Neighbourhood-level effects on psychoses: re-examining the role of context
Neighbourhood-level effects on psychoses: re-examining the role of context
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DOI：
10.1017/s0033291707000499
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发表时间：
2007-10-01
影响因子：
6.9
通讯作者：
Jones, Peter B.
中科院分区：
文献类型：
--
作者：
Kirkbride, James B.;Morgan, Craig;Jones, Peter B.
背景资料。精神分裂症的发病率因个人特征和邻里属性而异。在邻里一级确定的具体社会环境风险因素(农奴)很少。人们对跨级别的相互作用知之甚少。我们使用精神分裂症和其他精神病的病因学和种族研究(伊索)的数据来调查这些问题。伦敦东南部33个病房的16-年龄段的所有ICD-10精神分裂症(F20)和其他非情感性精神病(F21-29)的发病病例都是在两年内(1997年-1999年)确定的。人口普查数据提供了每个病区的分母。多水平泊松回归同时模拟了个人和邻里层面的农奴，包括社会经济贫困、选民投票率(社会资本的代表)、种族分裂(种族隔离)和种族密度。在565576人年中，共有218名受试者被确定为高危人群。各病房精神分裂症发病率的23%的差异可归因于邻里水平的危险因素[95%可信区间(CI)9-9-42-2]。因此，选民投票率[发病率比0-95，95%CI 0-92-0-99]和种族隔离(IRR 0-95，95%CI 0-92-0-99)增加1%与发病率降低5%独立相关，与年龄、性别、种族、贫困和人口密度无关。其他非情绪性精神病患者也是如此。有证据表明，在少数民族比例较小的地区，少数民族个体患精神分裂症的风险更大(p=0.07)。个体和邻里层面的农奴与精神病的病因学有关，但我们无法确定这些联系是否有因果关系。个人风险可能由社会资本来调节，社会资本可以作为一个保护因素，也许可以缓解精神病发作时的社会压力。
Background. The incidence of schizophrenia varies by individual-level characteristics and neighbourhood-level attributes. Few specific socio-environmental risk factors (SERFs) have been identified at the neighbourhood level. Cross-level interactions are poorly understood. We investigated these issues using data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study.Method. All incidence cases of ICD-10 schizophrenia (F20) and other non-affective psychoses (F21-29), aged 16-64 years, across 33 wards in Southeast London were identified over a 2-year period (1997-1999). Census data provided the denominator for each ward. Multilevel Poisson regression simultaneously modelled individual- and neighbourhood-level SERFs, including socioeconomic deprivation, voter turnout (proxy for social capital), ethnic fragmentation (segregation) and ethnic density.Results. A total of 218 subjects were identified during 565 576 person-years at risk. Twenty-three per cent of variance in incidence of schizophrenia across wards could be attributed to neighbourhood-level risk factors [95% confidence interval (Cl) 9-9-42-2]. Thus, 1% increases in voter turnout [incidence rate ratio (IRR) 0-95, 95 % Cl 0-92-0-99] and ethnic segregation (IRR 0-95, 95 % Cl 0-92-0-99) were both independently associated with a reduced incidence of 5 %, independent of age, sex, ethnicity, deprivation and population density. This was similar for other non-affective psychoses. There was some evidence that ethnic minority individuals were at greater risk of schizophrenia in areas with smaller proportions of minority groups (p = 0.07).Conclusion. SERFs at individual and neighbourhood levels were implicated in the aetiology of psychosis, but we were unable to determine whether these associations were causal. Individual risk may be mediated by social capital, which could operate as a protective factor, perhaps moderating social stress in the onset of psychoses.