Schizophrenia and the life course: national findings on gender differences in disability and service use

This article compares the social disability and service utilization across the life course of men and women with schizophrenia. Based on an analysis of data from the 1989 Mental Health Supplement to the National Health Interview Survey (n = 376), we compare functional limitations, service utilization and social integration among younger, middle aged, and older age groups. Compared to those with manic depression, individuals with schizophrenia are more disabled, and are more socially disadvantaged. These data confirm the generally held view of schizophrenia as the most disabling mental illness, point to the very high levels of need associated with it, and emphasize the need for general health care. Findings from the multivariate analysis provide mixed support for our hypotheses. Contrary to expectations based on new findings in the literature on course and outcome in schizophrenia, disability (both service utilization and functional limitations) was greater among older and middle aged adults than among their younger counterparts. In contrast, older individuals with schizophrenia appear to be more connected to potential sources of support. From a policy perspective, those improvements in social integration which do appear with age--whether marriage for men or the ability to make and keep friends among women--have their primary impact on the quality of life of the individual, without any direct opportunity for cost saving in terms of services to the seriously mentally ill.