Doctoral student Emily Mendenhall (Northwestern University), supervised by Dr. Rebecca Seligman, will undertake research on the relationship between the folk models for disease causality and control, and psychological and physiological health outcomes. This research contributes to broader understandings of mind-body interactions by investigating the relationship of traumatic experiences both to mental and physical health outcomes, and their overlap.
The research will focus on diabetes and will be conducted among low-income Mexican and Mexican-American women living in Chicago. The research builds upon a small body of research that demonstrates that Mexicans and Mexican-Americans often implicate stress and emotional distress in diabetes causality. The researcher will investigate the possibility that the significance of disease narratives about stressful and often traumatic experiences may reveal more than simply "folk models" and/or non-biomedical beliefs. The researcher will gather data through diabetes lifestyle questionnaires, anthropometric measures, biomarkers, psychiatric inventories, and in-depth qualitative interviews to (1) determine how individuals communicate psychological and social suffering in health narratives; (2) investigate the relationship between trauma exposure and mental health among women living with diabetes; and (3) examine the relationships among psychological and social suffering reported in diabetes narratives, psychological distress, and diabetes outcomes. By developing a more nuanced understanding of the ways in which individuals use diabetes as an idiom of distress, the researcher will measure how suffering revealed in diabetes narratives may be inscribed in both mind and body.
The research is important because it will contribute to social scientific theory about the connections between mind, culture, and biology. It also has application to understanding differences between individuals with good and poor diabetes outcomes, and may suggest new directions for intervention. Finally, supporting this research supports the education of a social scientist.
This mixed-methods study combined 121 life history narrative interviews with psychiatric inventories, surveys of psychosocial stress and diabetes management, finger stick blood samples, and anthropometrics. Seven major life stressors were identified from the narrative interviews: interpersonal abuse, stress related to health, family, neighborhood violence, immigration status, and work, and feeling socially isolated. Unusually high rates of interpersonal abuse (65%), likely depression (49%), severe depression (34%), and poor diabetes control (HbA1c>7.5; 77%) were found in this study. Results indicate that interpersonal abuse was a major stressor in women’s lives, and together with structural violence, poverty, and immigration stress contributes to the development of and complications with co-morbid diabetes and depression. Experiences of abuse were interconnected with political and social contexts that perpetuate women’s vulnerability to violence through the breakdown of social protection and social networks. In many cases, narratives of chronic adversity and severe stress were internalized for many years, revealing themselves years later in chronic depression and traumatic memory and interacting with diabetes self-care. This project developed a theory of syndemics to explain the intersections of psychological and social suffering with diabetes and depression among low-income first and second generation Mexican immigrant women in Chicago. Moving beyond concepts of "epidemic" and "comorbidity," a syndemics framework describes situations in which adverse social conditions, such as poverty and oppressive social relationships, stress a population, weaken its natural defenses, and expose it to a cluster of diseases. The VIDDA Syndemic was coined to unpack the cumulative negative affect of interactions among these various factors on the study population. The first dimension of The VIDDA Syndemic is Violence – encompassing structural, symbolic, and everyday forms. The second dimension is Immigration-related stress and associated feelings of social isolation as a result of being detached from social networks. The third aspect is Depression, which in many cases has been prolonged and internalized for decades, and for which very few poor women in the United States receive treatment. Type 2 Diabetes is the fourth dimension, as all women were diagnosed with the disease. The final dimension addresses verbal, emotional, physical, and sexual Abuse reported by two-thirds of the women in this study; more than half reported physical abuse and one-fourth reported sexual abuse. Through discussion of these five distinct and interactive dimensions of The VIDDA Syndemic this project demonstrates how women’s narratives of suffering cannot be dissociated from the political-economic and social inequalities that shape them, or the impact that such chronic adversity has on escalating rates of depression and diabetes. Thus, these synergies of distress are major factors that diminish the health and social well-being of the women in this study, and possibly marginalized and impoverished women in the Americas more broadly. Publications: Mendenhall, Emily. "Silenced