Psychosocial epidemiology, social structure, and ideology

Psychosocial epidemiology (that is, pertaining to the influence of social factors on a person's behaviour, and to the interrelation of behavioural and social factors ¹ ) is a controversial field within epidemiology. ^{2, 3} Here, we restrict our critique to epidemiological studies of psychosocial constructs and we acknowledge the relevance of neuroscience and neuroendocrinology to understand the proximal pathways by means of which psychosocial exposures affect the health of organisms. ⁴ Our goal is not to attack the work that has been done on psychosocial factors, but argue for the need to further integrate psychosocial factors with social structure. Important research has also been conducted on the psychosocial pathways that might mediate the effect of social structure on individual physical and mental health. This research includes studies of job control ^{5, 6, 7, 8, 9, 10} (despite negative findings in the Framingham study ¹¹ ), effort reward imbalance, ¹² social isolation/social support, ^{13- 15} and early psychosocial exposures. ¹⁶ In addition, the Whitehall study has already provided evidence suggesting that control explains an important part of the health gradient among workers using both self reports and independent assessments. ^{12, 17- 21} These studies lay the ground for future research that might integrate social structure, psychosocial exposures, and health.

However, some psychosocial constructs seem to gain and lose popularity without a strong justification for their fortunes. If this suspicion were correct, lack of strong cumulative progress might be attributable to methodological roadblocks such as the large number of omitted variables, the large number of associations that can be usually uncovered with a large enough sample, the occasional over-reliance on self reports, ² conflating independent and dependent variables (for example, social capital, violence, drug use), and the use of competing hypotheses that are as weak as those being tested.

Limitations also originate from psychosocial theory. Psychosocial constructs are expected to provide generalised risk factor associations across time and place, ignoring the determining social structure. Even when constructs are conceived under historical and social constraints, researchers seem to transform them into a-historical, psychological attributes. For example, the "type A" coronary prone behaviour pattern ²² originated in clinical findings of the work related behaviour of mostly white men middle managers in post-war USA bureaucratic corporations. The construct thus...