Social distress in midlife in Arizona: a mixed methods ethnographic case study

Northern Arizona University, Flagstaff AZ

Investigators

Abstract

Recently, epidemiologists have uncovered an unwelcome and unusual health trend in the United States: increasing death rates among non-Hispanic whites since 1999. This is a significant and sustained reversal of previous trends. Historically, increases in mortality have rarely occurred outside of war or epidemics. The rise was not seen for any other American ethnic group or in any other high income country. It is most severe among men and women who are 45 to 54 years of age, have a high school education or less, and are living in smaller metro and rural areas in the South and West census regions. It appears to be the result of increases in suicides and drug and alcohol abuse. However, the statistics can only reveal patterns. To get at underlying causes, it is necessary to also have smaller studies of social context and the distress driving the crisis. The research funded by this award addresses this need. Medical anthropologist Dr. Michelle A. Parsons, of Northern Arizona University, will undertake an ethnographic case study of life threatening social distress among middle-aged non-Hispanic whites in Arizona. Dr. Parsons' preliminary hypothesis is that distress is associated with social integration, in particular a feeling of not being needed or not being useful, which is produced through specific political, economic, cultural, and institutional structures. She will explore this hypothesis with a mixed methods ethnographic case study. The research will be carried out among a midlife generation with lower levels of education in Yavapai County, which has one of the highest age-standardized midlife suicide rates in Arizona and is among the top ten highest rates among all U.S. counties. She will draw her sample from employees of the social institutions that are the largest employers in the county: healthcare institutions, government institutions, and social service providers. Methods include secondary analysis of publicly available datasets, participant observation, archival research, key informant interviews (n=40), structured interviews (n=200), and semi-structured in-depth interviews (n=80). A community advisory board will work with the research team and help with dissemination of research results and recommendations to county and state health and government organizations. The broader impacts of the research are threefold. First, findings from the study will improve understanding of midlife distress in an area of the U.S. with a very high rate of midlife suicide. This will enable recommendations for multilevel interventions to reduce distress and mortality. The research also will elucidate the social context of rising mortality, identifying factors potentially related to mortality increases in other areas of the United States. Finally, the project will advance knowledge in medical anthropology, sociology, and other disciplines, including public health, epidemiology, and clinical psychology.