Social class and type of schizophrenia

The relationship between human development and prevalence of deficit schizophrenia: Results from a systematic review and meta-analysis

This study examined the relationship between the prevalence of deficit schizophrenia (DS) and a country's Human Development Index (HDI). A systematic review and meta-analysis of the literature published in the last decade were conducted to acquire data on the worldwide prevalence of deficit syndrome in schizophrenia cohorts and examine the correlation between DS prevalence and the HDI of the countries in the review. Twenty-six studies meeting our eligibility criteria provided prevalence data on DS in 14 countries with both low-to-middle and high-incomes, ranging from 14.34%-to 61.57%. The pooled prevalence of DS was 32.19% (95% CI = 26.17 to 38.52). Statistical analysis yielded a correlation coefficient (r) of -0.518 (95% CI = -0.754 to -0.164; p = 0.007), indicating a moderate inverse correlation between DS prevalence and HDI. This relationship remained significant in partial correlation analysis after controlling for potential sources of bias in the DS estimates (r = -0.489, p = 0.013). Our results show that schizophrenia cohorts from low-to-middle-income countries are more prone to primary and enduring negative symptoms, and contribute to the emerging evidence questioning the axiom that schizophrenia in the developing world has a better course than in high-income countries.

Dysfunctional family functioning in high socioeconomic status families as a risk factor for the development of psychiatric disorders in adoptees: the Finnish Adoptive Family Study of Schizophrenia

PURPOSE

Earlier findings indicate that socioeconomic status (SES) of family associates with family functioning. This study examined the impacts of family functioning and genetic risk for schizophrenia on psychiatric morbidity of adoptees in families of high SES (HSES) and low SES (LSES).

METHODS

The study population is a subgroup of the Finnish Adoptive Family Study of Schizophrenia. Of the adoptees, 152 had high genetic risk for schizophrenia spectrum disorders (HR) and 151 adoptees had low risk (LR). Of the adoptees, 185 (HR = 94, LR = 91) were raised in high-SES (HSES) families and 118 (HR = 58, LR = 60) in low-SES (LSES) families. The family SES was determined by the occupational status of the main provider of the family. The functioning of adoptive families was assessed based on Global Family Ratings (GFRs) and psychiatric disorders on DSM-III-R criteria.

RESULTS

In the HSES families, the psychiatric morbidity of the adoptees was emphasized by HR (OR = 4.28, CI 2.14-8.56) and dysfunctional family processes (OR = 6.44, CI 2.75-15.04). In the LSES families, the adoptees´ psychiatric morbidity was almost significantly increased by HR (OR = 2.10, CI 0.99-4.45), but not by dysfunctional family processes (OR = 1.33, CI 0.53-3.34).

CONCLUSIONS

This study showed that in HSES families, dysfunctional family processes and HR for schizophrenia increased the likelihoods for the development of psychiatric disorders in adoptees. The results can be utilized in identifying risk factors in the development of psychiatric disorders and focusing preventative strategies on risk groups with acknowledging the importance of family functioning.

Schizophrenia and education in Chinese metropolises: a population-based study

OBJECTIVE

Schizophrenia is a public concern in metropolises. Increases in city size may strengthen the correlation between prevalence of schizophrenia and indices of socioeconomic status, such as education. This study used population-based data of adults to investigate the association between education and schizophrenia in Chinese metropolises and its differences between inner city areas and outer suburbs.

METHODS

Data was obtained from the Second China National Sample Survey on Disability in 2006, and analysis was restricted to 189,143 participants aged 18 years or older in all counties (districts) of Beijing, Shanghai, and Tianjin. Schizophrenia diagnoses were ascertained according to the International Statistical Classification of Diseases, 10th Revision. Logistic regression models were fitted to examine the association between education and schizophrenia.

RESULTS

An inverse U-shaped pattern between education and schizophrenia was found in inner city areas of Chinese metropolises. Compared with the primary school or below group, the odds ratios of junior high school group and senior high school or above group was 2.79 (95% CI 1.96, 3.96) and 1.45(95% CI 0.99, 2.13), respectively. In outer suburbs, junior high school (OR = 0.87, 95% CI 0.63, 1.19) and senior high school or above groups (0.58, 95% CI 0.38, 0.87) were less likely to develop schizophrenia than the primary school or below group.

CONCLUSIONS

This study showed an association between education and schizophrenia in Chinese metropolises. In inner city areas, the association was an inverse U-shaped pattern between education and schizophrenia, whereas in suburban areas, the association was a negative linear pattern. Our findings can help identify high-risk populations of schizophrenia in Chinese metropolises. Programs for prevention and early intervention of schizophrenia will need to consider the socioeconomic disparities between inner city and outer suburban areas. Public policies can help improve mental health by developing social security for migrants in inner city areas and promoting regional equality.

