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• W2014133345 abstract "Introduction An understanding of the intricate relationship between an illness and the socio-economic complex of urban society is essential for its prevention. Are social, economic, occupational, or family circum stances associated with the illness? If so, are they causally connected or are they the results of the illness itself? Are unfavourable or economic factors connected with contracting the illness (inception), or do they operate only against the recovery of affected persons (prevalence)? Is the association between the inception of illness and environmental factors directly proportional, or do the latter enter into effect only beyond some thres hold of tolerance? Does the relationship between illness and environmental factors affect both sexes and all age groups similarly? Do or occupational factors operate in the same way in different cities or in different communities within the same city? These are only a few of the questions to which and preventive medicine needs answers. Some of these problems have been investigated in respect of acute physical illnesses such as infectious diseases, which become conspicuous fairly quickly after inception and for which the identification of the illness is relatively straightforward; but the identifi cation and separation of socio-economic and family factors is by no means straightforward. In mental illness, however, there are additional difficulties, as for example the unknown interval between the inception of illness and its manifestation, and between the latter and the demand for medical care; and there are further problems of precise diagnostic criteria and identification of mental illness outside hospital. It is not surprising, therefore, that as yet there are few conclusive findings on the relationship between mental illness and specific socio-economic factors; opinions on the possible reasons for?and even on the existence of?such relationships diverge considerably. Investigations into the hospital-treated prevalence of total psychiatric illness have agreed on the social gradient?the increase in prevalence with decrease in socio-economic status; but for individual diagnoses the findings have by no means agreed. Faris and Dunham (1939) found correlations between specific diagnoses and indices of isolation, and for schizophrenia in particular they showed that prevalence was highest in the central areas of Chicago and decreased progressively towards the periphery; however, studies of incidence in some cities of different types, as for example Kansas City (Schroeder, 1942) or in Austin, Texas (Belknap and Jaco, 1953), did not find such a regular pattern. Again, the findings in Bristol of Hare (1956) agreed with the Chicago findings in regard to male schizophrenics but differed somewhat for female schizophrenics; moreover, Hare found no association between the organization of the city and either manic depressive psychosis or the psychoses of old age. The class gradient in schizophrenia, observed in all studies in which a definite socio-occupational index has been used, has led to widely divergent hypotheses. Some investigators have construed the class gradient as resulting from downward occupa tional mobility?drift?of schizophrenics before reaching medical attention, while others have postu lated other factors connected with job-selection; for example Clark (1948) suggested that certain occupa tions and also low pay aggravated pre-schizophrenic problems, and Odegaard (1956) that schizophrenic persons tend to go into, and remain in, stationary or decreasing occupations rather than expanding occupations. Other investigators have considered that occupational mobility features are not relevant; Hollingshead and 'Redlich (1955), in a small 181" @default.
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• W2014133345 title "Social Class Gradient in Schizophrenia" @default.
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• W2014133345 doi "https://doi.org/10.1136/jech.11.4.181" @default.
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