title: Low socioeconomic status and perceptions of social inadequacy and shame: findings from the Dutch SMILE study.
abstract: BACKGROUND
  Based on presumed negative social comparisons in lower socioeconomic status groups, we set out to examine whether notions of 'internalized inferiority' are more common in these groups.
  
  
  METHODS
  Dutch Studie naar Medische Informatie en Leefwijzen in Eindhoven (SMILE) data on 1323 participants, aged 58-94 in 2008, were used to estimate odds ratios (ORs) of internalized inferiority by childhood and adulthood socioeconomic indicators. Questionnaires for social inadequacy and shame were used to measure internalized inferiority.
  
  
  RESULTS
  Both adulthood low educational level [OR 1.58; 95% confidence interval (CI): 1.04-2.40] and low income level (OR 1.88; 95% CI: 1.23-2.88) had substantial associations with reports of social inadequacy. Recalled childhood poverty was strongly associated with reports of shame (OR 2.20; 95% CI: 1.39-3.48).
  
  
  CONCLUSIONS
  The socioeconomic patterning of social inadequacy and shame suggests that notions of internalized inferiority in the individual, psychological makeup might be important in the generation and maintenance of socioeconomic inequalities in health.
authors.affiliation: 1 Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands hans.bosma@maastrichtuniversity.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Bosma
authors.affiliation: 1 Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Brandts
authors.affiliation: 1 Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands.
authors.forename: Audrey
authors.initials: A
authors.lastname: Simons
authors.affiliation: 1 Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands.
authors.forename: Danielle
authors.initials: D
authors.lastname: Groffen
authors.affiliation: 2 Department of Family Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands 3 Department of General Practice, Catholic University Leuven, Leuven, Belgium.
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D011203:Poverty / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D012752:Shame; D012923:Social Class; D012938:Social Perception; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires