The pursuit of socially modifiable contingencies in mental health.

The effort to understand the meanings of the well-demonstrated linkages between mental health and one's locations in the social structure has commanded a great deal of research attention over the past half century. Following a brief consideration of my early efforts to make a contribution in this regard, some recent and ongoing work is summarized. In concert with important work by others, these findings support the conclusion that differences in exposure to social stress represent a much more critical contingency in mental health and substance use outcomes than has generally been assumed. In addition, reported results indicate that the lifetime experience of multiple adversities is quite common among young people in South Florida and, presumably, elsewhere and the likelihood that the compelling linkage observed between cumulative adversity and risk for psychiatric and substance disorders is causal in nature. It is suggested that the development of interventions in the service of stress prevention or reduction should command a greater proportion of the attention of researchers and interventionists.