Social Class, Social Mobility and Risk of Psychiatric Disorder - A Population-Based Longitudinal Study

Sanna Tiikkaja,Ninoa Malki,Sven Sandin,Christina M Hultman,Pär Sparén,Bitte Modin,Matteo Convertino

doi:10.1371/journal.pone.0077975

Sanna Tiikkaja, Ninoa Malki + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0077975

Copy DOI

Abstract

ObjectivesThis study explored how adult social class and social mobility between parental and own adult social class is related to psychiatric disorder.Material and MethodsIn this prospective cohort study, over 1 million employed Swedes born in 1949-1959 were included. Information on parental class (1960) and own mid-life social class (1980 and 1990) was retrieved from the censuses and categorised as High Non-manual, Low Non-manual, High Manual, Low Manual and Self-employed. After identifying adult class, individuals were followed for psychiatric disorder by first admission of schizophrenia, alcoholism and drug dependency, affective psychosis and neurosis or personality disorder (N=24 659) from the Swedish Patient Register. We used Poisson regression analysis to estimate first admission rates of psychiatric disorder per 100 000 person-years and relative risks (RR) by adult social class (treated as a time-varying covariate). The RRs of psychiatric disorder among the Non-manual and Manual classes were also estimated by magnitude of social mobility.ResultsThe rate of psychiatric disorder was significantly higher among individuals belonging to the Low manual class as compared with the High Non-manual class. Compared to High Non-manual class, the risk for psychiatric disorder ranged from 2.07 (Low Manual class) to 1.38 (Low Non-manual class). Parental class had a minor impact on these estimates. Among the Non-manual and Manual classes, downward mobility was associated with increased risk and upward mobility with decreased risk of psychiatric disorder. In addition, downward mobility was inversely associated with the magnitude of social mobility, independent of parental class.ConclusionsIndependently of parental social class, the risk of psychiatric disorder increases with increased downward social mobility and decreases with increased upward mobility.

Highlights

Social class differences in health have been documented throughout the Western world for most major health and mortality outcomes [1,2,3,4]
The International Classification of Diseases (ICD) discharge diagnoses for psychiatric disorders recorded in the Swedish Registers are in agreement with diagnoses based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria and with those based on semistructured interviews and medical records [21,22,23]
The relative risks (RR) for psychiatric disorder varied by adult social class (Table 2, Model 1), with higher risks for the Manual and Selfemployed classes than for the Non-manual classes

Summary

Introduction

Social class differences in health have been documented throughout the Western world for most major health and mortality outcomes [1,2,3,4]. Psychiatric disorder, present in about 10% of the adult population at some point across the life-course, is a major global public health problem [5]. Previous studies have shown an inverse relation between adult social class and risk for psychiatric disorder [6,7]. Poor psychiatric health in adult life has been linked to low parental social class [8,9]. From parental to adult social class, is suggested to be an important aspect of social stratification that may affect the development of psychiatric disorder [9,10]. The focus of this paper is to study how social class and social mobility is related to the risk of subsequent psychiatric disorder

Objectives

Methods

Results

Conclusion