Sociocultural Factors in Schizophrenia
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1
What are sociocultural factors?
All aspects of society & culture in which an individual lives that affect their behaviour.
2
What did Boydell et al. (2004) propose about explaining schizophrenia?
Social environment cannot be ignored when understanding causes of schizophrenia. Both social & biological factors need studying; including their interaction.
3
What did Faris & Dunham (1939) report about urbanicity?
Greater incidence of schizophrenia in densely populated inner-city Chicago than less populated outskirts -> urban populations show higher incidence.
4
What did Van Os et al. (2010) report about urban upbringing?
0.5% higher incidence of schizophrenia among people born & raised in urban areas.
5
Which factors did Krabbendam & Van Os (2005) identify?
Greater socioeconomic adversity & environmental pollution; including overcrowding; drug abuse; exposure to toxins & infectious agents = factors influencing incidence of schizophrenia.
6
Why do the notes emphasise understanding urbanicity mechanisms?
Notes cite UN estimate that 66% of world population will live in urban areas by 2050 -> mechanism requires careful consideration.
7
What social backgrounds are reported by individuals with schizophrenia?
Solitary backgrounds; few friends & more limited social networks than individuals without schizophrenia.
8
How did Faris (1934) explain withdrawal & social isolation?
Contact with others experienced as stressful -> withdrawal. Urbanity & overcrowding can also lead to social isolation.
9
How might self-imposed isolation affect behaviour & thoughts?
Cuts individual off from feedback about inappropriate / antisocial behaviours & thoughts -> begins to act more strangely.
10
What was the design & sample of Jones et al. (1994)?
Longitudinal study of 5362 people born during a specific week in March 1946; found 30 diagnoses of schizophrenia. Primarily used 1946 birth cohort to support a neurodevelopmental model.
11
Which childhood & adolescent findings are given for Jones et al. (1994)?
Future patients more likely to prefer solitary play at ages 4-6. Printed slide = at age 13 more likely to rate themselves less socially confident. Handwritten mini essay also describes elevated social anxiety at 15 & significantly higher odds ratios for solitary play.
12
How do the Jones findings support sociocultural explanations?
Future patients show altered sociocultural development long before clinical onset. Early isolation can be conceptualised as a sociocultural stressor rather than purely a passive prodromal symptom.
13
How could early withdrawal interact with biological vulnerability?
Withdrawal deprives individual of a strong social-support network -> entrenches cycle of social defeat -> interacts dynamically with biological vulnerabilities -> increased risk of adult psychosis.
14
What pattern involving Afro-Caribbean populations is described by Ineichen (1984)?
Since 1970s; higher schizophrenia rates shown in Afro-Caribbean populations. Also more likely to be compulsorily admitted to psychiatric hospitals.
15
How do Mahy et al. (1999) findings challenge a genetic explanation of this pattern?
Increased risk not apparent in Caribbean population. Notes therefore argue against a genetic explanation for higher rates in migrant populations & suggest additional stress from migration / assimilation.
16
What did Harrison et al. (1988) find?
Increased diagnosis among children of Afro-Caribbean migrants in UK.
17
What explanations are proposed for higher rates in these populations?
Stress from migration & assimilation; discrimination in society & psychiatry = proposed explanations for higher incidence / diagnosis.
18
Which four risk factors do epidemiologists identify?
Being male; being a migrant; living in an urban environment & being born poor / in poverty.
19
What is unclear about concurrency in risk factors?
Whether sociocultural risk factors work concurrently or some predispose individuals to a higher risk than others.
20
What schizophrenia diagnosis rates were reported in Russia & UK in 1974?
Russia = 6 per 1000; UK = 3 per 1000.
21
What was sluggish schizophrenia & how was it used?
Soviet-era psychiatrists increasingly diagnosed this subtype even without symptoms / evidence of underlying psychiatric pathology. State & KGB used diagnosis to incarcerate thousands of political activists in mental institutions.
22
What change in Russian diagnosis is described after fall of communism?
Notes describe use of ICD & diagnosis rates levelling out to resemble other Western countries.
23
Why is urbanicity as a social stressor questioned?
Unclear whether urban living genuinely increases social stress compared with rural settings. Urban environments may also offer protective resources.
24
Which potential benefits of urban environments are identified?
Access to healthcare; higher employment rates; better educational levels & higher social capital.
25
What did McKenzie et al. (2002) propose?
Higher social capital may protect individuals from stress.
26
What does this imply about urbanicity as an explanation?
Uncertain whether urbanicity itself acts as a stressor or is confounded by complex interplay of environmental factors such as pollution. Urban-rural associations alone do not identify which factors account for risk.
27
What does the social drift hypothesis propose?
Developing mental illness such as schizophrenia -> decline in socioeconomic status -> migration to inner-city areas.
28
How does social drift challenge urbanicity as a cause?
Creates false impression urbanicity causes schizophrenia when urban residence may instead be an effect of illness -> direction of cause & effect uncertain.
29
What contrasting evidence did Pedersen & Mortensen (2001) report?
Individuals at higher risk of psychotic disorders reduced likelihood of developing schizophrenia when moving to more rural environments.
30
How does Pedersen & Mortensen challenge social drift?
Moving to rural environments linked with reduced risk -> supports direct link between urban living & onset; contrasts with explanation that urban residence merely follows illness.
31
What is the main causal limitation of social-isolation explanations?
Social isolation correlates with schizophrenia but establishing directionality is difficult. May be primary cause or early behavioural indicator of oncoming psychosis.
32
What did Van Os et al. (2000) find?
Single people living in neighbourhoods with fewer single individuals faced greater risk of developing schizophrenia -> supports social isolation as a relevant factor.
33
Why are longitudinal findings insufficient to settle causation?
Longitudinal data such as Jones et al. (1994) help; but definitive conclusions remain elusive. Controlled interventions such as community befriending groups need proper implementation to clarify role of isolation.
34
Why is ethnicity as a causal factor difficult to establish?
Unclear whether ethnicity itself or institutional discrimination accounts for higher schizophrenia rates observed in Afro-Caribbean populations.
35
How could psychiatric prejudice inflate diagnosis rates?
Past negative encounters with authority figures -> suspicion towards psychiatrists. Suspicion may be mislabelled as paranoia -> artificially inflated diagnostic rates.
36
What did Boydell et al. (2001) report about local ethnic composition?
Schizophrenia incidence among ethnic minorities increases as proportion of ethnic minorities in local area falls -> intensified social isolation.
37
What conclusion follows about ethnicity & discrimination?
Ethnicity; minority stress & psychiatric prejudice heavily intertwined -> difficult to assess as singular unlinked causes. Sociocultural accounts broaden environmental understanding but face methodological & causal limitations.
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