Occupational characteristics and the occurrence of psychotic disorders

This study was undertaken to investigate whether individuals working under various occupational stressors are at increased risk of three forms of psychotic conditions. This paper presents prospective analyses of antecedent occupational stressors in psychotic conditions with interview data from a community sample in five US metropolitan areas--the NIMH Epidemiologic Catchment Area Program. Three non-overlapping conditions were defined using DSM-III definitions as assessed by the Diagnostic Interview Schedule (DIS): (1) DSM-III schizophrenia criterion A; (2) full schizophrenia; and (3) criterion A and affective episode. Artistic (RR = 3.32, 95% CI 1.08-10.14) and construction trades occupations (RR = 2.58, 95% CI 1.15-5.77), "noisome working conditions" occupations (RR = 1.20, 95% CI 0.99-1.47) and physically demanding occupations (RR = 1.39, 95% CI 1.05-1.72) were associated with increased risk of developing DIS/DSM-III schizophrenia criterion A, even after adjustment for sociodemographic and psychopathology factors including alcohol and marijuana use. Psychologically demanding occupations (RR = 0.85, 95% CI 0.75-0.95) were associated with decreased risk of developing DIS/DSM-III schizophrenia. This finding is supported by results from experimental studies on the arousability of pre-schizophrenics. Finally, teachers (RR = 11.35, 95% CI 2.56-50.38), sales occupations (RR = 4.16, 95% CI 1.00-21.30) and occupations characterized by low control over work were associated with increased risk of developing DIS criterion A and affective episode, resembling previous findings on occupational stressors and depression. Overall, our results replicate and extend previous work on occupational stressors and psychotic conditions through use of prospective data, several psychotic conditions, multiple assessment of occupational stressors and adjustment for potential confounders.