Social influences on the prognosis of schizophrenia

Literature relating to social influences on prognosis of schizophrenia is selectively reviewed. The influence of the care system is considered separately from other social influences such as business cycle fluctuations, community organization and attitudes, social class membership, independent events in the patient's life, and expression of emotion by the patient's family members. Several studies of milieu indicate that milieu can influence course of illness for better, or for worse. One study of group psychotherapy suggests that groups help improve social function of schizophrenics in the community. Studies of individual psychotherapy fail to demonstrate its efficacy. Business cycle fluctuations clearly relate to admission rates of schizophrenics to hospitals; independent life events are associated with onset and relapse. Community attitudes and family emotional expression relate to relapse and rehospitalization. Clearly, social events, especially those occurring outside the care system, do influence the course of illness. There is also evidence for the influence of psychosocial treatment but at the present time is less consistent the evidence for the influence of other social events on the prognosis and course in schizophrenia.