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Small area-level variation in the incidence of psychotic disorders in an urban area in France: an ecological study

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank all the psychiatrists from the catchment area who accepted to participate in the study and helped with the identification and reporting of the incident cases. Dr. James B. Kirkbride (University College London) helped with the choice and implementation of the statistical methods by providing useful suggestions and comments. We thank Dr. Duncan Lee (University of Glasgow) for technical assistance in the use of CARBayes package. We also thank Cristian Cruceru (Do&Do Prepress & Printing) for graphic optimisation of Figs. 1 and 2. EU-GEI is the acronym of the project “European network of national schizophrenia networks studying gene-environment interactions”. The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement No. HEALTH-F2-2010-241909 (Project EU-GEI).

Author information

Authors and Affiliations

  1. INSERM, U955, Equipe 15, 94000, Créteil, France

    Andrei Szoke, Baptiste Pignon, Grégoire Baudin, Andrea Tortelli, Jean-Romain Richard, Marion Leboyer & Franck Schürhoff

  2. Pôle de Psychiatrie et Addictologie, DHU PePsy, AP-HP, Groupe Hospitalier “Mondor”, 94000, Créteil, France

    Andrei Szoke, Baptiste Pignon, Grégoire Baudin, Marion Leboyer & Franck Schürhoff

  3. Faculté de Médecine, Université Paris-Est Créteil, 94000, Créteil, France

    Andrei Szoke, Marion Leboyer & Franck Schürhoff

  4. Fondation Fondamental, 94000, Créteil, France

    Andrei Szoke, Baptiste Pignon, Jean-Romain Richard, Marion Leboyer & Franck Schürhoff

  5. Université de Tours “François Rabelais”, 37000, Tours, France

    Grégoire Baudin

  6. Maison Blanche Hospital, 75020, Paris, France

    Andrea Tortelli

Authors
  1. Andrei Szoke
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  2. Baptiste Pignon
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  3. Grégoire Baudin
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  4. Andrea Tortelli
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  5. Jean-Romain Richard
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  6. Marion Leboyer
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  7. Franck Schürhoff
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Corresponding author

Correspondence to Andrei Szoke.

Ethics declarations

Ethical approval

The relevant Regional Ethical Committee (Comité de Protection des Personnes—CPP Ile de France IX) examined and approved the study protocol (project number 2010-A00161-38) in accordance with the Helsinki Declaration and its later amendments.

The patients were not directly involved in the study and all the data send to the research team preserved their anonymity. The Ethical Committee agreed that for ethical reasons, it was important to preserve anonymity of the subjects, and thus no written consent was requested. However, the patients received from their treating psychiatrist written information about the study (approved by the ethical committee mentioned above) and had the opportunity to oppose the communication of their data.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Szoke, A., Pignon, B., Baudin, G. et al. Small area-level variation in the incidence of psychotic disorders in an urban area in France: an ecological study. Soc Psychiatry Psychiatr Epidemiol 51, 951–960 (2016). https://doi.org/10.1007/s00127-016-1231-6

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  • DOI: https://doi.org/10.1007/s00127-016-1231-6

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