Predictors of subjective social status among smokers with serious mental illness

Subjective social status (SSS), defined as perception of one's place in the socioeconomic structure, has predicted health outcomes better than education, income, and employment. We examined correlates of SSS among smokers with serious mental illness, a group that may face marginalization due to stigma surrounding psychiatric disability and their tobacco use.

Participants (N=224), recruited from an acute-stay psychiatric unit, completed the MacArthur SSS Scale, the Behavior and Symptom Identification Scale (BASIS-24), the Medical Outcomes Study Short Form (SF-12), measures of alcohol (AUDIT) and drug use (DAST) problems, and an assessment of tobacco use history. The MacArthur SSS Scale uses a ladder with 10 rungs to elicit perceived social standing in the United States.

The sample was 60% male, 63% Caucasian, and averaged 40 years of age (SD=14) and 14 years of education (SD=3). The sample's mean SSS was 4.5 (SD=2.5). SSS was unrelated to gender, age, ethnicity, marital status, education, or alcohol problems. Lower SSS was predicted by unemployment (r=.19), lower income (r=-.28), worse physical (r=.22) and mental health (r=.15) functioning on the SF-12, greater psychiatric severity on the BASIS-24 (r=-.23), and greater drug use problems on the DAST (r= -.20), all p's<.05. Controlling for age, years of smoking significantly predicted lower SSS (r=-.24, p<.001).

Smokers with serious mental illness reported perceptions of social standing that, on average, placed them in the lower half in the US. Lower social standing was associated with mental and physical health concerns and the use of tobacco and illicit drugs.