Free accessResearch articleFirst published online 1959-4
Factors Influencing First Admission Rates to Canadian Mental Hospitals.: III. An Analysis by Education,Marital Status,Country of Birth,Religion and Rural-Urban Residence,1950–1952.
This is the third and final part of a study of factors influencing first admission rates to Canadian mental hospitals, and consists of an analysis of variations in these rates (during the period 1950–1952) according to education, marital status, country of birth, religion and rural-urban residence.
In the two earlier parts of this study, variations according to time and place were analysed, and it was concluded that first admission rates do not simply reflect incidence, but that other basic determinants include such factors as the reliability of data and calculations, social judgement concerning what constitutes mental abnormality, social demand for mental hospital care, availability of mental hospital accommodation and of alternative facilities for psychiatric treatment, and variations in diagnostic criteria.
Nevertheless, variation in first admission rates may also result from variations in incidence, and in this event differences in rates between social groups may be interpreted as due to either selection (on the basis of established abnormality or of predisposition) or protection (against precipitating environmental stress or deprivation).
The present study confirms previous findings of high first admission rates among those of limited education; among the single, widowed and divorced; and among the foreign born, particularly fairly recent immigrants.
It appears that, in so far as these rates reflect differences in incidence, the latter are predominantly related to selection rather than protection; and it is postulated that selection (by education, marriage, migration, etc.) occurs on the basis of such factors as physical health, intellectual capacity, emotional stability and socio-economic opportunity.
Differences in rates according to religious affiliation and rural-urban residence have been discussed, and appear to reflect interaction of a number of variables.
References
1.
AndersonG. C. (1956) “Psychiatry's influence on religion”, Pastoral Psychology, Sept. 1956.
2.
BuckC., WanklinJ.M., and HobbsG. E. (1955a) “An analysis of regional differences in mental illness”,J. Nerv. & Ment. Dis., 122, 73.
3.
Eadem, (1955b) “A symptom analysis of rural-urban differences in first admission rates”,J. Nerv. & Ment. Dis., 122, 80.
4.
BurtC. (1957) “Inheritance of mental ability”, Eugenics Review, 49, 137.
5.
DaytonN. A. (1940) New Facts on Mental Disorders, Springfield, Illinois, Charles G Thomas, Chapters 3, 6 & 10.
6.
DewanJ. G. (1948) “Intelligence and emotional stability”,Amer. J. Psychiat., 104, 548.
7.
Dominion Bureau of Statistics (1953–1954) Annual Reports of Mental Institutions 1950–1952, Ottawa, Edmond Cloutier.
8.
Dominion Bureau of Statistics (1953) Census of Canada 1951, Volume II, Ottawa, Edmond Cloutier.
9.
Dominion Bureau of Statistics (1956, 1957) Unpublished mental health statistics.
10.
EisensteinV. W. (Editor) (1956) Neurotic Interaction in Marriage, New York, Basic Books, Inc.
11.
ElkindH. B. (1927) “The epidemiology of mental disease. A preliminary discussion”,Amer. J. Psychiat., 6, 623.
12.
FarisR. E. L., and DunhamH. W. (1939) Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses, Chicago, Univ. of Chicago Press.
13.
FellnerC. H., and WeilP. L. (1955) “Low normal intelligence and schizophrenia”, Amer.J. Psychiat., 112, 349.
14.
GayleR. F. (1956) “Conflict and cooperation between psychiatry and religion” (in Presidential Address), Amer.J. Psychiat., 113, 3.
15.
GerardD. L., and HoustonL. G. (1953) “Family setting and the social ecology of schizophrenia”,Psychiat. Quart., 27, 90.
16.
GoldhamerH., and MarshallA. W. (1949) Psychosis and Civilization, Glencoe, Illinois, The Free Press.
17.
GordonJ. E. (1950) “The newer epidemiology”, in Tomorrow's Horizon in Public Health, New York, Public Health Association of New York City.
18.
GordonJ. E., O'RourkeE., RichardsonF. L. W., and LindemannE. (1952) “The biological and social sciences in an epidemiology of mental disorder”, Amer.J. Med. Sci., 219, 321.
19.
GregoryI. (1956) “Factors influencing first admission rates to Canadian mental hospitals, I. An analysis of trends, 1932–1953”,Canad. Psychiat. Assoc. J., 1, 115.
20.
analysis of provincial differences, 1950–1952”,Canad. Psychiat, Assoc. J., in press.
21.
GruenbergE. M. (1950) in Epidemiology of Mental Disorder, New York, Milbank Memorial Fund, Pp. 36 & 176.
22.
HareE. H. (1952) “The ecology of mental disease”,J. Ment. Sci., 98, 37.
23.
Idem, (1955) “Mental illness and social class in Bristol”, Brit.J. prev. soc. Med., 9, 191.
24.
Idem, (1956) “Family setting and the urban distribution of schizophrenia”,J. Ment. Sci., 102, 753.
25.
Idem, (1959) “Factors influencing first admission rates to Canadian mental hospitals, II. An analysis of provincial differences, 1950–1952”,Canad. Psychiat. Assoc. J., 4, 51.
26.
HillA. B. (1955) Principles of Medical Statistics, New York, Oxford University Press,6th Ed., p. 215.
27.
HydeM. C., and KingsleyL. V. (1944) “Studies in medical sociology: II. The relation of mental disorders to population density”,New England J. Med., 231, 571.
28.
KailaM. (1942) “Uber die durchschnittshäufigkeit der geisteskrankheiten und des schwachsinns in Finnland”, Acta Psychiatric, 17, 47.
29.
KramerM., GoldsteinH., IsraelR. H., and JohnsonN. A. (1955) “A historical study of the disposition of first admissions to a state mental hospital”,Public Health Monograph No. 32, U.S. Dept. of Health, Education and Welfare, page 22.
