Subjective social status (SSS) is a marker of perceived social rank that has been linked with depressive symptoms over and above objective socioeconomic status (SES), but longitudinal studies are limited. SSS has been theorized to capture perceived relative versus absolute deprivation and the corresponding psychosocial processes underlying status-based disparities in health. The literature suggests that upward social comparisons inherent in appraising SSS may confer psychosocial risk, which may in turn increase risk for depressive symptoms and stress-related inflammation involved in the pathogenesis of depression. However, no studies have examined whether interpersonal and biological factors simultaneously contribute to the inverse relation between SSS and depressive symptoms. This study examined whether (1) lower SSS was longitudinally associated with increased depressive mood symptoms, independent of income, and (2) whether higher social strain and lower social support simultaneously mediated the SSS— depressive mood symptoms relation directly and indirectly through higher interleukin-6 (IL-6). This study utilized secondary data from a representative community sample of 804 middle-aged adults taking part in a study of healthy aging between 2007 and 2012. Plasma levels of IL-6 and self-reported SSS, social support, and social strain were assessed at baseline, followed by an assessment of depressive mood symptoms by phone interview on average 20 months later. Results from multiple regression analysis revealed that lower SSS predicted higher depressive symptoms at follow-up after adjustment for sociodemographic characteristics and baseline depressive mood symptoms. Path analysis indicated that social strain significantly mediated the relation between SSS and depressive mood symptoms, but not after adjustment for baseline mood symptoms. Lower social support mediated the relation between lower SSS and higher depressive symptoms, but relations were non-significant in adjusted models. Contrary to predictions, paths including IL-6 were not significant. Lower SSS may represent a robust risk factor for subsequent depressive mood symptoms above and beyond income, in line with the conceptualization of SSS as a measure of relative deprivation. Further research examining biopsychosocial mechanisms would elucidate the implications of perceived low status and inform intervention efforts aimed at reducing the global burden of depressive symptoms.

Socioeconomic status (SES) is linked with poorer health outcomes across the range of SES. The Reserve Capacity Model (RCM) proposes that low SES fuels repeated and/or chronic exposure to elevated levels of stress, producing deleterious emotional, psychological, social, and physiological changes that result in development of disease over time. The RCM further asserts that a relative lack of social and psychological resources, including efficacy and social support, among low SES individuals accounts for their greater vulnerability to the effects of stress. Although the links between stress, reserve capacity, and health outcomes are framed in the RCM as an ongoing process that produces disease, the majority of investigations testing the model have not examined its utility in explaining 1) coping with daily stressors or 2) symptom flares among individuals managing a chronic illness. This study investigated the effects of SES, reflected in income level, on the: 1) levels of daily financial events and financial worry; 2) relations between daily financial worry and symptoms of pain and fatigue; and 3) extent to which daily coping efficacy and social support mediated the daily financial worry-symptom relation across 21 daily diary reports collected from 220 individuals with fibromyalgia (FM). Simple correlations showed that income was inversely related to frequency of financial events and level of financial worry across 21 days. Results from multilevel models indicated that daily increases in financial worry were unrelated to pain regardless of income level, but were related to increased fatigue among individuals with lower relative to higher income. Daily efficacy and support mediated the relations between financial worry and pain and fatigue, but the extent of mediation did not differ based on high versus low income level. Taken together, the findings suggest that individuals of low versus high income encounter more frequent financial stress and experience greater daily fatigue exacerbation related to that stress, in line with the RCM. Over time, the greater exposure and reactivity to financial strain may account for the inverse relation between income and disability among those with chronic pain.