Social class and mental health: Testing exploitation as a relational determinant of depression

Carles Muntaner, Edwin Ng, Seth J. Prins, Katia Bones-Rocha, Albert Espelt, Haejoo Chung

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


This study tests whether social class exploitation operates as a relational mechanism that generates mental health inequalities in the nursing home industry. We ask, does social class exploitation (i.e., the acquisition of economic benefits from the labor of those who are dominated) have a systematic and predictable impact on depression among nursing assistants? Using cross-sectional data from 868 nursing assistants employed in 50 nursing homes in three U.S. states, we measure social class exploitation as "ownership type" (private for-profit, private not-for-profit, and public) and "managerial domination" (labor relations violations, perceptions of labor-management conflict). Depression is assessed using the original and revised versions of the Center for Epidemiologic Studies Depression Scale (CES-D and CESD-R). Using two-level logistic regressions, we find that private for-profit ownership and higher managerial domination are predictive of depression among nursing assistants even after adjustment for potential confounders and mediators. Our findings confirm the theoretical and empirical value of applying a social class approach to understanding how mental health inequalities are generated through exploitative mechanisms. Ownership type and managerial domination appear to affect depression through social relations that generate mental health inequalities through the process of acquiring profits, controlling production, supervising and monitoring labor, and enforcing disciplinary sanctions.

Original languageEnglish
Pages (from-to)265-284
Number of pages20
JournalInternational Journal of Health Services
Issue number2
Publication statusPublished - 2015 Apr

Bibliographical note

Publisher Copyright:
© The Author(s) 2015.


  • Depression
  • Exploitation
  • Mental health
  • Nursing assistant
  • Work organization

ASJC Scopus subject areas

  • Health Policy


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