Chronic stress and psychological well-being: evidence from Thailand on household crowding.

This paper examines the effect of one form of chronic stress--household crowding--on psychological well-being, as measured by multiple inverse indicators of psychological well-being. We rely on data from a large (n = 2017) random sample of households in Bangkok, Thailand, a context that has a higher level and broader range of crowding than typically found in the United States. Objective household crowding is found to be detrimental to psychological well-being, controlling for a number of background characteristics. The effect of objective crowding is mediated by subjective crowding, which has strong, consistent and direct detrimental effects on well-being. There is no evidence of a gender effect. Extended family households are not uncommon in Bangkok, but the effects of objective and subjective crowding are similar in both two- and three-generation households, as well as in one- and multiple-couple households. The argument that subjective crowding is an effect, rather than a cause, of psychological well-being is examined and rejected. The findings suggest that crowding, as a chronic source of stress, constitutes a major threat to psychological well-being. Although the empirical analyses are based on data from one city, we frame the issue of household crowding in a historical and theoretical context in order to suggest in which cultural settings household crowding is most likely to have detrimental effects on psychological well-being.

Gender and health: some Asian evidence.

In Thailand, like the U.S., women's higher rates of illness and health service use imply that they are "sicker." But, as in the U.S., females live longer than males. Based on a large representative sample of Bangkokians, we find that married women report more sickness, are more likely to utilize health services and, according to self-reports, have poorer health. Western literature suggests five prominent explanations for gender differences in health: biological risks, acquired risks, psychosocial aspects of symptoms and care, health-reporting behavior, and prior health care and caretakers. However, analyses show that these explanations largely fail to account for morbidity differences between Thai men and women. The observed gender differences in health among Thais remain significant after eliminating pregnant women and new mothers, and after controlling for several aspects of acquired risk. Problems associated with the reproductive system among Thai women, along with greater psychological distress, appear to account for most of the gender differences in health. The theoretical implications of these findings are discussed. As for the apparent contradiction between gender differences in health and mortality in Thailand, the evidence indicates that Thai men, like their American counterparts, suffer from more serious chronic ailments that may explain their higher mortality rates.

Housing, stress, and physical well-being: evidence from Thailand.

The proposition that poor housing and congested living conditions have a detrimental impact on health has been promulgated for at least 150 years. At a minimum, two major causal mechanisms are thought to be involved in the relationship between crowding and physical health. First, high levels of household crowding can produce stress that leads to illness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can be exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrimental effects of housing conditions on a variety of illnesses, including various contagious diseases. Poor housing has even been linked to high infant and adult mortality rates. The view that poor housing conditions and household crowding inevitably leads to poor health is challenged, however, by several observers, who question the role played by both crowding and housing quality. Most existing research has been conducted in affluent countries. Little is known, however, about the nature of these relationships within the context of less developed countries, where health status and housing quality are generally much poorer and where levels of household crowding are generally higher. Determination of the effects, if any, of housing quality--including household crowding--on physical health in developing countries is particularly important given the rapid growth of their urban populations and the difficulty of increasing the physical infrastructure fast enough to keep pace with this growth. This paper reports on an investigation of the impact of housing conditions and household crowding in the context of one developing country, Thailand. Using data from a representative sample of households in Bangkok (N = 2017), our results provide reason for some skepticism regarding the influence on housing on health, at least in its objective dimensions. While the skepticism of some is based on a reading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowding are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction and a felt lack of privacy, have detrimental effects on health. Furthermore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three factors have independent effects on health outcomes bearing on both men and women.

Household crowding and reproductive behavior.

Ethological studies suggest that animal populations that live in crowded conditions display a number of behaviors that tend to limit the size of the population, such as aberrant forms of sexual behavior, small litter sizes, a higher incidence of spontaneous abortion, ineffectual maternal care, and even cannibalism of their young. Studies of household crowding in North America cities have produced only modest and selective evidence that crowding has similar effects among humans. In this paper, we examine the effect of household crowding on marital sexual relations, on desire for additional children, and on fetal and child loss in Bangkok, Thailand, a city with a much wider range of household crowding than is typically found in North America. In spite of the wider range, and higher mean level of crowding, we find that both the objective and subjective dimensions of crowding have only modest selective effects on sexual and reproductive behavior.

PIP: In ethological studies, animals have been observed to exhibit aberrant forms of sexual behavior when forced to live in crowded conditions. Studies in humans have indicated a possible connection between crowding and frequency of coitus, desire for additional children, the effective use of birth control, and the survival of offspring. The psychological distress which may arise from crowding may also have an impact on reproductive behavior. Because these studies give very little indication of possible findings in a very crowded area, focus groups were convened to lend direction to the development of a questionnaire for use in Bangkok, Thailand, where people live in conditions (12.25/sq. meter) which would be comparable to 17 people in a 1,500 sq. foot house in the West. The choice of Thailand for a research site allowed an exploration of the role of culture in reactions to crowding. In fact, the modest demeanor of the Thai people did mean that the subject of privacy was consistently raised in the focus groups. The resultant survey was administered to 1,399 wives and 618 husbands in families living in Bangkok for at least 1 year in 1988 who had at least 1 child with the mother under 45 years old. The average household samples had 5.5 people, including nuclear and 3-generation families. Scales were composed for perceived crowding, lack of privacy, and psychological distress. Findings were also tabulated for 1) frequency of sexual relations/month by sex, age, years married, age of oldest child, education, income, number of generations, number of married couples in the household, and health of respondent; 2) zero-order correlations among crowding, sexual relations, and reproductive behavior by frequency, reluctance, temporary cessation, desire for additional children, using birth control, forgot to use birth control, lack of privacy prevents use of birth control, child loss, miscarriage, and abortion; and 3) a standardized coefficient regression for the relationship between measures of reproductive behavior and objective and subjective crowding with the following controls: persons/room, lack of privacy, and psychological distress. Analyzing the data revealed that the objective level of crowding (persons/room) leads to greater reluctance to engage in sexual relations and some periods of temporary cessation, but does not affect frequency, desire to have children, use of birth control, or fetal and child survival. Subjective crowding leads to similar results, but these parents are less likely to have ceased sexual relations or to have lost a child. Lack of privacy affects only one measure examined; it increases reluctance to have sexual intercourse. Thus, these findings suggest that household crowding has a very minor impact, if any, on sexual and reproductive behavior.