# 07 - Society as a risk factor

# Society as a risk factor

© SPMM Course 
6. Social factors and mental health issues 
Society as a risk factor 
Engel’s model of biopsychosocial approach is widely used in aetiological formulations in 
psychiatric practice, highlighting the prominence of social factors in the practice of 
psychiatry. 
Social Causation Theory: According to this concept, mental illnesses are caused by social 
deprivation. Most psychiatric disorders are seen in lower socio-economic class as a mental 
disorder is seen as directly due to the poverty and social conditions. This theory may hold for 
some conditions such as depression or alcohol misuse, but not for others such as bipolar 
disorder or schizophrenia. 
In a survey sampling males aged 25-34 on first 
admission of schizophrenia, an expected excess 
of social class V was noted but social class 
distribution of fathers of the patients was the 
same as the general population suggesting that 
schizophrenia results in a downward drift of 
economic status rather than poverty being a 
cause for schizophrenia. This Social Drift or 
Social Selection Theory was first suggested by 
Faris & Dunham on the basis of their ‘Chicago 
study 1922 – 1934’ that explored the relation 
between the spatial distribution of psychosis and 
social organization by applying the concentric zone 
model of urban organization (see the figure from 
university of Manitoba, Centre of Health Policy 
website). In this model, the social organization increased with distance from the epicenter. 
(Inner urban zones = most disorganized and unstable communities; outer zones = most 
organized and stable communities). Faris and Dunham found that the least socially 
organized inner urban zones had the highest rates of schizophrenia; they argued that this 
effect was due to the downward drift in economic status after developing the illness. 
 
Factors mediating the effect of social class: Several factors such as lower educational levels, 
poverty, immigration, overcrowding, poorer physical health and nutrition influence the 
higher prevalence of mental illness in some social classes. For example, high parental 
education levels are associated with a lower risk of ADHD, especially in boys. There is no 
proven link with food additives but lead exposure is associated with risk. Similarly,