Is Recovery from Schizophrenia a Privilege? The Relationship Between Socioeconomic Status, Race and Remission from Serious Mental Illness
Despite growing recognition that some people may recover from schizophrenia and other psychoses, potential social determinants of recovery remain largely unexplored. There is some evidence that psychological well-being, quality of life and educational and occupational outcomes are impacted by race, childhood socioeconomic status, and current poverty, but no evidence exists as to how the interaction of these variables might impact the recovery efforts of people with psychotic disorder over time. This study looks at the impact of privilege (conceptualized as race, childhood socioeconomic status and current poverty) on outcomes related to recovery: remission, quality of life, clinical global functioning, and educational and occupational status. The analysis was conducted using data from the Recovery After an Initial Schizophrenia Episode (RAISE) study. A total of 404 subjects who were experiencing first episode psychosis were enrolled in the study, across 34 sites in the U.S. Latent class analysis established the three privilege groups, higher, middle and lower, and multilevel modeling was used to evaluate the differences between the three privilege groups on the outcome variables.
Results indicated that the higher privilege group had significantly better quality of life and clinical global functioning than did the other two groups, with and without covariates. However, there were no significant difference between the middle and lower privilege groups once the covariates were added. Though the higher privilege group had distinctly higher rates of remission throughout all RAISE assessments, the differences were not statistically significant. The results indicated that the covariates, diagnosis, treatment type and marital status, also significantly impacted outcomes.
Due to large amounts of missing data and unequal attrition among privilege groups, these results may be considered hypothesis-generating only. The results remain important, however, as this is the only study that is looking at the effects of privilege on recovery outcomes in people with schizophrenia and as such the need for further research exploring this relationship is warranted. This may help us better understand the social determinants related to recovery in psychosis and find specific areas, in which treatment can be improved, including directly addressing potential issues with race and economic distress.