Social Integration, Emotional Adjustment and Illness Behavior

This paper first focuses on the relationships betxveen students' satisfaction with the academic and social aspects of college life and their emotional status. It then goes on to investigate how these relationships influence students' inclinations to "adopt the sick role." Analysis of data from a sample of undergraduates at a men's liberal arts college reveals that the two intervening variables, friendship solidarity and academic satisfaction, are more immediately associated with emotional disturbance and with sick-role inclination than is the prior variable, organizational affiliation. Further analysis shows that lower solidarity and academic dissatisfaction are more closely associated with sick-role inclination among the emotionally disturbed students than among the better-adjusted ones. T his paper examines relationships between undergraduates' reports of dissatisfaction with academic and nonacademic aspects of their college environment, and their emotional status. The paper then proceeds to show how these relationships affect students' inclinations to "adopt the sick role." A pioneering investigation in this area of inquiry, by Mechanic and Volkart, concerned relations among stress, illness, and the inclination to seek medical attention.1 Their most striking finding concerned the strength of the association between the inclination to use the college clinic and the rates for actually using it: scores on the scale measuring sick-role inclination proved better predictors of clinic use than did questions bearing on loneliness and nervousness which were supposed to be operational indices of stress. There is little doubt that psychiatric utilization rates among undergraduates tend to rise as stress increases. At Yale, in separate studies, Davie and Rust each found that students who used the mental hygiene clinic were more likely than others to report having difficulties with their social and academic adjustment.2 Students who were mental hygiene clinic patients also had higher rates for the use of the general clinic facilities. A partial explanation and corroboration of these results comes from the Midtown studies.3 Using an extensive probability sample of a general rather than a college population, the Midtown investigators were able to concludewith age, sex, and social class controlled-that people who had fewer friends, or no intimate neighbors, or no memberships in voluntary organizations, had poorer mental health ratings than their counterparts who were better integrated socially. Another community study, again attending more to the prevalence of emotional disturbance than to the utilization of medical facilities per se, arrived at an even more general conclusion. "There are," wrote Leighton et al., "three main dimensions in terms of which we found marked variation in the distribution of psychiatric disorder in Stirling County. These are sex, age, and disintegration of the sociocultural system. . . . Dis1 David Mechanic and Edmund A. Volkart, "Stress, Illness, and the Sick Role," American Sociological Review, 26 (February 1961), pp. 51-58. 2 James Davie, "Who Uses a College Mental Hygiene Clinic?" in Bryand M. Wedge (ed.), Psycho-Social Problemts of College AMeat (New Haven: Yale University Press, 1958); Ralph M. Rust, "Epidemiology of Mental Health in College," The Journal of Psychology, 49 (October