The study discussed here involves a number of distinguished people in psychiatry (see the reference below) and looks at some data from the AESOP study (Aetiology and Ethnicity in Schizophrenia and other Psychoses) – in those people who had completed the employment schedule. There were three aims of the study: 1) To investigate the impact of employment status on the the interaction between social isolation and psychosis 2) The relationship between employment goals and achievement and their impact on psychosis 3) Whether these effects might be seen most strongly in African-Carribeans (in order to explain a higher observed incidence of schizophrenia). The authors point out that being unemployed is associated with schizophrenia up to 15 years before admission and clearly there is an important relationship.
546 people were included in the study, 322 controls and 224 people with first-episode psychosis. There were slightly more women than men in the study. A number of different ethnic groups were included and in cases there was a roughly equal split between those under 30 years old and those over this age. A number of demographic variables were collected as well as outcomes of an employment scale and contacts with services. A number of different statistical methods were also used including logistic regression and Kaplan-Meier survival curves (for examining contact with services).
There were a number of findings. There was increased unemployment in people with psychosis and this didn’t differ between the two study sites of London and Nottingham. In terms of primary outcome measures, the researchers found that the number of social contacts a person had influenced the relationship between unemployment and non-affective psychosis. If a person had a low level of social contacts then the odds ratio of having psychosis if they were unemployed compared to those in employment was 7.52 (95% Confidence Interval 2.97-19). However the modifying effect of social relations on the relationship between psychosis and employment didn’t hold for affective psychosis. Also those with lower levels of social contacts had longer periods of psychosis.
There was also found to be a relationship between expectation of employment and achievement in the direction predicted. Thus people with psychosis were more likely to achieve below their expectations. Afro-carribean people with psychosis were more likely to have a bigger gap between employment achievement and expectations than either Afro-Carribean controls or White-British people with psychosis. However this did not reach statistical significance although the authors argue that the study may not have been sufficiently powered to answer this specific question.
This is an interesting study with clear aims and some important findings, particularly the relationship of social contacts and unemployment to untreated psychosis and non-affective psychosis.
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Ulrich Reininghaus, Craig Morgan, Jayne Simpson, Paola Dazzan, Kevin Morgan, Gillian Doody, Dinesh Bhugra, Julian Leff, Peter Jones, Robin Murray, Paul Fearon and Tom Craig. Unemployment, social isolation, achievement-expectation mismatch and psychosis: findings from the AESOP study. Soc Psychiatry Psychiatr Epidemiol. 2008. 43. 743-751.