Social Psychiatry and Psychiatric Epidemiology

, Volume 39, Issue 8, pp 597–599

The association of inequality with the incidence of schizophrenia

An ecological study
  • J. Boydell
  • J. van Os
  • K. McKenzie
  • R. M. Murray
ORIGINAL PAPER

Abstract

Background

Socio–economic factors are known to be associated with schizophrenia, but no studies have investigated the effect of inequality on incidence rates of schizophrenia. The aim of the study was to determine whether those electoral wards with greater inequality have a higher incidence of schizophrenia.

Method

An ecological study was carried out involving a retrospective case record study to calculate the incidence of schizophrenia across wards in Camberwell, South London for the period 1988–1997, and an index of inequality within each ward was calculated.

Results

There was no significant effect of inequality overall. However, in the group of deprived wards, the incidence of RDC schizophrenia increased as inequality increased (IRR 3.79, 95 %CI 1.25.11.49 p = 0.019 after adjusting for age, sex, absolute deprivation, ethnicity, proportion of ethnic minorities and the interaction between individual ethnicity and proportion of ethnic minorities.

Conclusion

Increased inequality is associated with increasing incidence of schizophrenia, but only in the most deprived areas. This is independent of other known social risk factors.

Key words

schizophrenia inequality deprivation incidence social risk factors 

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References

  1. 1.
    Croudace TJ, Kayne R, Jones PB,Harrison GL (2000) Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis. Psychol Med 30:177–185PubMedGoogle Scholar
  2. 2.
    Moser K (2001) Inequalities in treated heart disease and mental illness in England and Wales, 1994–1998. Br J Gen Pract 51:438–444PubMedGoogle Scholar
  3. 3.
    Koppel S, McGuffin P (1999) Socio-economic factors that predict psychiatric admissions at a local level. Psychol Med 29:1235–1241CrossRefPubMedGoogle Scholar
  4. 4.
    Wilkinson R (1996) Unequal Societies. The Affliction of Inequality. Routledge, LondonGoogle Scholar
  5. 5.
    Kaplan GA, Pamuk ER, Lynch JW, Cohen RD, Balfour JL (1996) Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ 312:999–1003PubMedGoogle Scholar
  6. 6.
    Kennedy BP, Kawachi I, Prothrow-Stith D (1996) Income distribution and mortality: cross sectional ecological study of the Robin Hood Index in the United States. BMJ 312:1004–1007PubMedGoogle Scholar
  7. 7.
    Lynch JW, Kaplan GA, Pamuk ER, Cohen RD, Heck KE, Balfour JL,Yen IH (1998) