Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 10, pp 1189–1198 | Cite as

Development of the Australian neighborhood social fragmentation index and its association with spatial variation in depression across communities

  • Nasser BagheriEmail author
  • Philip J. Batterham
  • Luis Salvador-Carulla
  • Yingxi Chen
  • Andrew Page
  • Alison L. Calear
  • Peter Congdon
Original Paper



We know little about how community structures influence the risk of common mental illnesses. This study presents a new way to establish links between depression and social fragmentation, thereby identifying pathways to better target mental health services and prevention programs to the right people in the right place.


A principal components analysis (PCA) was conducted to develop the proposed Australian neighborhood social fragmentation index (ANSFI). General practice clinical data were used to identify cases of diagnosed depression. The association between ANSFI and depression was explored using multilevel logistic regression. Spatial hot spots (clusters) of depression prevalence and social fragmentation at the statistical area level 1 (SA1) were examined.


Two components of social fragmentation emerged, reflecting fragmentation related to family structure and mobility. Individuals treated for depression in primary care were more likely to live in neighborhoods with lower socioeconomic status and with higher social fragmentation related to family structure. A 1-SD increase in social fragmentation was associated with a 16% higher depression prevalence (95% CI 11%, 20%). However, the association attenuated with adjustment for neighborhood socio-economic status. Considerable spatial variation in social fragmentation and depression patterns across communities was observed.


Developing a social fragmentation index for the first time in Australia at a small area level generates a new line of knowledge on the impact of community structures on health risks. Findings may extend our understanding of the mechanisms that drive geographical variation in the incidence of common mental disorders and mental health care.


Social fragmentation index Depression Mental disorders Geographic information systems (GIS) Primary care 



We would like to thank Australian Research Council‘s support of data collection via Dr Bagheri’s DECRA (DE140101570). PJB and ALC are supported by NHMRC fellowships 1083311 and 1122544. We also thank all 16 general practices from the west Adelaide area that provided clinical data.

