The impact of geographic isolation on mental disability in the United States
The impact of geographic isolation on mental disability in the United States
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DOI：
10.1016/j.ssmph.2019.100437
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发表时间：
2019-08-01
影响因子：
4.7
通讯作者：
Doogan, Nathan J.
中科院分区：
文献类型：
--
作者：
Hudson, Christopher G.;Doogan, Nathan J.
长期以来，地理隔离一直被假设在心理残疾的起源和发展中发挥作用。大量的研究已经建立了这样一种相关性。然而，研究设计限制了研究者建立因果关系和排除竞争假设的能力，因此，本研究旨在评估地理隔离-精神残疾关系的强度，并将其与其他可能性（即它反映了社会经济地位、社会隔离、经济不平等或反向因果关系）区分开来。该研究使用人口普查和疾病预防控制中心的数据分析了美国2960个县的精神残疾率。除了偏相关和普通最小二乘分析，该研究采用了两阶段最小二乘回归与工具变量（2SLS-IV），一个程序，允许解决问题的endoadministration涉及的潜在影响不可测量的变量和反向causation.Results显示，最初的双变量影响的地理隔离率的精神残疾是强大的社会经济地位，收入不平等，社会孤立，和其他预测因素的介绍，并与2SLS-IV程序进行测试时。县精神残疾率的大部分变化（54.4%）是由地理隔离，社会经济地位，收入不平等和其他变量的独立影响。提出的结果虽然不是结论性的，但支持在美国和其他国家的农村地区进行更有针对性的服务规划和更公平的资源投资。
Geographic isolation has long been hypothesized to have a role in the origins and development of mental disabilities. A considerable body of research has established such a correlation. However, study designs have limited researchers' ability to establish a causal connection and rule out rival hypotheses.This study, therefore, aims to assess the strength of the geographic isolation - mental disability relationship and to disentangle it from alternative possibilities, namely that it reflects socioeconomic status, social isolation, economic inequality, or reverse causation. The study employs an analysis of variations in the rates of mental disability throughout 2960 U.S. counties using both Census and CDC data. In addition to partial correlation and ordinary least square analyses, the study employs two-stage least squares regression with instrumental variables (2SLS-IV), a procedure that permits resolution of the problem of endogeneity involving the potential effects of unmeasured variables and reverse causation.Results reveal that the initial bivariate effects of geographic isolation on rates of mental disability are robust after controls for socioeconomic status, income inequality, social isolation, and other predictors are introduced and when tested with the 2SLS-IV procedure. Most variation (54.4%) in county mental disability rates is accounted for by the independent effects of geographic isolation, socioeconomic status, income inequality, and other variables. The results presented, although not conclusive, supports more targeted service planning and more equitable resource investments in rural parts of the United States and other nations.