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Causal Role of Social Deprivation in Schizophrenia

The association between low socioeconomic status (SES) and schizophrenia has long been viewed as a consequence of the illness -- that is, the "social drift" of patients; this contrasts with the link between lower SES and such disorders as depression -- in which social status is believed to contribute to the onset of the disorder. To examine whether low SES at birth is associated with adult-onset schizophrenia, researchers assessed the SES of 82 patients (mean age, 25) with first episodes of psychosis (58 patients with schizophrenia and 24 with other psychotic illnesses) and of 198 age- and sex-matched controls residing in the same area (Nottingham, England). Father's occupation and mother's place of residence were used to form an index of social deprivation at birth.

Individuals with low SES index scores had an increased risk for a psychosis diagnosis, an association that was significant for patients with schizophrenia (odds ratio, 8.1) and approached significance for patients with other psychotic illness (OR, 3.6), despite the few patients with that diagnosis in this study. The association was strongest in patients older than 25 and in patients from African-Caribbean families, but was unaffected by family history of psychosis.

Comment: These data suggest that the association between low SES and schizophrenia is not entirely due to social drift and that social inequality in early life may play a causal role in schizophrenia, either through biologic (e.g., exposure to infection or toxins) or nonbiologic (e.g., social stressors) mechanisms. Although these findings are limited to patients who did not migrate from their place of birth and who sought mental health treatment, they are consistent with those from other studies reporting associations between schizophrenia and lower paternal social class.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry December 5, 2001

Citation(s):

Harrison G et al. Association between schizophrenia and social inequality at birth: Case-control study. Br J Psychiatry 2001 Oct 179 346-350.

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