Mental Illness and the Economy: A Critique and Partial Replication

Two problematic aspects of a landmark study in psychiatric epidemiology (Brenner, 1973) are considered in this research note. First, one of the processes used in transforming the data of the study, Mental Illness and the Economy, is critically examined. Second, the difficulties inherent in drawing epidemiological inferences from the mental hospitalfirst-admission rate are emphasized. It is suggested that mental hospital capacity should be explicitly controlled in any attempt to base a study of mental illness incidence upon the rate of admission to mental hospitals. An alternative to the statisticalformulations utilized by Brenner is proposed and utilized in a partial replication of one of the central chapters of Mental Illness and the Economy. The results of this replication confirm that the effect of the state of the economy upon mental hospital admissions is generally confined to working-age populations of men and women. We found that mental hospital capacity is generally an important predictor of the hospitalfirst-admission rate and that, for the young andfor the aged, hospital capacity is a better predictor of the admission rate than is the state of the economy.