BMJ 2001;323:1398-1401 ( 15 December )

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Effect of social class at birth on risk and presentation of schizophrenia: case-control study

Fiona Mulvany, researcher, ^a Eadbhard O'Callaghan, professor, ^b Noriyoshi Takei, associate professor, ^c Majella Byrne, researcher, ^a Paul Fearon, psychiatrist, ^d Conall Larkin, psychiatrist. ^a

^a Stanley Foundation Research Unit, Department of Adult Psychiatry, Hospitaller Order of St John of God, Cluain Mhuire Family Centre, Blackrock, Co Dublin, Ireland, ^b Department of Psychiatry, University College, Dublin, ^c Department of Psychiatry and Neurology, Hammamatsu University School of Medicine, 3600 Handa-cho, Hammamatsu, 431-3192, Japan, ^d Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF

Correspondence to: E O'Callaghan, Stanley Foundation Research Unit, Department of Adult Psychiatry, Hospitaller Order of St John of God, Cluain Mhuire Family Centre, Blackrock, Co Dublin, Ireland eadbhard{at}indigo.ie

Objectives: To examine if low parental social class increases children's risk of subsequently developing schizophrenia or modifies the presentation.
Design: Case-control study with historical controls.
Setting: Geographically defined region in south Dublin.
Participants: 352 patients with first presentation of schizophrenia matched with the next registered same sex birth from the same birth registration district.
Main outcome measures: Social class at birth. Age at presentation to psychiatric services, admission to hospital, and diagnosis of schizophrenia.
Results: Risk of schizophrenia was not increased in people from lower social classes. There was a slight excess risk among people in highest social classes (odds ratio 0.59, 95% confidence interval 0.40 to 0.85). However, the mean age at presentation was 24.8 years for patients whose parents were in the highest social class compared with 33.1 years for those in the lowest social class at birth.
Conclusions: Although social class of origin does not seem to be an important risk factor for schizophrenia, it partially determines the age at which patients receive treatment. The relation between low social class at birth and poor outcome may be at least partially mediated through treatment delay.

What is already known on this topic Schizophrenia is more common in people from lower social classes This could be due to increased vulnerability or social drift What this study adds Low social class at birth was not associated with increased risk of schizophrenia People from lower social classes were older at first contact with psychiatric services than those from higher social classes Delay in treatment of psychosis may explain the adverse outcome among people in low social classes

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Social class at birth may affect outcome in schizophrenia
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