Socioeconomic Deprivation and Extended Hospitalization in Severe Mental Disorder: A Two-Year Follow-Up Study (original) (raw)
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More Deprived Areas Need Greater Resources for Mental Health
Australian and New Zealand Journal of Psychiatry, 2003
Objective: This study set out to investigate the relationship in New Zealand between the newly developed small area index of socio-economic deprivation, NZDep96, and measures of psychiatric bed utilisation. It aims to contribute to the debate on resource allocation and to estimate the distribution of beds required in relation to levels of deprivation. Method: A cohort study of 872 persons admitted to the psychiatric in-patient unit within Counties Manukau, involving 1299 episodes of in-patient care between 1998 and 2000. The annual period prevalence of admission and the rate of total occupied bed days were calculated for the different deciles of deprivation, standardized for age and gender. Results: There was a three-fold gradient in admission prevalence and in total occupied bed days between persons living in the most and least deprived areas. Conclusions: Mental health services need to be organized and funded in ways that take account of the high use of in-patient care among those living in deprived areas. Further research is required to explore the relationship between socio-economic deprivation and use of community mental health services.
Health & Place, 2006
We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/ addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We discuss the interpretation of these results and the issues they raise in terms of the potential and limitations of international comparison. r
Schizophrenia Research, 2020
We investigated whether associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs, including schizophrenia and bipolar disorder) is accounted for by social drift or social causation. We extracted primary and secondary care electronic health records from 2004 to 2015 from a population of 3.9 million. We identified prevalent and incident individuals with SMIs and their level of deprivation and urbanicity using the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator. The presence of social drift was determined by whether odds ratios (ORs) from logistic regression is greater than the incidence rate ratios (IRRs) from Poisson regression. Additionally, we performed longitudinal analysis to measure the proportion of change in deprivation level and rural/urban residence 10 years after an incident diagnosis of SMI and compared it to the general population using standardised rate ratios (SRRs). Prevalence and incidence of SMIs were significantly associated with deprivation and urbanicity (all ORs and IRRs significantly N1). ORs and IRRs were similar across all conditions and cohorts (ranging from 1.1 to 1.4). Results from the longitudinal analysis showed individuals with SMIs are more likely to move compared to the general population. However, they did not preferentially move to more deprived or urban areas. There was little evidence of downward social drift over a 10-year period. These findings have implications for the allocation of resources, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.
Social deprivation and psychiatric service use for different diagnostic groups
Social Science & Medicine, 2001
Recent research has shown that the relationship between social deprivation and admission rates varies according to diagnosis. We have replicated a study of this kind. Furthermore, in addition to admission rates, we also look at variations in length of stay and the proportion of readmitted patients. Psychiatric admission data for the 79 Amsterdam neighbourhoods was obtained from the City Psychiatric Register. This data covered all the admissions between 1992 and 1995 of people from Amsterdam aged 19 and older, with the exception of short-term crisis admissions to the Crisis Centre. These admissions were divided into six diagnostic groups. The admission rates, the average length of stay and the proportion of patients readmitted were compared to the level of socioeconomic deprivation in the area concerned, a factor which was determined using factor analysis. Admission rates for schizophrenia, other psychoses and neurosis disorders showed a significant relation with the level of socioeconomic deprivation. Admission rates for affective disorders, organic psychoses and personality disorders showed no significant relation with deprivation. The findings on average length of stay and proportion of readmitted patients showed no clear relation with deprivation according to diagnosis category. As was found in previous studies, the relationship with socioeconomic deprivation varies according to diagnosis. The average length of stay and the risk of readmission, given the diagnosis, do not vary according to level of deprivation.