Compliance with ethical standards

Conflict of interest

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


  1. 1.
    World Health Organization (2014) Mental health: strengthening our response. WHO. Accessed 12 Sept 2016
  2. 2.
    Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol. CrossRefGoogle Scholar
  3. 3.
    Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(9):655–679. CrossRefPubMedGoogle Scholar
  4. 4.
    RANZCP (2016) Economic cost of serious mental illness and comorbidities in Australia and New Zealand. RANZCP. Accessed 9 Oct 2016
  5. 5.
    Begg SJ, Vos T, Barker B, Stanley L, Lopez AD (2008) Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Med J Aust 188(1):36–40CrossRefGoogle Scholar
  6. 6.
    Lee Y-C, Chatterton ML, Magnus A, Mohebbi M, Le LK-D, Mihalopoulos C (2017) Cost of high prevalence mental disorders: findings from the 2007 Australian national survey of mental health and wellbeing. Aust N Z J Psychiatry 51(12):1198–1211. CrossRefPubMedGoogle Scholar
  7. 7.
    Berkman LF, Glass T (2000) Social integration, social networks, social support, and health. In: Berkman LF, Glass T (eds) Social epidemiology. Oxford University Press, New York, pp 137–173Google Scholar
  8. 8.
    Ivory VC, Collings SC, Blakely T (1982) Dew K (2011) When does neighbourhood matter? Multilevel relationships between neighbourhood social fragmentation and mental health. Soc Sci Med 72(12):1993–2002. CrossRefGoogle Scholar
  9. 9.
    Pearson AL, Ivory V, Breetzke G, Lovasi GS (2014) Are feelings of peace or depression the drivers of the relationship between neighbourhood social fragmentation and mental health in Aotearoa/New Zealand? Health Place 26:1–6. CrossRefPubMedGoogle Scholar
  10. 10.
    Curtis S, Copeland A, Fagg J, Congdon P, Almog M, Fitzpatrick J (2006) The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City. Health Place 12(1):19–37. CrossRefPubMedGoogle Scholar
  11. 11.
    Allardyce J, Gilmour H, Atkinson J, Rapson T, Bishop J, McCreadie RG (2005) Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. Br J Psychiatry 187:401–406. CrossRefPubMedGoogle Scholar
  12. 12.
    Congdon P (2013) Assessing the impact of socioeconomic variables on small area variations in suicide outcomes in England. Int J Environ Res Public Health 10(1):158–177. CrossRefGoogle Scholar
  13. 13.
    Sampson RJ, Morenoff JD, Gannon-Rowley T (2002) Assessing “Neighborhood effects”: social processes and new directions in research. Ann Rev Sociol 28(1):443–478. CrossRefGoogle Scholar
  14. 14.
    Sampson RJ, Raudenbush SW, Earls F (1997) Neighborhoods and violent crime: a multilevel study of collective efficacy. Science (New York, NY) 277(5328):918–924CrossRefGoogle Scholar
  15. 15.
    Xue Y, Leventhal T, Brooks-Gunn J, Earls FJ (2005) Neighborhood residence and mental health problems of 5- to 11-year-olds. Arch Gen Psychiatry 62(5):554–563. CrossRefPubMedGoogle Scholar
  16. 16.
    Veling W, Susser E, Selten J-P, Hoek H (2015) Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study. Psychol Med 45(09):1789–1798CrossRefGoogle Scholar
  17. 17.
    Putnam RD (2007) E Pluribus Unum: diversity and community in the twenty-first century The 2006 Johan Skytte prize lecture. Scand Political Stud 30(2):137–174. CrossRefGoogle Scholar
  18. 18.
    Fagg J, Curtis S, Stansfeld SA, Cattell V, Tupuola AM (1982) Arephin M (2008) Area social fragmentation, social support for individuals and psychosocial health in young adults: evidence from a national survey in England. Soc Sci Med 66(2):242–254. CrossRefGoogle Scholar
  19. 19.
    Ivory V, Witten K, Salmond C, Lin E-Y, You RQ, Blakely T (2012) The New Zealand index of neighbourhood social fragmentation: integrating theory and data. Environ Plan A 44(4):972–988CrossRefGoogle Scholar
  20. 20.
    Congdon P (1996) Suicide and parasuicide in London: a small-area study. Urban studies 33(1):137–158CrossRefGoogle Scholar
  21. 21.
    Amaddeo F, Salazzari D, Salinas-Perez JA (2014) Is a geographical approach worthwhile for epidemiological research in mental health? Epidemiol Psychiatr Sci 24(1):38–41. CrossRefPubMedGoogle Scholar
  22. 22.
    Diez Roux AV, Mair C (2010) Neighborhoods and health. Ann N Y Acad Sci 1186:125–145. CrossRefPubMedGoogle Scholar
  23. 23.
    Curtis AJ, Lee WA (2010) Spatial patterns of diabetes related health problems for vulnerable populations in Los Angeles. Int J Health Geogr 9:43. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Qi X, Hu W, Page A, Tong S (2012) Spatial clusters of suicide in Australia. BMC Psychiatry 12:86. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Chang S-S, Sterne JAC, Wheeler BW, Lu T-H, Lin J-J, Gunnell D (2011) Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates. Health Place 17(2):641–650. CrossRefPubMedGoogle Scholar
  26. 26.
    Middleton N, Sterne JAC, Gunnell D (2006) The geography of despair among 15–44-year-old men in England and Wales: putting suicide on the map. J Epidemiol Community Health 60(12):1040–1047. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Middleton N, Whitley E, Frankel S, Dorling D, Sterne J, Gunnell D (2004) Suicide risk in small areas in England and Wales, 1991–1993. Soc Psychiatry Psychiatr Epidemiol 39(1):45–52. CrossRefPubMedGoogle Scholar
  28. 28.
    Ngamini Ngui A, Vasiliadis H-M, Préville M (2015) Individual and area-level factors correlated with death by suicide in older adults. Prev Med 75:44–48. CrossRefPubMedGoogle Scholar
  29. 29.
    Collins J, Ward BM, Snow P, Kippen S, Judd F (2016) Compositional, contextual, and collective community factors in mental health and well-being in Australian rural communities. Qualitative Health Res 27(5):677–687. CrossRefGoogle Scholar
  30. 30.
