Does socioeconomic status predict course and outcome in patients with psychosis?
BACKGROUND
We examined the relationship between socioeconomic status (SES) and course and outcome of patients with psychosis. Two hypotheses were examined: a) patients with higher best-ever SES will have better course and outcome than those with lower best-ever SES, and b) patients with greater downward drift in SES will have poorer course and outcome than those with less downward drift.


METHODS
Data were drawn from the baseline and 2-year follow-up assessments of the UK700 Case Management Trial of 708 patients with severe psychosis. The indicators of SES used were occupational status and educational achievement. Drift in SES was defined as change from best-ever occupation to occupation at baseline.


RESULTS
For the baseline data highly significant differences were found between best-ever groups and negative symptoms (non-manual vs. unemployed--coef -10.5, p=0.000, 95% CIs 5.1-15.8), functioning (non-manual vs. unemployed--coef -0.6, p=0.000, 95% CIs 0.3 to -0.8) and unmet needs (manual vs. unemployed - coef 0.5, p=0.004, 95% CIs 0.2-0.9). No significant differences between best-ever groups were found for days in hospital, symptoms, perceived quality of life and dissatisfaction with services. Significant differences for clinical and social variables were found between drift and non-drift SES groups. There were no significant findings between educational groups and clinical and social variables.


CONCLUSIONS
Best-ever occupation, but not educational qualifications, appeared to predict prognosis in patients with severe psychosis. Downward drift in occupational status did not result in poorer illness course and outcome.
Samele
C
C
Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, UK. sphachs@iop.kcl.ac.uk
van Os
J
J
McKenzie
K
K
Wright
A
A
Gilvarry
C
C
Manley
C
C
Tattan
T
T
Murray
R
R
D000328:Adult; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D017063:Outcome Assessment, Health Care / Q000379:methods; D017060:Patient Satisfaction / Q000208:ethnology; D011618:Psychotic Disorders / Q000208:ethnology / Q000534:rehabilitation*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012559:Schizophrenia / Q000208:ethnology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D012923:Social Class; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology