8
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Neighbourhood deprivation is positively associated with detection of the ultra-high risk (UHR) state for psychosis in South East London

      research-article
      * , ,
      Schizophrenia Research
      Elsevier Science Publisher B. V

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Individuals are defined as being at ultra-high risk (UHR) for psychosis based on a combination of attenuated psychotic symptoms, help-seeking behaviour, genetic risk, and social/occupational deterioration. Limited evidence is available on whether UHR detection differs by neighbourhood, and potential explanations.

          Aims

          To examine neighbourhood distribution of detected UHR using cases from the OASIS service in South East London, investigating neighbourhood deprivation as an explanatory variable.

          Methods

          Geographic data were collected on patients who met UHR criteria over a fourteen-year period, at the neighbourhood (lower super output area, LSOA) level. Rates were calculated based on cases and age-specific population estimates. Poisson regression assessed associations between UHR rate and neighbourhood deprivation, and with particular deprivation domains, adjusting for referrals for UHR assessment, population density, and proportions of non-White people, and young single people.

          Results

          Rate of UHR detection was statistically related to neighbourhood deprivation, but referral rate was not: compared to the least deprived neighbourhoods, the most deprived neighbourhoods had a greater than two-fold increase in incidence rate of detected UHR (adjusted incidence rate ratio (IRR): 2.11, 95% confidence interval (CI): 1.21,3.67). In contrast, a small, imprecise association was observed for referral for assessment for UHR (adjusted IRR: 1.26 (95%CI: 0.84,1.89)). Evidence was also found for associations of UHR detection rate with domains of deprivation pertaining to health and barriers to services.

          Conclusions

          The distribution of UHR detection rates by neighbourhood is not random and may be explained in part by differences in the social environment between neighbourhoods.

          Related collections

          Most cited references32

          • Record: found
          • Abstract: found
          • Article: not found

          Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.

          Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms-individual risk factor epidemiology and an ecological approach. Keyword searching of Index Medicus (Medline) and additional references from retrieved articles. All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries. The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects. The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The logic in ecological: I. The logic of analysis.

            M Susser (1994)
            This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment.

              To determine whether the incidence of schizophrenia among people from non-white ethnic minorities is greater in neighbourhoods where they constitute a smaller proportion of the total population. Ecological design including retrospective study of case records to calculate the incidence of schizophrenia in the ethnic minority population across electoral wards and multi-level analysis to examine interaction between individuals and environment. 15 electoral wards in Camberwell, South London. All people aged 16 years and over who had contact with psychiatric services during 1988-97. Incidence rates of schizophrenia according to Research Diagnostic Criteria. The incidence of schizophrenia in non-white ethnic minorities increased significantly as the proportion of such minorities in the local population fell. The incidence rate ratio varied in a dose-response fashion from 2.38 (95% confidence interval 1.49 to 3.79) in the third of wards where non-white ethnic minorities formed the largest proportion (28-57%) of the local population to 4.4 (2.49 to 7.75) in the third of wards where they formed the smallest proportion (8-22%). The incidence of schizophrenia in non-white ethnic minorities in London is greater when they comprise a smaller proportion of the local population.
                Bookmark

                Author and article information

                Contributors
                Journal
                Schizophr Res
                Schizophr. Res
                Schizophrenia Research
                Elsevier Science Publisher B. V
                0920-9964
                1573-2509
                1 February 2018
                February 2018
                : 192
                : 371-376
                Affiliations
                Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King's College London, United Kingdom
                Author notes
                [* ]Corresponding author. vishal.2.bhavsar@ 123456kcl.ac.uk
                Article
                S0920-9964(17)30334-1
                10.1016/j.schres.2017.06.006
                5821699
                28601502
                4656fa7b-f7e4-4f55-b449-f69103769eab
                Crown Copyright © 2017 Published by Elsevier B.V. All rights reserved.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Neurology
                Neurology

                Comments

                Comment on this article