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

最近，流行病学家在美国发现了一个不受欢迎且不同寻常的健康趋势：自1999年以来，非西班牙裔白人的死亡率不断上升。这是对以往趋势的重大和持续的逆转。从历史上看，除了战争或流行病之外，死亡率的上升很少发生。这一增长在其他美国族裔和其他高收入国家都没有出现。在45岁至54岁、高中以下学历、居住在南部和西部人口普查区较小的地铁和农村地区的男性和女性中，这种情况最为严重。这似乎是自杀、吸毒和酗酒增加的结果。然而，统计数据只能揭示模式。为了找出潜在的原因，还需要对社会背景和引发危机的痛苦进行较小规模的研究。该奖项资助的研究解决了这一需求。北亚利桑那大学的医学人类学家米歇尔·a·帕森斯博士将对亚利桑那州中年非西班牙裔白人中危及生命的社会困境进行一项人种学案例研究。帕森斯的初步假设是，痛苦与社会融合有关，尤其是一种不被需要或无用的感觉，这种感觉是通过特定的政治、经济、文化和制度结构产生的。她将通过混合方法的人种学案例研究来探索这一假设。这项研究将在亚瓦派县受教育程度较低的中年一代中进行，亚瓦派县是亚利桑那州年龄标准化中年自杀率最高的县之一，也是美国所有县中自杀率最高的十个县之一。她将从社会机构的雇员中抽取样本，这些机构是该县最大的雇主：医疗机构、政府机构和社会服务提供者。方法包括对公开数据集的二次分析、参与者观察、档案研究、关键信息提供者访谈（n=40）、结构化访谈（n=200）和半结构化深度访谈（n=80）。一个社区咨询委员会将与研究小组合作，帮助向县和州卫生及政府组织传播研究成果和建议。这项研究的广泛影响有三个方面。首先，这项研究的发现将提高人们对美国一个中年自杀率很高的地区的中年痛苦的理解。这将有助于提出多层次干预措施的建议，以减少痛苦和死亡率。这项研究还将阐明死亡率上升的社会背景，确定可能与美国其他地区死亡率上升有关的因素。最后，该项目将促进医学人类学、社会学和其他学科的知识，包括公共卫生、流行病学和临床心理学。

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.