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.

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.

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.
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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