Social class and mental disorders

Summary We have ascertained the social class distribution at different care levels for a semi-rural area of southeastern Bavaria. The analysis is based on a prevalence study of psychiatric patients treated as in-and outpatients (n=3,788), a study of patients in general practices (n = 1,274) and a field study (n= 1,536). The first study is based solely on secondary statistical material (case histories); in the latter two studies, the psychiatric diagnosis was reached with the aid of the Clinical Psychiatric Interview (Goldberg et al. 1970). In classifying the psychiatric diagnoses we used the ICD (8th revision). Social class was recorded in all three samples according to the classification of Moore and Kleining (1960). During the first 6 months of 1971, psychiatric outpatients were clearly overrepresented in the lower social classes, above all in the upper working class. With the exception of the diagnoses of (pre)senile dementia and other organic mental disorders, significant class differences were found. The lower the social class, the higher the rate of inpatient treatment (6 months' treated prevalence). The rate for the lower working class was especially high. The differences in class distribution between in-and outpatients are due primarily to those patients resident on 1 January 1971, mostly chronically ill, who, to a great extent, belong to the lower class. No significant difference exists between the social class distributions of inpatient and outpatient admissions, whether first or readmissions. In contrast to those under psychiatric treatment, and with the exception of the mentally retarded, we found no significant classspecific differences for patients in general practices. The rate of mental illnesses in need of treatment in the lower lower class in the field study was clearly higher than the expected value for the general population. The high rate in Class V is due to the diagnoses of mental retardation, alcoholism and neurotic/psychosomatic illnesses.This study was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft) within the research division Psychiatric Epidemiology (Sonderforschungsbereich 116, Psychiatrische Epidemiologie). Revised version of a paper presented at the 31st Congress of the Deutsche Gesellschaft für Psychologie in Mannheim, FRG, 17–21 September 1978.