Social deprivation, inequality, and the neighborhood-level incidence of psychotic syndromes in East London.
Social deprivation, inequality, and the neighborhood-level incidence of psychotic syndromes in East London.
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DOI：
10.1093/schbul/sbs151
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发表时间：
2014-01
影响因子：
6.6
通讯作者：
Coid JW
中科院分区：
文献类型：
--
作者：
Kirkbride JB;Jones PB;Ullrich S;Coid JW
虽然城市出生，成长和生活与非情感性精神障碍的风险增加，很少有研究使用适当的多层次技术占空间依赖性的风险调查精神病发病率的社会，经济或身体的决定因素。我们采用贝叶斯分层模型，以调查精神病风险的社会空间分布在东伦敦的DSM-IV非情感性和情感性精神障碍，确定超过2年的时间在东伦敦首次发病的精神病研究。我们纳入了427例首次精神病发作受试者的个人和环境数据，以估计56个社区的疾病发病率，并对年龄，性别，种族和社会经济地位进行了标准化。一个贝叶斯模型，包括空间结构的邻里水平的随机效应，确定了大量的原因不明的变化，非情感性精神病的风险后，控制个人水平的因素。这种变化与更高水平的邻里收入不平等（不平等的SD增加：贝叶斯相对风险[RR]：1.25; 95% CI：1.04-1.49）、绝对剥夺（RR：1.28; 95% CI：1.08-1.51）和人口密度（RR：1.18; 95% CI：1.00-1.41）独立相关。对于加勒比黑人和非洲黑人来说，社区种族组成影响与非情感性精神病的发病率有关。情感性精神病的空间分布没有变化，这与情感性和非情感性精神病不同病因起源的可能性一致。我们的数据表明，绝对和相对措施的邻里社会组成与非情感性精神病的发病率。我们认为，这些协会是一致的作用，精神病风险的社会压力，特别是当人们生活在更不平等的社区。
Although urban birth, upbringing, and living are associated with increased risk of nonaffective psychotic disorders, few studies have used appropriate multilevel techniques accounting for spatial dependency in risk to investigate social, economic, or physical determinants of psychosis incidence. We adopted Bayesian hierarchical modeling to investigate the sociospatial distribution of psychosis risk in East London for DSM-IV nonaffective and affective psychotic disorders, ascertained over a 2-year period in the East London first-episode psychosis study. We included individual and environmental data on 427 subjects experiencing first-episode psychosis to estimate the incidence of disorder across 56 neighborhoods, having standardized for age, sex, ethnicity, and socioeconomic status. A Bayesian model that included spatially structured neighborhood-level random effects identified substantial unexplained variation in nonaffective psychosis risk after controlling for individual-level factors. This variation was independently associated with greater levels of neighborhood income inequality (SD increase in inequality: Bayesian relative risks [RR]: 1.25; 95% CI: 1.04–1.49), absolute deprivation (RR: 1.28; 95% CI: 1.08–1.51) and population density (RR: 1.18; 95% CI: 1.00–1.41). Neighborhood ethnic composition effects were associated with incidence of nonaffective psychosis for people of black Caribbean and black African origin. No variation in the spatial distribution of the affective psychoses was identified, consistent with the possibility of differing etiological origins of affective and nonaffective psychoses. Our data suggest that both absolute and relative measures of neighborhood social composition are associated with the incidence of nonaffective psychosis. We suggest these associations are consistent with a role for social stressors in psychosis risk, particularly when people live in more unequal communities.