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Poverty, inequality and the treated incidence of first-episode psychosis

An ecological study from South Africa

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It is now commonly accepted that a range of psychosocial and environmental factors interact with genetic vulnerability in the genesis of psychotic illness. The aim of this study was to investigate whether measures of poverty and income inequality impact upon the treated incidence of first-episode psychosis (FEP) in the District of Umgungundlovu, South Africa.


Clinical and demographic data was collected from hospital records on all people aged 15–49 years from the District who presented to psychiatric services with FEP (DSM IV criteria) during 2005 (n = 160). All incident cases were grouped by municipality according to their recorded address. Measures of poverty and income inequality were calculated for each of the seven municipalities using data from the Statistics SA online database for the National Census 2001. Correlations were performed using SPSS to determine the relationships between treated incidence of FEP and poverty and inequality indices per municipality.


There was a significant positive relationship between treated incidence and Inequality Index (Partial correlation coefficient 0.840; P = 0.036) and a non-significant negative relationship between treated incidence and Poverty Measure per municipality (Partial correlation coefficient −0.660; P = 0.154). These findings remained significant after adjusting for gender, age, ethnicity, urbanicity and employment status. Importantly, these results were not adjusted for individual level poverty.


These findings lend support, in an African context, to increasing evidence that social, economic and political factors such as poverty and income inequality “shape both the landscape of risk for developing (psychosis) and the context in which health-care is provided” (Kelly in Soc Sci Med 61:721–730, 2005). These complex environmental factors appear to impact on the development and course of psychotic illness.

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  1. Boydell J, van Os J, McKenzie K, Murray RM (2004) The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 39:597–599

    Article  PubMed  CAS  Google Scholar 

  2. Brunner E (1997) Socioeconomic determinants of health: stress and the biology of inequality. BMJ 314:1472–1476

    PubMed  CAS  Google Scholar 

  3. Byrne M, Agerbo E, Eaton WW, Mortensen PB (2004) Parental socio-economic status and risk of first admission with schizophrenia—a Danish national register based study. Soc Psychiatry Psychiatr Epidemiol 39:87–96

    Article  PubMed  Google Scholar 

  4. Cantor-Graae E, Selten JP (2005) Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 162:12–24

    Article  PubMed  Google Scholar 

  5. Cohen CI (2002) Economic grand rounds: social inequality and health: will psychiatry assume centre stage? Psychiatr Serv 53:937–939

    Article  PubMed  Google Scholar 

  6. Cooper B (2005) Schizophrenia, social class and immigrant status: the epidemiological evidence. Epidemiol Psychiatr Soc 14:137–144

    Google Scholar 

  7. Deininger K, Squire L (1997) Economic growth and income inequality: reexamining the links. Finance and Development

  8. Diez-Roux AV, Link BG, Northridge ME (2000) A multilevel analysis of income inequality and cardiovascular disease risk factors. Soc Sci Med 50:673–687

    Article  PubMed  CAS  Google Scholar 

  9. Farmer P (2005) Pathologies of power. University of California Press, Berkeley

    Google Scholar 

  10. George SL, Shanks NJ, Westlake L (1991) Census of single homeless people in Sheffield. BMJ 302:1387–1389

    Article  PubMed  CAS  Google Scholar 

  11. Goldner EM, Hsu L, Waraich P, Somers JM (2002) Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Can J Psychiatry 47:833–843

    PubMed  Google Scholar 

  12. Gunnell D, Middleton N, Whitley E, Dorling D, Franker S (2003) Why are suicide rates rising in young men but falling in the elderly? Soc Sci Med 57:595–611

    Article  PubMed  Google Scholar 

  13. Harrison G, Gunnell D, Glazebrook C, Page K, Kwiecinski R (2001) Association between schizophrenia and social inequality at birth: a case-control study. Br J Psychiatry 179:346–350

    Article  PubMed  CAS  Google Scholar 

  14. Kahn RS, Wise PH, Kennedy BP, Kawachi I (2000) State income inequality, household income, and maternal mental and physical health: cross sectional national survey. BMJ 321:1311–1315

    Article  PubMed  CAS  Google Scholar 

  15. Kawachi I, Subramanian SV, Almeida-Filho N (2002) A glossary for health inequalities. J Epidemiol Community Health 56:647–652

    Article  PubMed  CAS  Google Scholar 

  16. Kawachi I, Kennedy BP (1997) Socioeconomic determinants of health: health and social cohesion: why care about income inequality? Br Med J 314:1037–1040

    CAS  Google Scholar 

  17. Kelly BD (2005) Structural violence and schizophrenia. Soc Sci Med 61:721–730

    Article  PubMed  Google Scholar 

  18. Kennedy BP, Kawachi I, Prothrow-Stith D (1996) Income distribution and mortality: cross-sectional ecological study of the Robin Hood Index in the United States. BMJ 312:1004–1007

    PubMed  CAS  Google Scholar 

  19. Krabbendam L, van Os J (2005) Schizophrenia and urbanicity: a major environmental influence—conditional on genetic risk. Schiz Res 31:795–799

    Google Scholar 

  20. Kuznets S (1955) Economic growth and income inequality. Am Econ Rev 45:1–28

    Google Scholar 

  21. Lynch JW, Davey Smith G, Kaplan GA, House JS (2000) Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 320:1200–1204

    Article  PubMed  CAS  Google Scholar 

  22. Marwaha S, Johnson S (2004) Schizophrenia and employment. Soc Psychiatry Psychiatr Epidemiol 39:337–349

    Article  PubMed  Google Scholar 

  23. Mashaphu S, Mkize DL (2007) HIV seropositivity in first-episode psychosis. SAJP 13:90–94

    Google Scholar 

  24. Saha S, Chant D, Welham J, McGrath J (2005) A systematic review of the prevalence of schizophrenia. PLoS Med 2:e141

    Article  PubMed  Google Scholar 

  25. StatsOnline (2007) Statistics South Africa (accessed 14 December 2007)

  26. Sturm R, Gresenz CR (2002) Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. BMJ 324:1–5

    Article  Google Scholar 

  27. Subramanian SV, Kawachi I (2004) Income inequality and health: what have we learned so far? Epidemiol Rev 26:78–91

    Article  PubMed  CAS  Google Scholar 

  28. Van Os J, Krabbendam L, Myin-Germys I, Delespaul P (2005) The schizophrenia envirome. Curr Opin Psychiatry 18:141–145

    Article  PubMed  Google Scholar 

  29. Weich S, Lewis G, Jenkins SP (2001) Income inequality and the prevalence of common mental disorders in Britain. Br J Psychiatry 178:222–227

    Article  PubMed  CAS  Google Scholar 

  30. Wicks S, Hjern A, Gunnell D, Lewis G, Dalman C (2005) Social adversity in childhood and the risk of developing psychosis: a national cohort study. Am J Psychiatry 162:1652–1657

    Article  PubMed  Google Scholar 

  31. Wilkinson RG (1992) Income distribution and life expectancy. BMJ 304:165–168

    PubMed  CAS  Google Scholar 

  32. Wilkinson RG (1996) Unhealthy societies: the afflictions of inequality. Routledge, London

    Google Scholar 

  33. Wood A (2005) Empirical studies of the correlation between social and economic inequalities and violence. International Conference of the World Organisation Against Torture: (accessed 14 December 2007)

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Correspondence to Jonathan K. Burns.

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Burns, J.K., Esterhuizen, T. Poverty, inequality and the treated incidence of first-episode psychosis. Soc Psychiat Epidemiol 43, 331–335 (2008).

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