Marital and labor market status in the long run in schizophrenia

Abstract

Background: Singleness and unemployment increase the risk of schizophrenia. Schizophrenia subsequently increases the risk of singleness and unemployment.

Objective: To describe long-term changes in marital status and labor market affiliation before and after the first admission with schizophrenia.

Design: A case-control study.

Setting and participants: The sample included 5341 patients with a diagnosis of schizophrenia at the first admission to a psychiatric facility between 1970 and 1999, and 53 410 matched control subjects. A person admitted in 1999 was followed up in the registers from 1980 to 1997 (ie, from 19 to 2 years before admission). Individuals admitted in 1970 could be followed up from 10 years until 27 years after admission.

Main outcome measures: Annual socioeconomic indicators.

Results: Individuals who were later hospitalized were more frequently living alone, unemployed, receiving social benefits, or otherwise outside the labor market when compared with controls, as early as 19 years before their first admission. For individuals with schizophrenia, the odds ratios of being unmarried or not being fully employed were significantly increased even 25 years after admission. This pattern was especially pronounced for men and for individuals who had more admissions. The ratios increased until admission, with a steeper increase in the years before admission. After admission, the odds declined to the level shown before admission and then stabilized.

Conclusions: Schizophrenia hinders social achievement long before the first admission. The first hospital episode is followed by a period during which social status does not deteriorate further except for the transition into disability pension.