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Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study

Published online by Cambridge University Press:  17 November 2014

W. Veling ,
E. Susser ,
J.-P. Selten  and
H. W. Hoek
W. Veling*
Affiliation:
Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
E. Susser
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
J.-P. Selten
Affiliation:
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands Rivierduinen Psychiatric Institute, Leiden, The Netherlands
H. W. Hoek
Affiliation:
Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
*
* Address for correspondence: W. Veling, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. (Email: w.veling@umcg.nl)
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Abstract

Background

Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders.

Method

The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization.

Results

A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ21 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ25 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38–2.75) compared with the lowest disorganization category.

Conclusions

The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.

Keywords

Incidenceneighborhoodpsychotic disordersschizophreniasocial environment
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 9 , July 2015 , pp. 1789 - 1798
Copyright
Copyright © Cambridge University Press 2014 

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