Social Class and Psychiatric Disturbance among Women in an Urban Population

While an association between social status and prevalence of psychiatric disurbance has often been reported, little has been established about aetiology or its significance for social class differences. In a survey of a random sample of women living in south London a large class difference in the prevalence of psychiatric disturbance was found. This difference is particularly great among women with young children at home. This paper examines why working class women have a greater prevalence of (i) conditions with an onset in the year before interview and (ii) conditions that have lasted longer than one year. Severe life-events and major long term difficulties occurring in the year before onset play an important aetiological role. However although these aetiological agents are more common among working class women, they only explain a small part of the social class differences. The class difference is essentially due not to the greater frequency of events and difficulties but to the much greater likelihood of working class women breaking down once one of these has occurred; this greater vulnerability is shown to relate to certain social factors. The greater likelihood of working class women suffering from chronic psychiatric disturbance is also shown to relate to environmental differences. Results for a series of depressive patients treated by psychiatrists support these interpretations; but it is necessary to take into account `treatment seeking' factors.