Socioeconomic Status and Psychiatric Disorders: The Causation-Selection Issue

TLDR

Ethnic status is determined at birth, whereas socioeconomic status depends on education and occupation, making it a suitable proxy for studying causation versus selection in psychiatric disorders. The study investigates whether inverse relationships between psychiatric disorders and socioeconomic status are driven by social causation or social selection, using ethnic status as the key variable. A birth cohort of 4,914 Israeli adults of European and North African descent was selected from the national register, screened, and diagnosed by psychiatrists, and their ethnic status was linked to socioeconomic outcomes. Results show that social selection predominates for schizophrenia, while social causation predominates for depression in women and for antisocial personality and substance use disorders in men.

Abstract

Are inverse relations between psychiatric disorders and socioeconomic status due more to social causation (adversity and stress) or social selection (downward mobility of genetically predisposed)? This classical epidemiological issue is tested by focusing on ethnic status in relation to socioeconomic status. Ethnic status cannot be an effect of disorder because it is present at birth whereas socioeconomic status depends on educational and occupational attainment. A birth cohort sample of 4914 young, Israel-born adults of European and North African background was selected from the country's population register, screened, and diagnosed by psychiatrists. Results indicate that social selection may be more important for schizophrenia and that social causation may be more important for depression in women and for antisocial personality and substance use disorders in men.