title: Small area-level variation in the incidence of psychotic disorders in an urban area in France: an ecological study.
abstract: We sought to determine whether significant variation in the incidence of clinically relevant psychoses existed at an ecological level in an urban French setting, and to examine possible factors associated with this variation. We aimed to advance the literature by testing this hypothesis in a novel population setting and by comparing a variety of spatial models.
  
  
  
  We sought to identify all first episode cases of non-affective and affective psychotic disorders presenting in a defined urban catchment area over a 4 years period, over more than half a million person-years at-risk. Because data from geographic close neighbourhoods usually show spatial autocorrelation, we used for our analyses Bayesian modelling. We included small area neighbourhood measures of deprivation, migrants' density and social fragmentation as putative explanatory variables in the models.
  
  
  
  Incidence of broad psychotic disorders shows spatial patterning with the best fit for models that included both strong autocorrelation between neighbouring areas and weak autocorrelation between areas further apart. Affective psychotic disorders showed similar spatial patterning and were associated with the proportion of migrants/foreigners in the area (inverse correlation). In contrast, non-affective psychoses did not show spatial patterning.
  
  
  
  At ecological level, the variation in the number of cases and the factors that influence this variation are different for non-affective and affective psychotic disorders. Important differences in results-compared with previous studies in different settings-point to the importance of the context and the necessity of further studies to understand these differences.
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France. andrei.szoke@inserm.fr.|Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier "Mondor", 94000, Créteil, France. andrei.szoke@inserm.fr.|Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France. andrei.szoke@inserm.fr.|Fondation Fondamental, 94000, Créteil, France. andrei.szoke@inserm.fr.
authors.forename: Andrei
authors.initials: A
authors.lastname: Szoke
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier "Mondor", 94000, Créteil, France.|Fondation Fondamental, 94000, Créteil, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Pignon
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier "Mondor", 94000, Créteil, France.|Université de Tours "François Rabelais", 37000, Tours, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Baudin
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Maison Blanche Hospital, 75020, Paris, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tortelli
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Fondation Fondamental, 94000, Créteil, France.
authors.forename: Jean-Romain
authors.initials: JR
authors.lastname: Richard
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier "Mondor", 94000, Créteil, France.|Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.|Fondation Fondamental, 94000, Créteil, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
authors.affiliation: INSERM, U955, Equipe 15, 94000, Créteil, France.|Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier "Mondor", 94000, Créteil, France.|Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France.|Fondation Fondamental, 94000, Créteil, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Schürhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000453:epidemiology; D001499:Bayes Theorem; D002391:Catchment Area, Health; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology*; D012111:Residence Characteristics; D017062:Small-Area Analysis; D012931:Social Environment; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Ecological study; Psychotic disorders; Risk factors; Schizophrenia; Spatial epidemiology