Box 4.1

Illustrations from the Behavioral and Social Sciences

Many theoretical concepts originating in the behavioral sciences have relevance to research on prevention of mental disorders. These include self-esteem, regulation of emotions, attribution, cultural and gender-based diversity, social networks, community context, and ecological perspectives. Other concepts are presented here as illustrations of specific areas of study that have had—and will continue to have —an impact on the conceptual design of prevention studies.

Psychological stress is associated with a variety of negative effects on health, although the specific mechanisms for this relationship are not well understood. Recent research in psychoneuroimmunology (Ader, Felten, and Cohen, 1991) has suggested that stress can directly affect interactions between the central nervous system and the immune system. Studies of the neuroendocrine correlates of stress, for example, may lead to a better understanding of the physiological pathways by which environmental stressors affect personal health (IOM, 1989, 1984, 1982b; CBASSE, 1988).

Social support mechanisms appear to perform an essential function in several areas, including increasing or decreasing an individual's sensitivity to certain stressors, increasing or decreasing an individual's likelihood of using or abstaining from drugs, and increasing compliance with therapeutic regimes. The quantity and quality of social support networks are also thought to have a role in the onset and course of mental disorders, including depression and schizophrenia. One line of inquiry has examined how perceptions of personal control mediate the effects of social networks on health outcomes, a factor that appears to be far more significant than has been recognized by health care providers (CBASSE, 1988; IOM, 1984, 1982a).

Analysis of the usage of health care delivery systems is also relevant to prevention. Research on the role of health maintenance organizations (HMOs), for example, has indicated that certain forms of public and private subsidies of diagnostic and preventive health care practices affect the use of such services by individuals and groups. Data from these studies strongly suggest that the delivery of health care services for the general population could be greatly improved by subsidizing expanded preventive interventions for people at risk for certain health disorders, although the economic and social consequences of such targeted practices have yet to be determined (CBASSE, 1988).

Interpersonal transaction research in recent years has defined a complex interplay among expectancies, self-concepts, and motives. For example, hostile acts are often stimulated and guided by expectations of aggression that may be influenced by early childhood experiences. If the individual has experienced aggressive behavior in the past, his or her perceptions may be negatively distorted, rather than assuming ambiguous acts to be benign or accidental (CBASSE, 1993, 1988; Dodge, Bates, and Pettit, 1990).

Attachment theory postulates that early relationships between infants and their caregivers, usually their mothers, have a critical role in the infants' later development, especially in social relationships. Infants show attachment behavior by seeking comfort and protection, and caregivers' responses dem-

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