Social class and schizophrenia in a Dutch cohort

Abstract

SynopsisRecent data from a 2-year follow-up of functional non-affective psychosis, and particularly schizophrenia, favoured social selection rather than social causation theory. Data concerning the cohort were compared with inter- and intra-generational mobility in a random Dutch sample. The results indicate that the educational and occupational mobility of patients, relative to their fathers, was greater than expected. Although patients were better educated than the random sample, they fared less well occupationally. An analysis of patterns of occupational mobility before and after the onset of psychosis also showed that social selection played a major role in achieving social status. The outcome of patients' occupational career at follow-up was poor, and only a minority succeeded in obtaining or keeping a regular job.

Psychiatric disorder and work life: A longitudinal study of intra-generational social mobility

“…Several studies in this area of research have not included mobility out of the labour force in their analyses (Eaton et al, 2001;Power et al, 2002;Shin et al, 2010), something that neglects the influence on long-term labour force participation among psychiatric patients. One exception is a study by Wiersma (Wiersma et al, 1983), who demonstrated that of 30 schizophrenic patients, about half were mobile out of the labour force (unemployed) and none was upwardly mobile and only a few had a satisfactory occupational role (Bacani-Oropilla et al, 1991). Psychiatric patients have also been found to have high mortality rates (Osby et al, 2001) and we observed that a larger proportion of the EPD in our study died prematurely.…”

“…Several studies have reported that individuals with psychiatric disorders have larger proportions of downward mobility than healthy individuals (Shin et al, 2010;Murphy et al, 1991). Other studies on intra-generational mobility did not report the social mobility proportions of EPD and a comparison group (Eaton et al, 2001;Power et al, 2002;Tiffin et al, 2005;Wiersma et al, 1983), although these studies found that individuals with psychosis (Wiersma et al, 1983) or psychological distress (Power et al, 2002) are more often a Alcohol-related diagnosis as main diagnosis or co-morbid to other psychiatric disease and alcohol-related diagnosis.…”

“…Moreover, working-aged individuals with psychiatric disorders have shown high rates of premature death (mortality under the age of 65 years) (Druss, Chaix, Lynch, Lindström, & Merlo, 2006) that describes shifts between social classes, either between generations (inter-generational mobility) or within a generation (intragenerational mobility) (Erikson & Goldthorpe, 1992). Only a handful of studies have examined whether psychiatric outcomes influence intra-generational social mobility (Eaton, Muntaner, Bovasso, & Smith, 2001;Murphy et al, 1991;Power, Stansfeld, Matthews, Manor, & Hope, 2002;Shin, Han, & Kohzuki, 2010;Tiffin, Pearce, & Parker, 2005;Wiersma, Giel, De Jong, & Slooff, 1983), the results of which have been inconsistent. Downward mobility has been associated with significantly elevated risks for psychological distress among women (Power et al, 2002) and significantly poorer self-assessed mental health among men (Tiffin et al, 2005).…”

2. Psychopathology and social performance in a cohort of patients with schizophrenic psychoses. A seven-year follow-up study

“…In 1986 more patients lived alone, and most of those who were employed or looking for paid work were receiving an invalidity pension. It is difficult to comment on this tendency to lose employment, and even more problematic to compare our results with the findings of other studies describing a poor outcome in respect of the occupational level of psychiatric patients (Goldberg & Morrison, 1963;Wiersma et al 1983). In Italy, in fact, early pensioning (not only for psychiatric reasons) is quite a complex phenomenon to judge.…”

Globalisation and psychiatry

“…Psychiatric disorders are more common in people from lower socio-economic groups (Goldberg & Morrison, 1963;Wiersma et al, 1983). This relationship is likely to be bi-directional, with health affecting socio-economic status and socio-economic status also affecting health (Lewis & Araya, 2002).…”