Neighborhood linking social capital as a predictor of psychiatric medication prescription in the elderly: a Swedish national cohort study.
OBJECTIVE
Little is known about the association between neighborhood linking social capital and psychiatric medication in the elderly. The present study analyzes whether there is an association between linking social capital (a theoretical concept describing the amount of trust between individuals and societal institutions) and prescription of antipsychotics, anxiolytics, hypnotics/sedatives, antidepressants, or anti-dementia drugs.


METHODS
The entire Swedish population aged 65+, a total of 1,292,816 individuals, were followed from 1 July 2005 until first prescription of psychiatric medication, death, emigration, or the end of the study on 31 December 2010. Small geographic units were used to define neighborhoods. The definition of linking social capital was based on mean voting participation in each neighborhood unit, categorized in three groups. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance in three different models.


RESULTS
There was an inverse association between the level of linking social capital and prescription of psychiatric medications (except for anti-dementia drugs). The associations decreased, but remained significant, after accounting for age, sex, family income, marital status, country of birth, and education level (except for antidepressants). The OR for prescription of antipsychotics in the crude model was 1.65 (95% CI 1.53-1.78) and decreased, but remained significant (OR = 1.26; 95% CI 1.17-1.35), after adjustment for the individual-level sociodemographic variables.


CONCLUSIONS
Decision-makers should take into account the potentially negative effect of linking social capital on psychiatric disorders when planning sites of primary care centers and psychiatric clinics, as well as other kinds of community support for elderly patients with such disorders.
Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jan.sundquist@med.lu.se.
Jan
J
Sundquist
Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan; Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan.
Tsuyoshi
T
Hamano
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Xinjun
X
Li
Waseda Institute of Sport Sciences, Waseda University, Tokorozawa, Japan.
Naomi
N
Kawakami
Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan.
Kuninori
K
Shiwaku
Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
Kristina
K
Sundquist
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012111:Residence Characteristics; D066270:Social Capital; D012959:Socioeconomic Factors; D013548:Sweden
D011619:Psychotropic Drugs
Linking social capital; Neighborhood; Psychiatric medication; Socioeconomic status