to the Emotions, A.L. Hinton, ed. Cambridge University Press.
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| 1998 |
A. Angold, E.J. Costello, and C.M. Worthman, "Puberty and depression: the roles of age, pubertal status, and pubertal timing." Psychological Medicine 28:51-61. |
| 1997 |
J.F. Stallings, C.M. Worthman, D. Olson, and R. Barrett, "Blood spot cortisol and dehydroepiandrosterone-sulfate levels in Alzheimer's disease: association among hormone levels, agitation, and cognitive function." American Journal of Human Biology 9(1):144. |
| 1996 |
E.J. Costello, A. Angold, B.J. Burns, D.K. Stangl, D.L. Tweed, A. Erkanli, & C.M. Worthman, "The Great Smoky Mountains Study of Youth: Goals, design, methods, and the prevalence of DSMIII-R disorders." Archives of General Psychiatry 53:1129-1136. |
| 1995 |
A. Angold, E.J. Costello, & C.M. Worthman, "Sex-differentiated effects of puberty on the relationship between adversity and symptoms of depression: a report from the Great Smoky Mountains Study." American Journal of Physical Anthropology Suppl. 20:58. |
| 1993 |
A. Angold and C.M. Worthman, "Puberty onset of gender differences in rates of depression: a developmental, epidemiologic and neuroendocrine perspective." Journal of Affective Disorders 29:145-58. |
| 1992 |
C.M. Worthman, "Cupid and Psyche: Investigative syncretism in biological and psychosocial anthropology." In: The Social Life of Psyche: Debates and Directions in Psychological Anthropology, T. Schwarz, G.M. White, & K.A. Lutz, eds. , pp. 150-178. Cambridge: Cambridge University Press (Psychological Anthropology Series).
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