Psychosocial determinants of health in social epidemiology

The current issue of the International Journal of Epidemiology (IJE) has several papers with a psychosocial theme. As its popularity has increased over the past decade, the use of the term ‘psychosocial’ has been very varied within health research including social epidemiology. A quick glance at Medline shows that it has been used in connection with at least the following: causes and risk factors (‘psychosocial causation’, ‘psychosocial influences’, ‘psychosocial risk factors’), mediating factors and contexts (‘psychosocial mechanisms’, ‘psychosocial environment’, ‘psychosocial context’, ‘psychosocial resources’, ‘psychosocial support’), and outcomes (‘psychosocial (di)stress’, ‘psychosocial well-being’ and ‘psychosocial health’). The ideas underlying many of the articles in this themed issue of IJE reflect this broader and more general use of the term ‘psychosocial’. The articles derive from diverse sociological, psychological and social epidemiological paradigms, and they do not share common roots, nor do they arrive at common theoretical frameworks or a set of common testable research questions. Rather, ‘psychosocial’ is used as an umbrella term under which diverse research inquiries are carried out, without any specific consideration for how ‘psychosocial’ might further our understanding of the pathways leading to ill-health. In part the definition of ‘psychosocial’ and the collection of articles in this issue reflect choices made by the IJE’s editors, and it is possible that some of the articles’ authors are surprised to find that their work has been branded as using a psychosocial approach to epidemiology. In particular, one or two papers in the collection do not even refer to or use the term ‘psychosocial’. Unspecified use of ‘psychosocial’—something of which we are equally guilty—is likely to degrade the usefulness of the term. It refers to everything and nothing in particular. As none of the articles in this issue, or the literature on psychosocial effects more generally, elaborate the meaning of psychosocial, we have taken this task as the main focus of this editorial. Although we do not feel particularly qualified to undertake this task, a brief examination of the term may be helpful in disentangling some of the possible social and psychological pathways underlying health and illness.