King's College London

All three of these outcomes were strongly linked to living alone and substance misuse, indicating these factors could play an important role in helping to address and prevent health and economic inequalities in this group.

The research was funded by the ESRC Centre for Society and Mental Health and NIHR Maudsley BRC.

People with severe mental illnesses such as schizophrenia and bipolar disorder are known to experience debilitating health conditions and to have a lower likelihood of employment compared to the general population. Little research has been done to explore the social factors that could influence these outcomes. In particular, employment has rarely been the focus of larger investigations.

To address this issue, researchers have used a unique tool called the Clinical Record Interactive Search (CRIS) which can analyse anonymised mental health records from South London and Maudsley NHS Foundation Trust. This data has been linked to UK Census data at person-level, which has socioeconomic information such as employment, living arrangements, housing tenure, education. The linkage is one of the first of its kind in England and has brought information on people’s social circumstances into mental healthcare records for the first time. This type of information is usually missing in health records. The study also benefited from including census data from 596,124 people not in contact with mental health services, which enabled comparisons to be made.

The study focused on those with a diagnosis of schizophrenia-spectrum or bipolar affective disorders, and the researchers investigated how employment status, self-rated health and disability were reported at census. Health and disability were from self-reported measures from the Census and ‘employed’ was defined as having worked more than 15 hours the preceding week.

Published in Schizophrenia Bulletin, the findings highlight the considerable social exclusion and disability experienced by individuals living with severe mental illness. The sample comprised 8,249 people with a diagnosis of schizophrenia or bipolar affective disorders, and a comparison group of 596,124 people without these conditions. Whereas 77.3 per cent of people with schizophrenia reported economic inactivity in the last week, 68.3 per cent reported disability and 61.1 per cent reported poor health, much lower proportions of the general population comparison group reported economic inactivity (29.4%), disability (13.3%) and poor health (16.2%).

Substance misuse and living alone were both associated with economic inactivity, poorer self-rated health, and disability. This agrees with previous findings that social isolation is linked to an increased risk for diagnosis of severe mental illness. However, researchers stress that living alone could be due to other factors such as stigma and discrimination which could be the driving factors of inequalities.

Relative to the White British group, Black African, South Asian, and Other Black groups were more likely to be economically inactive. Black Caribbean and other groups were less likely to report poorer health or disability.

The study provides insight into the different factors at play in the health and social inequalities shown by those with severe mental illness, which could help inform new approaches to support this group.

'Health, Disability, and Economic Inactivity Following a Diagnosis of a Severe Mental Illness: Cohort Study of Electronic Health Records Linked at the Individual-Level, to Census from England' (L Cybulski, M E Dewey, R Hildersley, C Morgan, R Stewart, M Wuerth, J Das-Munshi) was published in Schizophrenia Bulletin. DOI: 10.1093/schbul/sbae195/7912352