Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South.
Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South.
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DOI：
10.1017/s0033291722003749
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发表时间：
2023-01-16
影响因子：
6.9
通讯作者：
Morgan, Craig
中科院分区：
文献类型：
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作者：
Roberts, Tessa;Susser, Ezra;Pow, Joni Lee;Donald, Casswina;John, Sujit;Raghavan, Vijaya;Ayinde, Olatunde;Olley, Bola;Esponda, Georgina Miguel;Lam, Joseph;Murray, Robin M.;Cohen, Alex;Weiss, Helen A.;Hutchinson, Gerard;Thara, Rangaswamy;Gureje, Oye;Burns, Jonathan;Morgan, Craig
大量的证据表明，与城市较少的地区相比，城市较多的地区精神障碍的发病率较高，但这一证据主要来自北方欧洲。目前尚不清楚是否在全球范围内存在相同的关联。本研究探讨了印度（坎切普拉姆，泰米尔纳德邦），尼日利亚（伊巴丹，奥约）和北方特立尼达的集水区城市居住和精神障碍的发病率之间的关联。基于广泛的试点工作，开发了综合病例检测系统，以识别居住在每个集水区（2018年5月至2020年4月/5月/7月）的18-64岁的既往未接受过治疗的精神病患者。收集合格病例的居住区和基本人口统计学详细信息。我们比较了每个集水区内城市行政区域的精神障碍发病率，基于所有检测到的病例，并重复这些分析，同时限制于最近发病的病例（<2年/<5年）。我们发现特立尼达集水区内更多城市地区的精神病总体发病率较高（IRR：3.24，95% CI 2.68-3.91），尼日利亚集水区呈负相关（IRR：0.68，95% CI 0.51-0.91），印度集水区无相关性（IRR：1.18，95% CI 0.93-1.52）。当限制到最近发病的情况下，我们发现在印度集水区有适度的正相关。这项研究表明，在北方欧洲以外的一些但不是所有情况下，城市化与精神障碍的高发病率有关。未来的研究应测试可能构成所观察到的关联的潜在机制，如接触暴力。
Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad. Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18–64 with previously untreated psychotic disorders residing in each catchment area (May 2018–April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years). We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68–3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51–0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93–1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area. This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.