The Epidemiology of Social Stress

We examine the social distribution of exposure to stress to test the hypothesis that differences in stress exposure are one factor in sociodemographic variations in mental health. We make a more comprehensive effort to estimate stress exposure than has been typical, and present data that challenge the prevailing view that differences in exposure to stress are of only minimal significance for understanding variations in mental health. We report several findings, principal among which are: Differences in exposure to stress account for substantially more variability in depressive symptoms and major depressive disorder than previous reports have suggested; the distributions of stress exposure across sex, age, marital status, and occupational status precisely correspond to the distributions of depressive symptoms and major depressive disorder across the same factors; and differences in exposure to stress alone account for between 23 and 50 percent of observed differences in mental health by sex, marital status, and occupation. These findings contrast with the prevailing view that differences in vulnerability to stress across social statuses account for social status variations in mental health.