Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses.
BACKGROUND
Social disorganisation, fragmentation and isolation have long been posited as influencing the rate of psychoses at area level. Measuring such societal constructs is difficult. A census-based index measuring social fragmentation has been proposed.


OBJECTIVE
To investigate the association between first-admission rates for psychosis and area-based measures of social fragmentation, deprivation and urban/rural index.


METHODS
We used indirect standardisation methods and logistic regression models to examine associations of social fragmentation, deprivation and urban/rural categories with first admissions for psychoses in Scotland for the 5-year period 1989-1993.


RESULTS
Areas characterised by high social fragmentation had higher first-ever admission rates for psychosis independent of deprivation and urban/rural status. There was a dose-response relationship between social fragmentation category and first-ever admission rates for psychosis. There was no statistically significant interaction between social fragmentation, deprivation and urban/rural index.


CONCLUSIONS
First-admission rates are strongly associated with measures of social fragmentation, independent of material deprivation and urban/rural category.
Allardyce
Judith
J
Section of Psychological Medicine, University of Glasgow, UK. j.allardyce@clinmed.gla.ac.uk
Gilmour
Harper
H
Atkinson
Jacqueline
J
Rapson
Tracey
T
Bishop
Jennifer
J
McCreadie
R G
RG
D003430:Cross-Sectional Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D010343:Patient Admission / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D012931:Social Environment; D014504:Urban Health / Q000706:statistics & numerical data*