Sociodemographic determinants of disability in patients with schizophrenia (Bulgaria, 2018-2019)

Abstract

Abstract Background Schizophrenia is an increasing public health problem. Despite its low prevalence and mortality, it causes significant disability and has enormous health, social, and economic burden for patients, families, society and health systems worldwide. The aim was to assess the impact of some sociodemographic determinants on disability in patients with paranoid schizophrenia (PS). Methods The study includes 108 patients in Psychiatric Clinic at Pleven University Hospital: 66 males and 42 females, mean age 38.9±10.0, duration of disease 12.8±8.2 years; mean onset of disease - 24 years (Me = 25 and Mo = 22). The study was approved by Ethical Committee. The disease burden was assessed by Positive and Negative Syndrome Scale (Ð ANSS), and level of disability - by 36-item WHO Disability Assessment Schedule 2.0. Four variables (gender, age, education, type of employment) were chosen and their impact on disability was assessed by one-way ANOVA (F-test), Tukey's NDS test, two-sided t-test, Pierson r. Data processing was performed by IBM SPSS v.24. Results The most severe deficits were observed in “getting along with people” (61.34±25.77),”life-activities-household” (55.74±23.45), “participation in society” (53.13±19.12), “understanding and communicating” (41.67±17.67). Age at disease onset and its duration showed weak positive correlation. In most domains, males had higher deficits (р=0.0001). Age had an impact only on “getting around” (r = 0.41;p=0.0001) and “self-care” (r = 0.260;p=0.007). Significant differences (F (2,104)=7.565, p < 0.01) were found between groups by education level and occupation (employed/students, unemployed and disabled) - F (3,103)=16.734; p<0.001. Conclusions Sociodemographic factors play a major role for different function domains deficits in PS patients. Most pronounced is the impact of education and occupation. Patients with higher education and those engaged in study or work demonstrate better social functioning than less educated and disabled people. Key messages Education is an important protective factor for disability. Lower educational level decreases competitiveness in workforce market, both in general population and in patients with schizophrenia. Sociodemographic determinants should be considered in planning appropriate preventive and rehabilitation activities to stimulate better social functioning and adaptation of PS patients.