ECONOMIC CONDITIONS AND MENTAL HOSPITALIZATION FOR FUNCTIONAL PSYCHOSIS

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Abstract
The most consistent findings in the social epidemiology of mental disorder in the last 15 years are that socioeconomic status is inversely related to the incidence, prevalence and possibly severity of functional mental disorder. These findings provide the empirical basis for the proposition that short term upward shifts in the incidence of functional psychosis in a given population are likewise related to inverse, downward, short term shifts in the overall economic status of that population. This proposition is supported by further consistent findings of negative relationships between the incidence over time of suicide, which psychiatrists believe is frequently a symptom of severe mental disorder, and economic indicators. The initiating hypothesis of the present study sought to interpret both of these sets of findings in a single hypothesis. The hypothesis was that downward shifts in economic conditions are precipitating proximal factors in the occurrence of functional mental disorders. New York 1st admissions were analyzed for the period 1922-1941 for all public hospitals and 1947-1954 for all private hospitals. The overall correlations for both public and private hospitals were high, with the lowest (-.63) for female 1st admissions to public hospitals. For both sexes there was a clear tendency for manic-depressive 1st admissions to be admitted earlier in the economic downturn than 1st admissions for schizophrenia. First admissions for involutional psychosis, however, did not show a clear temporal pattern of negative relationship with the economic indicator. Three somewhat different perspectives on the problem of the time of "appearance" of psychiatric hospitalization were presented. Each of these perspectives, in turn, supports different clinical interpretations of the varying temporal reaction patterns of 1st admissions of each major diagnostic category of functional psychosis to the economic indicator. The data appear to show different 1st admission patterns by sex. These findings supported the expectation that differences in economic aspects of male and female roles possibly lead to different hospitalization patterns, by sex, in response to economic fluctuations.

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