More severe mental illness is more concentrated in deprived areas
The British Journal of Psychiatry, 1999
Access the most recent version at doi: 1999 175: 544-548 The British Journal of Psychiatry GR Glover, M Leese and P McCrone More severe mental illness is more concentrated in deprived areas References http://bjp.rcpsych.org/cgi/content/abstract/175/6/544#otherarticles Article cited in: permissions Reprints/ permissions@rcpsych.ac.uk to To obtain reprints or permission to reproduce material from this paper, please write to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/175/6/544
Social deprivation and use of mental health legislation in New Zealand
International Journal of Social Psychiatry, 2012
Background: Low socioeconomic status has consistently been associated with poorer health outcomes. Few studies have used ecological analysis to explore relationships between area measures of deprivation and use of mental health legislation. Methods: We used an ecological design to explore associations between two area measures of relative deprivation and the two most commonly used sections of New Zealand mental health legislation. Results: High levels of relative deprivation were positively correlated with use of both acute and long-term community care provisions of mental health legislation with the correlation with long-term care achieving significance (r = .518, p = .016). Low levels of relative deprivation showed negative correlations with use of both provisions. The correlation of −.493 between low levels of relative deprivation and acute care provisions was significant at p = .023. In stepwise regression, the proportion of the population aged 15-64 contributed to the model for section 11, but ethnicity contributed to neither model. Conclusion: Mental health legislation is used disproportionately in areas with high levels of relative deprivation. The results have implications for regional allocation of funding for mental health and social services to support communitybased care. Further research is needed to explore other factors that may account for the regional variation.
Modeling the geographic distribution of serious mental illness in New Zealand
Social Psychiatry and Psychiatric Epidemiology, 2013
Purpose This study aims to estimate, apply, and validate a model of the risk of serious mental illness (SMI) in local service areas throughout New Zealand. Methods The study employs a secondary analysis of data from the Te Rau Hinengaro Mental Health Survey of 12,992 adults aged 16 years and over from the household population. It uses small area estimation (SAE) methods involving: (1) estimation of a logistic model of risk of SMI; (2) use of the foregoing model for computing estimates, using census data, for District Board areas; (3) validation of estimates against an alternative indicator of SMI prevalence. Results The model uses age, ethnicity, marital status, employment, and income to predict 92.2 % of respondents' SMI statuses, with a specificity of 95.9 %, sensitivity of 16.9 %, and an AUC of 0.73. The resulting estimates for the District Board areas ranged between 4.1 and 5.7 %, with confidence intervals from ±0.3 to ±1.1 %. The estimates demonstrated a correlation of 0.51 (p = 0.028) with rates of psychiatric hospitalization. Conclusions The use of SAE methods demonstrated the capacity for deriving local prevalence rates of SMI, which can be validated against an available indicator.
Does relative deprivation predict the need for mental health services?
The journal of mental health policy and economics, 2004
Several studies postulate that psychological conditions may contribute to the link between low relative income and poor health, but no one has directly tested the relationship between relative deprivation and mental health disorders. In this paper, we investigate whether low income relative to a reference group is associated with a higher probability of depressive disorders or anxiety disorders. Reference groups are defined using groups of individuals with similar demographic and geographic characteristics. We hypothesize that perceptions of low social status relative to one's reference group might lead to worse health outcomes. We attempt to determine whether an individual's income status relative to a reference group affects mental health outcomes. Our contributions to the literature include (i) defining reference groups using demographic characteristics in addition to geographic area, (ii) looking at an individual's relative income status rather than low income or agg...
Socio-economic position and common mental disorders
British Journal of Psychiatry, 2006
BackgroundIndividuals in lower socio-economic groups have an increased prevalence of common mental disorders.AimsTo investigate the longitudinal association between socio-economic position and common mental disorders in a general population sample in the UK.MethodParticipants (n=2406) were assessed at two time points 18 months apart with the Revised Clinical Interview Schedule. The sample was stratified into two cohorts according to mental health status at baseline.ResultsNone of the socio-economic indicators studied was significantly associated with an episode of common mental disorder at follow-up after adjusting for baseline psychiatric morbidity. The analysis of separate diagnostic categories showed that subjective financial difficulties at baseline were independently associated with depression at follow-up in both cohorts.ConclusionsThese findings support the view that apart from objective measures of socio-economic position, more subjective measures might be equally important ...