Nonmedical Interventions for Schizophrenia: A Review of Diet, Exercise, and Social Roles

Schizophrenia is a major mental illness with a disease course that is influenced by lifestyle. The risk-benefit ratio for alternative interventions is more favorable than for antipsychotics in long-term treatment. Dietary interventions may target autoimmune features, vitamin or mineral deficiencies, abnormal lipid metabolism, gluten sensitivity, or others. Examples of interventions involving diet, physical activity, or physical processes or social interventions including talk therapy exist in the literature. Notwithstanding, the general utility of these types of interventions remains inconclusive, awaiting long-term randomized trials. A perspective that separates the cause of the disease from its symptoms may be helpful in treatment planning and is warranted to distinguish between short-term and long-term recovery goals.

Gender difference in the association between education and schizophrenia in Chinese adults

BACKGROUND

Improving education level was evidenced to decrease the risk of schizophrenia, but whether this strength of education role depends on gender is not. This study aimed to investigate whether there was gender difference in the association between education and schizophrenia in Chinese adults.

METHODS

Data were obtained from the Second China National Sample Survey on Disability in 2006, including 1,909,205 participants aged 18 years or older. Schizophrenia was ascertained according to the International Statistical Classification of Diseases, Tenth Revision. Logistics regression models were fitted to examine the combined effect of gender and education on schizophrenia.

RESULTS

The lifetime prevalence of schizophrenia in female groups was higher than in male groups, with 0.44% (95%CI: 0.42-0.45%) and 0.36% (95%CI: 0.35-0.37%), respectively. Compared with schizophrenia male patients, more females with schizophrenia experienced severe or extreme difficulty in understanding and communicating. However, more males with schizophrenia suffered from severe or extreme difficulty in the function of daily activities. The combined effect of education and schizophrenia was statistically significant, indicating that, as the level of education increased, schizophrenia risk of females decreased faster than the risk of males.

CONCLUSIONS

This study showed that additional years of education associated with lower risk of schizophrenia, and this association was stronger in females than in males. As education elevated, the risk of schizophrenia decreased more for women than for men. The findings indicate that improving education level may have an effect on reducing the gender disparities in mental health of China. Actions to prevent schizophrenia and address its gender disparities will require attention to the improving educational opportunities.

Early-onset schizophrenia: Symptoms and social class of origin

BACKGROUND

The genesis of schizophrenia is multifactorial, including biological and environmental risk factors. We tested for an interactive effect between early-onset schizophrenia (EOS) and social class of origins (socioeconomic status (SES)). Data were further analyzed for a possible connection to type of schizophrenic symptoms. Sampling/Methods: Data for the study are taken from the medical records of 642 patients from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about age of onset and SES of origin was obtained through Social Service Assessment interviews.

RESULTS

We uncovered a significant impact of EOS among the poor that elevates risk for negative symptomatology.

CONCLUSION

Poor SES alone does not increase the likelihood of EOS, but it magnifies the deleterious effect of EOS on negative symptoms. Future research on these variables may inform the relative contribution of each.

What Influences Mental Illness? Discrepancies Between Medical Education and Conception

OBJECTIVE

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness.

METHODS

The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception.

RESULTS

Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences.

CONCLUSIONS

If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

Neglect and hereditary risk: Their relative contribution to schizophrenia with negative symptomatology

BACKGROUND

There is evidence that genetic and environmental stressors contribute to the genesis of schizophrenia. However, the relevant impact of each factor remains unclear. We tested for an interactive effect between childhood neglect and family history of serious mental illness. Data were further analyzed for a possible connection to type of schizophrenic symptoms.

SAMPLING/METHODS

Data for the study are taken from the medical records of 641 patients with schizophrenia from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about childhood neglect and family history of serious mental illness was obtained through Social Service Assessment interviews at intake and during hospital stay.

RESULTS

Among clients with no family history of mental illness, childhood neglect does not meaningfully affect the risk of negative versus positive schizophrenia. For clients with such history, on the other hand, neglect significantly raises the risk of schizophrenia with negative symptomatology.

CONCLUSION

Our central finding is that risk for negative symptoms of schizophrenia are elevated by childhood neglect combined with a history of serious mental illness within the family. This is the only report to combine schizophrenic symptoms, familial risk and childhood neglect to date. Implications for primary prevention and treatment are discussed.

Stressful life events, social class and symptoms of schizophrenia

We test to see if severe stressful life events precede onset of specific symptoms of schizophrenia. Our analyses extend to possible variations in the effect by socioeconomic status (SES) of origin. The medical records of 431 schizophrenic patients were categorized into negative and positive subtypes by application of SANS, SAPS and PANS scales. SES was bifurcated into low SES and high SES groups. Stressful life events were classified into four domains. The study variables were tested by the use of chi-square analysis. Our results show that there is an elevated rate of positive symptoms among low SES patients who underwent a stressful life event before symptom onset. Significance is confirmed with a X2 value of 5.418, p=.020. The finding does not hold true for high SES patients and is not related to type of stressful life event. Thus, we conclude that environmental stressors frequently precede onset of positive symptoms of schizophrenia. This is only true for patients of low SES of origin. We hypothesize that low SES patients have a heightened reactivity to stressors, a reactivity that is incubated by the human toll of impoverishment.

