COMMUNITY ADJUSTMENT O F SCHIZOPHRENICS1 DAVID LEVINE AND LOUIS DELMAN

Univeraity of Nebraska V . A . Hospital, Lyons, N . J .

PROBLEM This study is an exploratory investigation of the manner in which psychiatric

hospitalization is related to other psychological variables. The design of the study is a comparison of two groups of Veterans Administration neuropsychiatric hospital patients. One group consists of schizophrenics who remained out of the mental hospital for a t least five years following their first trial visit, while the second group consists of patients who returned to the hospital within the five-year period.

METHOD The sample consisted of those male, white, World War I1 veteran, schizophrenic

patients released for their first “trial visit” from a Veterans Administration neuro- psychiatric hospital during 1947 who had no previous neuropsychiatric hospitaliza- tions. Any patient on whom five-yea.r follow-up data could not be obtained was dropped from the study.

For each of the remaining subjects, all official Veterans Administration folders were obtained. The material in these folders was read by one of several V. A. staff psychologists, who then completed a questionnaire and rating form covering the following general areas: descriptive data, socio-economic status, family background, early childhood, military experiences, attitudes towa,rd “his illness” , personality characteristics, self-concept and goals, history of anti-social behavior, and present family picture.*

RESULTS The results indicate that schizophrenics who are readmitted from a trial visit

differ in some important respects from those who remain in the community for a t least five years, The readmitted patient is likely to have been older at the time he went on trial visit ( P < .05)3 and to have spent more time in the hospital prior to his release ( P < .05). These findings support the importance of a distinction between the “chronic” or process and the “acute” or reactive schizophrenic and are consistent with the data in the literature. The difference which reaches the highest level of statistical significance ( P < .Ol), however, is one which does not generally receive much attention: religion. The findings indicate that Catholics are more likely to be readmitted than Protestants. (The sample of Jews is too small to be meaningful.)

In order to cross-validate the present study, a second sample of schizophrenics was selected utilizing the same criteria as were employed in selecting the original sample. Although the records for all trial visits starting in 1951 were studied, only 35 patients fulfilled all criteria for inclusion in the cross-validation study. Analysis indicates, moreover, that the two samples differ significantly on important variables. The cross-validation sample is an older group of patients ( P < .lo) and they have spent more time in mental institutions ( P < .Ol ) . Statistical analysis revealed that none of the descriptive items having a .05 level of significance in the original sample is significant at the .05 level in the cross-validat,ion study. Since the original and cross-validation samples differed significantly on crucial variables, it may be con- cluded that the validity of the findings of the original study could not be tested on the present cross-validating sample.

The present study does not supply us with information concerning religious training, religious beliefs or religious practices. This is an area that might merit ‘

‘The following sychologista also took an active part in the planning of this study: Marianne Beran, Ekasmue Hoe\, John Tucker. Elizabeth Goucher carried out the crossvalidation etudy. Harry P. Shelley made valuable contributiona to our understanding of the possible relevance of socio- economic factors.

*An %page table giving the recbe items and readta haa been deposited with the American Documentation Institute. Order focument No. 6457, remitting $1.25 for 35-mm microfii or $1.25 for 6” by 8’‘. .hotocopies.

‘Probab&y values are baaed on Chi Square b e t a of significance.

COMMUNITY ADJUSTMENT OF SCHIZOPHRENICS 139

further exploratio?. However, a second construct which may underlie the observed differences between religious groups is socio-economic status. Analysis of five items that may reflect socio-economic status (e.g., father’s occupation, level of employment skill) indicates that although only one of these variables is significant a t the .05 level (age at the time of leaving school), all the data are consistent with the hypoth- esis that patients from lower social classes will tend to be readmitted more frequently than patients from the middle class. In addition, the data revealed an obvious re- lation between father’s occupation and religion. The results, then, are difficult to interpret because of the confounding of two variables, religion and socio-economic status. Confounding of religion and socio-economic status has been reported also by Strodtbeck@). Since the present investigation was not designed to isolate either of these two variables, our conclusion can best be phrased as follows: In our original sample, Catholics tended to come from lower socio-economic class families than Protestants and also tended to be readmitted more frequently than Protestants.

Apart from the findings described thus far, none of the other variables reached the .05 level of statistical significance except: “Correspondence with the VA origi- nates exclusively or partially pi th the patient”. Patients who took this initiative in correspondence tended to remain out of the hospital. Taking the initiative in cor- respondence also has been reported(’) to be reiated to socio-economic status, how- ever, and as such is consistent with the possibility that all the differences found in the original sample are related to socio-economic status.

SUMMARY This study compared a group of schizophrenics who remained out of a neuro-

psychiatric hospital for a t least five years following their first trial visit with a group of schizophrenics who returned to the hospital within a five year period. It was found that the re-admitted patient was likely to have been older at the time he went on trial visit, to have spent more time in neuropsychiatric hospitals prior to his release, to have been Catholic rather than Protestant, and to be of lower socio-economic status.

REFERENCES 1. PARTEN, MILDRED. Surveys, polls, and samples. New York: Harper, 1950. 2. STRODBECK, F. L. Family interactions, values, and achievement. In McClelland, D. C., et. al.

Talent and society. New York: Van Nostrand, 1958.

DIRECTIVE TREATMENT OF LONG-TERM CLOSED WARD SCHIZOPHRENICS’

MILTON B. JENSEN AND GARRET H. YANAGI

Veterans Administration Center, Hot Springs, South Dakota

University of Tennessee

INTRODUCTION Some recent studies suggest that schizophrenic withdrawal may be amenable to

some form of external direction. According to Piotrowski(6) and Greenberg ( I ) , when this direction is given in the form of verbal instruction, responses are produced which indicate learning in schizophrenics. Peters and Jenkins“) concluded that guided problem solving, following sub-insulin shock and rewarded by candy, improved the social adjustment of chronic schizophrenics as seen by the ward nurse, O’Connor

‘The study waa accomplished at the Veterans Administration Hos ital, Salisbury, North Caro- lina. Paper read before The North Carolina Psychological Association !hay 7, 1960.