    O’Donoghue B, Roche E, Lane A (2016) Neighbourhood level social deprivation and the risk of psychotic disorders: a systematic review. Soc Psychiatry Psychiatr Epidemiol 51(7):941–950CrossRefGoogle Scholar
  31. 31.
    van Baal PH, Engelfriet PM, Hoogenveen RT, Poos MJ, van den Dungen C, Boshuizen HC (2011) Estimating and comparing incidence and prevalence of chronic diseases by combining GP registry data: the role of uncertainty. BMC Public Health 11:163. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Noble D, Smith D, Mathur R, Robson J, Greenhalgh T (2012) Feasibility study of geospatial mapping of chronic disease risk to inform public health commissioning. BMJ Open 2(1):e000711. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gabert R, Thomson B, Gakidou E, Roth G (2016) Identifying high-risk neighborhoods using electronic medical records: a population-based approach for targeting diabetes prevention and treatment interventions. PLoS One 11(7):e0159227. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bagheri N, Gilmour B, McRae I, Konings P, Dawda P, Del Fante P, van Weel C (2015) Community cardiovascular disease risk from cross-sectional general practice clinical data: a spatial analysis. Prev Chronic Dis 12:E26. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Bagheri N, McRae I, Konings P, Butler D, Douglas K, Del Fante P, Adams R (2014) Undiagnosed diabetes from cross-sectional GP practice data: an approach to identify communities with high likelihood of undiagnosed diabetes. BMJ Open 4(7):1–10. CrossRefGoogle Scholar
  36. 36.
    Jiwa M, Gudes O, Varhol R, Mullan N (2015) Impact of geography on the control of type 2 diabetes mellitus: a review of geocoded clinical data from general practice. BMJ Open 5(12):1–8. CrossRefGoogle Scholar
  37. 37.
    Australian Bureau of Statistics Australian Statistical Geography Standard (ASGS). Accessed 24 Aug 2018
  38. 38.
    Garrido-Cumbrera M, Almenara-Barrios J, Lopez-Lara E, Peralta-Saez JL, Garcia-Gutierrez JC, Salvador-Carulla L (2008) Development and spatial representation of synthetic indexes of outpatient mental health care in Andalusia (Spain). Epidemiol Psichiatria Sociale 17(3):192–200CrossRefGoogle Scholar
  39. 39.
    Congdon P (2004) Commentary: contextual effects: index construction and technique. Int J Epidemiol 33(4):741–742. CrossRefPubMedGoogle Scholar
  40. 40.
    Mazumdar S, Konings P, Hewett M, Bagheri N, McRae I, Del Fante P (2014) Protecting the privacy of individual general practice patient electronic records for geospatial epidemiology research. Aust N Z J Publ Health 38(6):548–552. CrossRefGoogle Scholar
  41. 41.
    Ord JK, Getis A (1995) Local spatial autocorrelation statistics: distributional issues and an application. Geograph Anal 27(4):286–306CrossRefGoogle Scholar
  42. 42.
    Takagi D, Kondo K, Kondo N, Cable N, Ki Ikeda, Kawachi I (2013) Social disorganization/social fragmentation and risk of depression among older people in Japan: multilevel investigation of indices of social distance. Soc Sci Med 83:81–89. CrossRefPubMedGoogle Scholar
  43. 43.
    Hudson CG (2005) Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. Am J Orthopsychiatry 75(1):3–18CrossRefGoogle Scholar
  44. 44.
    Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157(2):98–112. CrossRefGoogle Scholar
  45. 45.
    Inaba A, Thoits PA, Ueno K, Gove WR, Evenson RJ, Sloan M (2005) Depression in the United States and Japan: gender, marital status, and SES patterns. Soc Sci Med 61(11):2280–2292. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Fernandez A, Gillespie JA, Smith-Merry J, Feng X, Astell-Burt T, Maas CLS-C (2017) Integrated mental health atlas of the Western Sydney local health district: gaps and recommendations. Aust Health Rev 41(1):38–44CrossRefGoogle Scholar
  47. 47.
    Organisation WH (2016) Shanghai declaration on promoting health in the 2030 agenda for sustainable developmen. Accessed 20 Oct 2018
  48. 48.
    Salinas-Pérez JA, García-Alonso CR, Molina-Parrilla C, Jordà-Sampietro E, Salvador-Carulla L (2012) Identification and location of hot and cold spots of treated prevalence of depression in Catalonia (Spain). Int J Health Geograph 11(1):36. CrossRefGoogle Scholar
  49. 49.
    Rodero-Cosano ML, Salinas-Pérez JA, González-Caballero JL, García-Alonso CR, Lagares-Franco C, Salvador-Carulla L (2016) A multi-level analysis of the relationship between spatial clusters of outpatient-treated depression, risk factors and mental health service planning in Catalonia (Spain). J Affect Disord 201:42–49. CrossRefPubMedGoogle Scholar
  50. 50.
    Furst M, Reynolds J, Salinas JA, Tsou C, Rock D, Hopkins J, Bell T, Woods L, McLoughlin L, Stretton A, Mendoza J, Bagheri N, Salvador-Carulla L (2018) The integrated atlas of mental health of the perth north primary health network region. Australian National University and Western Australia Primary Health Alliance (WAPHA), PerthGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nasser Bagheri
    • 1
    • 5
    Email author
  • Philip J. Batterham
    • 1
  • Luis Salvador-Carulla
    • 1
  • Yingxi Chen
    • 2
  • Andrew Page
    • 3
  • Alison L. Calear
    • 1
  • Peter Congdon
    • 4
  1. 1.Centre for Mental Health ResearchThe Australian National UniversityCanberraAustralia
  2. 2.Research School of Population HealthThe Australian National UniversityCanberraAustralia
  3. 3.Translational Health Research InstituteWestern Sydney UniversitySydneyAustralia
  4. 4.School of GeographyQueen Mary University of LondonLondonUK
  5. 5.Visual and Decision Analytics (VIDEA) Lab, Centre for Mental Health Research, Research School of Population HealthAustralian National UniversityCanberraAustralia

Personalised recommendations