Stories: A Syndemic of Depression and Diabetes." Los Angeles: Left Coast Press, in press. *Title under discussion. Mendenhall, Emily, and Elizabeth A. Jacobs. "Subjective Stress and Depression among First and Second Generation Mexican Immigrant Women with Type 2 Diabetes in Chicago." Culture, Medicine, and Psychiatry, Revise and Resubmit. Last Modified: 09/21/2011 Submitted by: Emily A Mendenhall Project Outcomes Report This mixed-methods study combined 121 life history narrative interviews with psychiatric inventories, surveys of psychosocial stress and diabetes management, finger stick blood samples, and anthropometrics. Seven major life stressors were identified from the narrative interviews: interpersonal abuse, stress related to health, family, neighborhood violence, immigration status, and work, and feeling socially isolated. Unusually high rates of interpersonal abuse (65%), likely depression (49%), severe depression (34%), and poor diabetes control (HbA1c>7.5; 77%) were found in this study. Results indicate that interpersonal abuse was a major stressor in women’s lives, and together with structural violence, poverty, and immigration stress contributes to the development of and complications with co-morbid diabetes and depression. Experiences of abuse were interconnected with political and social contexts that perpetuate women’s vulnerability to violence through the breakdown of social protection and social networks. In many cases, narratives of chronic adversity and severe stress were internalized for many years, revealing themselves years later in chronic depression and traumatic memory and interacting with diabetes self-care. This project developed a theory of syndemics to explain the intersections of psychological and social suffering with diabetes and depression among low-income first and second generation Mexican immigrant women in Chicago. Moving beyond concepts of "epidemic" and "comorbidity," a syndemics framework describes situations in which adverse social conditions, such as poverty and oppressive social relationships, stress a population, weaken its natural defenses, and expose it to a cluster of diseases. The VIDDA Syndemic was coined to unpack the cumulative negative affect of interactions among these various factors on the study population. The first dimension of The VIDDA Syndemic is Violence – encompassing structural, symbolic, and everyday forms. The second dimension is Immigration-related stress and associated feelings of social isolation as a result of being detached from social networks. The third aspect is Depression, which in many cases has been prolonged and internalized for decades, and for which very few poor women in the United States receive treatment. Type 2 Diabetes is the fourth dimension, as all women were diagnosed with the disease. The final dimension addresses verbal, emotional, physical, and sexual Abuse reported by two-thirds of the women in this study; more than half reported physical abuse and one-fourth reported sexual abuse. Through discussion of these five distinct and interactive dimensions of The VIDDA Syndemic this project demonstrates how women’s narratives of suffering cannot be dissociated from the political-economic and social inequalities that shape them, or the impact that such chronic adversity has on escalating rates of depression and diabetes. These data also bring forth questions surrounding the role of social and emotional stresses in the onset of chronic diseases. There is an established body of research in psychology and psychiatry linking childhood trauma and prolonged distress with poor mental health. Recent interest in the social and emotional origins of chronic disease, and particularly those findings of The ACE Study from UCSF, indicate that social and psychological distress may increase risk for chronic disease through behavioral and psychophysiological pathways. Indeed, psychological and biological markers of distress revealed that the women interviewed were extraordinarily stressed psychologically (measured in high rates of depression and PTSD) and biologically (revealed in their extreme obesity, poor glycemic control, hypertension, and high rates of Epstein Barr Virus Antibody titers – a biological marker of chronic stress). Although, because the women in this study previously were diagnosed with type 2 diabetes, and therefore there is no comparative group of non-diabetics, conclusions surrounding the role of such stressors in diabetes onset cannot be made. Nevertheless, these findings provide evidence of the significant burden of past distress, ongoing social stress, and the chronicity of mental distress among these women with diabetes. More research is needed to evaluate if indeed a higher number of women with diabetes report a history of interpersonal abuse and other social stresses compared to women of Mexican descent without diabetes in the United States. Publications: Mendenhall, Emily. "Silenced Stories: A Syndemic of Depression and Diabetes." Los Angeles: Left Coast Press, in press. *Title under discussion. Mendenhall, Emily, and Elizabeth A. Jacobs. "Subjective Stress and Depression among First and Second Generation Mexican Immigrant Women with Type 2 Diabetes in Chicago." Culture, Medicine, and Psychiatry, Revise and Resubmit.