30.
LaPousseR.MonkM.A., and TerrisM. (1956) “The drift hypothesis and socioeconomic differentials in schizophrenia”, Amer.J. Pub Hlth., 46, 978.
31.
LarssonT., and SjögrenT. (1954) A Methodological, Psychiatric and Statistical Study of a Large Swedish Rural Population, Acta Psychiatrica, Supplementum 89, page 139.
32.
LeeJ. A. H. (1957) “Regional variations in intellectual ability in Britain: A discussion of their importance, and of the possible effects of selective migration”, Eugenics Review, 49, 19.
33.
LemkauP., TietzeC., and CooperM. (1943) “A survey of statistical studies on the prevalence and incidence of mental disorder in sample populations”, Pub. Hlth. Reports, 58, 1909.
34.
MalzbergB. (1940) Social and Biological Aspects of Mental Disease, Utica, New York, State Hospitals Press, chapters 3, 4, 6, 12 and 15.
35.
MalzbergB. (1955a) “Trends of mental disease in New York State, 1920–1950”,Proc. Amer. Philosoph. Soc., 99, 174.
36.
MalzbergB. (1955b) “The distribution of mental diseases in New York State, 1949–1951”, Psychiat. Quart. Supplement, part 2.
37.
MalzbergB. (1955c) “Mental disease among the native and foreign-born white populations of New York State, 1939–1941”,Mental Hygiene, 39, 545.
38.
MalzbergB. (1956) “Education and mental disease in New York State”,Mental Hygiene, 40, 177.
39.
MalzbergB., and LeeE. S. (1956) Migration and Mental Disease, New York, Social Science Research Council.
40.
McKeownT. (1957) quoted by special correspondent,Brit. Med. J., 2, 936.
41.
MorganN. C., and JohnsonN. A. (1957) “Failures in psychiatry: the chronic hospital patient”, Amer.J. Psychiat., 113, 824.
42.
MoroneyM. J. (1956) Facts from Figures, Pelican Book No. A 236, Penguin Books, Ltd., 3rd ed., p. 334.
43.
NeelJ. V., and SchullW. J. (1954) Human Heredity, Chicago, University of Chicago Press, chapter 17.
44.
NorrisV. (1956) “A statistical study of the influence of marriage on the hospital care of the mentally sick”,J. Ment. Sci., 102, 467.
45.
ØdegaardØ. (1932) “Emigration and Insanity”,Acta psychiatrica, supplementum 4.
46.
ØdegaardØ. (1945) “The distribution of mental disease in Norway”, Acta psychiatrica,20, 247.
47.
ØdegaardØ. (1946) “Marriage and mental disease: a study in social psychopathology”,J. Ment Sci.,92.
48.
Idem (1952) “The incidence of mental diseases as measured by census investigations versus admission statistics”,Psychiat. Quart., 26, 212.
49.
Idem (1953) “New data on marriage and mental disease: the incidence of psychoses in the widowed and the divorced”,J. Ment. Sci., 99, 778.
50.
Idem (1956) “The incidence of psychoses in various occupations”, Internat.J. Soc. Psychiat., 2, 85.
51.
PenroseL. S. (1944) “Mental illness in husband and wife; a contribution to the study of assortative mating in man”, Psychiat. Quart. Supplement, part 2.
52.
QueenS. A. (1940) “The ecological study of mental disorders”,Amer. Sociol. Rev., 5, 201.
53.
RedlichF. C., HollingsheadA. B., RobertsB. H., RobinsonH. A., FreedmanL.Z., and MyersJ. K. (1953) “Social structure and psychiatric disorders”,Amer. J. Psychiat., 109, 729.
54.
RennieT. A. C., and SroleL. (1956) “Social class prevalence and distribution of psychomatic conditions in an urban population”,Psychosomat. Med., vol. 18, No. 6.
55.
RennieT. A. C., SroleL., OplerM. K., and LangnerT. S. (1957) “Urban life and mental health”, Amer.J. Psychiat., 113, 831.
56.
RobertsB. H., and MyersJ. K. (1954) “Religion, national origin, immigration, and mental illness”, Amer.J. Psychiat., 110, 759.
57.
RuchF. L. (1953) Psychology and Life, Chicago, Scott, Foresman and Co., 4th ed., Pp. 91–95.
58.
SchroederC. W. (1942) “Mental disorders in cities”, Amer.J. Sociol., 48, 40.
59.
SessionsP. M. (1957) “Ego religion and superego religion in alcoholics”, Quart.J. Stud. Alc., 18, 121.
60.
ShepherdE. A. (1954) “Current positions of American religious bodies on problems related to alcohol: summary of data, 1954”,Yale Summer School of Alcohol Studies, unpublished.
61.
SlaterE., and WoodsideM. (1951) Patterns of Marriage, London, Cassell & Co. Ltd.
62.
SroleL., and LangnerT. (1956) “Treated and untreated mental disorder in the metropolis”, presented at the meetings of the American Association for the Advancement of Science, December 28, 1956.
63.
StrömgrenE. (1950) “Statistical and genetical population studies within psychiatry. Methods and principal results”, in Congres International de Psychiatrie. Paris 1950, VI, Psychiatrie Sociale, Genetique et Eugenique, Paris, Hermann & Cie, Editeurs, p. 155.
64.
TermanL. M. (1940) “Psychological approaches to the biography of genius”,Science, 92, 293.
65.
TyhurstL. (1951) “Displacement and migration”, Amer.J. Psychiat., 107, 561.
66.
WanklinJ. M., FlemingD. F., BuckC. W., and HobbsG. E. (1955) “Factors influencing the rate of first admission to mental hospital,J. Nerv. & Ment. Dis., 121, 103.
