Social precursors to onset and recovery from episodes of common mental illness.

Background: Social disadvantage and lack of social support have been identified as important risk factors for the onset and continuance of episodes of common mental illness. This study aimed to identify the social precursors to episodes of and recovery from common mental illness in a large, general population sample over eight yearly intervals.

Method: The analytical samples were drawn from those aged > or = 16 in the British Household Panel Survey from 1991 to 1998. The samples were: (1) onset--over 42,000 paired years from 10,204 persons; (2) recovery--over 10,000 paired years from 4878 persons; and (3) 1812 spells with observed onset and recovery. Markov and discrete-time complementary log-log models were used. Common mental illness was measured using the 12-item General Health Questionnaire.

Results: Sex, age, changes in marital and employment status, physical health, family care and social support were all associated with differential rates of onset and recovery. Severity of disorder was associated with less likelihood of recovery and longer time to recovery.

Conclusions: The study confirms many previous findings concerning social factors associated with onset and recovery. Low social support acted as expected by increasing chances of onset and decreasing chances of recovery. Other social factors such as separation or divorce, becoming and remaining unemployed, health limiting daily activities, caring for a sick relative all decreased chances of recovery. The chances of observing a change in state (either onset or recovery) decreased with the number of prior observations in that state. Reduced rates of recovery with increasing degrees of severity of distress was expected, but not previously demonstrated.