my personal edition > schizophrenia > news


  E-Mail this DGReview to a colleague

DGReview

Schizophrenia Treatment Delay For Less Well Off

Socioeconomic status at birth does not affect the risk of developing schizophrenia among men and women but it does affect when they receive treatment for the disorder.

Researchers found differences among 352 patients with first presentation of schizophrenia matched with the next registered same sex birth from the same birth registration district.

Clinicians point out that psychiatric disorders have been consistently shown to be more common among blue collar men and women, and schizophrenia is the mental illness most strongly linked to socioeconomic status. Blue collar men and women are about five times more likely to be diagnosed with schizophrenia than other groups.

"Evidence is accumulating that the origins of the disorder lie in early life, and various environmental factors have been shown to be associated with an increased risk of later schizophrenia," the clinicians add. These factors include obstetric complications, prenatal infections, and nutritional deprivation, all of which are more common among people who are more economically deprived.

What has remained unclear is whether people born into lower socioeconomic groups are at increased risk of schizophrenia.

The researchers compiled clinical and demographic data for each patient within the catchment area from case notes and computerized records. They defined age at first contact with psychiatric service as any inpatient or outpatient contact with a mental health professional. The age at first diagnosis was defined as the date at which schizophrenia was diagnosed.

In their study, they found that the risk of schizophrenia was not increased in people from more disadvantaged backgrounds. There was a slight excess risk among people in the highest social and economic groups (odds ratio 0.59).

What was different across social strata was the mean age at presentation. This was found to be at 24.8 years for patients whose parents were in the highest social and economic groups, compared with 33.1 years for those in the less affluent socioeconomic groups at birth.

The researchers said that if, as they suspect, people with schizophrenia from less economic well off groups are not presenting to family doctors, "those with the least financial resources and opportunities for employment may be the most exposed to the adverse effects of untreated psychosis."

This delay could be one explanation why men and women from more deprive groups have a less favorable outcome for treatment.

The doctors conclude that efforts to reduce the duration of untreated psychosis through earlier detection should be particularly focused on the more deprived men and women. In addition, researchers should be careful to adjust for socioeconomic status at birth if using age at first presentation as a measure of age at onset of schizophrenia.

This study was undertaken by Dr Eadbhard O'Callaghan and colleagues at the Department of Psychiatry, University College Dublin, Ireland.
BMJ 2001; 323: 1398-1401.

E-Mail this DGReview to a colleague

To print, use this version