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Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses

Section of Psychological Medicine, University of Glasgow

HARPER GILMOUR, BSc, MSc and JACQUELINE ATKINSON, PhD

Section of Public Health and Health Policy, University of Glasgow

TRACEY RAPSON, BSc, MSc and JENNIFER BISHOP, BSc

Information and Statistics Division Scotland, Edinburgh

R. G. McCREADIE, FRCPsych

Department of Clinical Research, Crichton Royal Hospital, Dumfries, UK

Correspondence: Dr Judith Allardyce, Section of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: j.allardyce{at}clinmed.gla.ac.uk

Declaration of interest. None.

Background Social disorganisation, fragmentation and isolation have long been posited as influencing the rate of psychoses at area level. Measuring such societal constructsis difficult. A census-based index measuring social fragmentation has been proposed.

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

Method 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.

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