Obstetrical complications, social class and type of schizophrenia

The emerging neurodevelopmental model posits that prenatal and perinatal factors can play an etiological role in schizophrenia. Consistently, the research on obstetrical complications (OCs) reports an association with the development of more severe schizophrenic symptoms. Low socioeconomic status (SES) has also been linked to both limited prenatal healthcare and to worse prognosis of schizophrenic symptoms. A large sample (n=437) of patients from a state hospital population in the U. S. was screened for study variables. A sequential analysis was conducted, first applying cross tabulations using the chi-square test, and then building separate logit models for poor and nonpoor patients. The cross tabulations indicated an association between OCs and negative symptoms for poor schizophrenic patients, but not for nonpoor patients. Multivariate logit models further supported this result. This is the first study to examine the interaction of OCs, schizophrenic symptomatology and SES of origin.

[Evaluation of a two-year intensive outpatient care programme for adolescents with schizophrenia]

OBJECTIVE

The Trialog project offers patients with early-onset schizophrenia (EOS) a two-year programme of residential outpatient care following discharge from a clinic. The programme aims to support their further recovery and independence and encompasses interactive and psycho-educational multifamily care, coping with persistent symptoms, development of socio-emotional competence, independent house keeping, and support of school and vocational training.

METHODS

To evaluate psychopathology along with social and neuropsychological function for 12 participants over a period of 2 years. Their progress was compared with that of 12 EOS patients who did not attend Trialog following discharge.

RESULTS

Participants showed a significantly greater decrease of positive and negative symptoms, as opposed to an increase in positive symptoms in the comparison group. Measures of social function, neuropsychological indicators of memory, (selective) attention, and psychomotor speed improved more than in the comparison subjects. Neither group showed changes in measures of intelligence or in the subjective quality of life.

CONCLUSIONS

First analyses raise hope that monitoring participant performance in the programme of the "Trialog project" will improve the treatment and care of EOS-patients in the critical first years following the onset of schizophrenia.

Estigma e esquizofrenia: repercussões do estudo sobre discriminação experimentada e antecipada

O artigo "Padrão global da discriminação experimentada e antecipada contra pessoas com esquizofrenia: estudo transversal", publicado originalmente na Lancet, despertou interesse entre psiquiatras de vários países da Europa. As cartas enviadas por eles à revista inglesa foram reunidas aqui.

Social class, family history and type of schizophrenia

To date, there are numerous studies supporting a genetic model of schizophrenia. There is a paucity of studies, however, screening for a connection between family history of serious mental illness and deficit vs. nondeficit schizophrenia. The aim of the present study was to explore the association between family history, deficit vs. nondeficit schizophrenia and socioeconomic status (SES) of family of origin. Patients (N=437) from a United States psychiatric hospital were separated into deficit vs. nondeficit presentation and bifurcated into poor vs. nonpoor SES. Family history data were utilized to classify patients into subgroups characterized by serious mental illness within immediate family, within extended family, or no evidence of mental illness. Statistical testing was conducted using logistic regression analysis. SES of family of origin was significantly associated with schizophrenic subtype independently of family history, sex and race; specifically, poverty raised the risk of deficit schizophrenia. Family history of mental illness showed no net association, and no statistical interaction with poverty, in predicting risk of deficit schizophrenia.

Schizophrenic subtype, seasonality of birth and social class: a preliminary analysis

OBJECTIVE

The neurodevelopmental model of schizophrenia includes the etiological impact of fetal brain stressors possibly connected with birth seasonality. Specification of social class of origin (SES) as a related risk factor remains unexamined as does type of schizophrenia as an outcome variable. The objective of this study was to test for an interconnection between SES, type of schizophrenia and seasonality of birth.

METHODS

Patients (N=436) from a United States psychiatric hospital were separated into deficit/non-deficit presentation and bifurcated into poor/non-poor SES. Birth seasonality was assessed by months hypothetically connected with winter-related trimesters of gestation.

RESULTS

Results showed that there is a significant difference (p=0.0411) in the monthly birth patterns of poor vs. non-poor patients and that the difference connects with the likelihood of deficit vs. non-deficit schizophrenia. Specifically, an elevated proportion of patients with deficit schizophrenia were born to impoverished women who likely conceived in January. Findings were confirmed by multiple levels of statistical assessment including log linear analysis.

CONCLUSION

The resultant model suggests the environmental location (lower SES) and timing (winter conception) of adult schizophrenia with poor outcome (deficit).