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Employment outcome for people with schizophrenia in rural v. urban China: population-based study

  • Lawrence H. Yang (a1), Michael R. Phillips (a2), Xianyun Li (a3), Gary Yu (a4), Jingxuan Zhang (a5), Qichang Shi (a6), Zhiqiang Song (a7), Zhijie Ding (a8), Shutao Pang (a9) and Ezra Susser (a10)...

Abstract

Background

Although outcomes among people with schizophrenia differ by social context, this has rarely been examined across rural v. urban settings. For individuals with schizophrenia, employment is widely recognised as a critical ingredient of social integration.

Aims

To compare employment for people with schizophrenia in rural v. urban settings in China.

Method

In a large community-based study in four provinces representing 12% of China's population, we identified 393 people with schizophrenia (112 never treated). We used adjusted Poisson regression models to compare employment for those living in rural (n = 297) v. urban (n = 96) settings.

Results

Although rural and urban residents had similar impairments due to symptoms, rural residents were three times more likely to be employed (adjusted relative risk 3.27, 95% Cl 2.11-5.07, P<0.001).

Conclusions

People with schizophrenia have greater opportunities to use their capacities for productive work in rural than urban settings in China. Contextual mechanisms that may explain this result offer a useful focus for future research.

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Copyright

Corresponding author

Lawrence H. Yang, PhD, Columbia University, Department of Epidemiology, School of Public Health, 722 West 168th Street, Room 1610, New York, NY 10032, USA. Email: lhy2001@columbia.edu

Footnotes

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These authors contributed equally to the work.

See editorial, pp. 247–249, this issue.

Declaration of interest

None.

Footnotes

References

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Employment outcome for people with schizophrenia in rural v. urban China: population-based study

  • Lawrence H. Yang (a1), Michael R. Phillips (a2), Xianyun Li (a3), Gary Yu (a4), Jingxuan Zhang (a5), Qichang Shi (a6), Zhiqiang Song (a7), Zhijie Ding (a8), Shutao Pang (a9) and Ezra Susser (a10)...
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eLetters

The rural employment advantage in psychotic patients- Is it real?

Sundar Gnanavel, Senior Resident, Department of Psychiatry
04 February 2014

The population based study on employment outcome for people with schizophrenia in rural vs urban China by Yang et al made for an interesting read and has revived the issue of rural advantage in psychotic patients as compared to an urban setting in terms of functional outcome.[1] However, I would like to point out a few methodological issues and practical considerations in the study that limit the interpretation of the study results. Non-inclusion of premorbid employment as a sociodemographic variable prevents us from gaining insight into the current employment status as a functional outcome marker. In addition, not incorporating elements of total work hours, income status and most importantly satisfaction with the current employment and simply considering the dichotomy of employed and unemployed with six subcategories in toto seems too simplistic considering that employment outcome is the primary and infact only outcome that the study deals with. Inclusion of the category of underemployment (in addition to the categories of employed and unemployed) defined as employment not commensurate with one's educational level or premorbid occupational functioning might have provided further valuable information regarding the employment outcome in these patients.[2] Not including the type of psychotic illness in the regression model is a major drawback considering some forms of psychotic illnesses included in the study like delusional disorder and brief psychotic disorder typically are associated with better functional outcome as compared to other psychotic illnesses like schizophrenia which has been documented in previous studies.[3,4]Further, a basic question that has been left unaddressed in the discussion by the authors is whether the differences in rates of employment in psychotic patients in rural vs urban China is just reflective of differences in the overall employment-unemployment rates for general population in the rural and urban regions of the country. Reports have documented higher unemployment in the urban regions of the country as compared to the rural regions.[5] It would also be important to conceptualise the concept of social integration or social inclusion that the authors have discussed as a composite of employment, community networking and a supportive social environment without undue emphasis on only employment measures.[6] Last, but not the least, the authors could have avoided using the term schizophrenia as a synonym for psychotic illnesses in the title considering the spectrum of psychotic illnesses apart from schizophrenia the study population has covered.Not withstanding the above methodological issues and practical considerations, I would like to congratulate the authors for undertaking a population based study addressing the crucial issue of rural advantage in psychotic illnesses and the variables mediating the advantage that has potential policy implications in this disadvantaged population.

REFERENCES:

1.Yang LH, Phillips MR, Li X, Yu G, Zhang J, Shi Q, et al. Employment outcome for people with schizophrenia in rural v. urban China: population-based study. Br J Psychiatry 2013;203:272-9. 2. www.ilo.org [homepage on the internet]. International Labour Organisation c1996-2013 http://www.ilo.org/global/statistics-and-databases/statistics-overview-and-topics/underemployment/current-guidelines/lang--en/index.htm [cited 2013 Dec 13]3.Jorgensen P. Course and outcome in delusional disorders. Psychopathology 1994;27(1-2):79-88.4.Pillmann F, Wustmann T, Marneros A. Acute and transient psychotic disorders versus persistent delusional disorders: a comparative longitudinal study. Psychiatry Clin Neurosci. 2012;66(1):44-52. 5.www.clb.org.hk [homepage on the internet] China labour bulletin. http://www.clb.org.hk/en/content/employment-china [cited 2013 Dec 13].6.Baumgartner JN, Susser E. Social integration in global mental health:what is it and how can it be measured? Epidemiol Psychiatr Sci 2013;22(1):29-37.
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Conflict of interest: None declared

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