Occupation and schizophrenia in a Xhosa population--a variant of the social drift theory?

To the Editor: As we are all aware, schizophrenia is a prevalent disorder (1% prevalence rate in the general population), with a substantial effect on social and occupational functioning. In fact it could be said that functional impairment constitutes an integral part of the illness and is reflected in the poor social environment and unemployment status these patients often find themselves trapped in. The impact on functioning may be reflected by the inverse relationship between social class and schizophrenia reported in most epidemiological studies. 1,2 This inverse relationship can be explained by the so-called well-known 'social drift theory' which maintains that the illness interferes with the expected social and functional development of the individual. The World Health Organisation 10-country study 3 evaluated employment status as one of the parameters of schizophrenia. Across all 10 countries 43-97% of patients suffering from schizophrenia had some occupational history. This supports the fact that the majority of people suffering from this serious illness were able to work at some stage of their lives, most likely before the onset of symptoms. To date, however, there has been little study of occupational status in a South African population suffering from schizophrenia. We therefore decided to examine parental and patient occupational status in a Xhosa-speaking group suffering from schizophrenia. We argued that the occupational status of these patients would be an indirect measure of their social status. Three hundred and fifty-four men and 106 women took part in the study. Their mean age at interview was 36.9 (± 9.97) years. The mean age of onset of schizophrenia was 22.87 (± 6.1) years. The majority of patients (61.1%) reported some previous employment history. Thirty-eight per cent (38.7%) of the group had previously been employed as handlers, equipment cleaners, helpers or labourers. A sizeable proportion (17%) reported their highest previous level of function as that of full-time student. One-fifth (21.9%) of the group had never been gainfully employed, while 1.1% previously occupied managerial, professional or specialty positions. Sixty-seven per cent of subjects had been gainfully employed for most of their lives before the interview. Again, handlers, equipment cleaners, helpers and labourers constituted the largest group (37.2%), while 2.6% functioned at managerial, professional and specialty level. This study therefore found the majority of patients with schizophrenia to have a previous history of gainful employment. This is comparable to findings in other countries, and even higher than findings in other developing …