Work environment and schizophrenia: an extension of the arousal hypothesis to occupational self-selection

The present study investigated a possible mechanism underlying the occupational self-selection of future schizophrenic patients prior to their first admission. More precisely, we explored whether schizophrenic patients are more likely than other psychotic patients to work in environments with a low potential for arousal (low complexity environments) in the last full-time job that preceded their hospitalization. All first admissions with psychotic symptoms to 15 hospitals providing inpatient psychiatric services in the Baltimore-Washington area were surveyed during a 6-year period. Patients diagnosed with schizophrenia were compared to patients diagnosed with bipolar disorder and other psychotic disorders to evaluate the suspected association. Study participants were assessed with a modified version of the Diagnostic Interview Schedule. Standard survey questions were used to assess occupational background. A measure based on the dictionary of occupational titles (DOT) was used to estimate the degree of complexity to which patients had been exposed in their last full-time occupation. Data were analyzed using multinomial logistic regression. After adjustment for age, gender, marital status, unemployment, socioeconomic status, hospital type, and physical demands and hazards on the job, patients with schizophrenia were more likely to have been working in low complexity environments in their last full-time jobs (e.g., janitors, gardeners, guards) than patients with bipolar disorder or with other psychotic disorders. Alternative explanations and potential implications regarding which work environments might be best suited to the social behavior of patients with schizophrenia are examined.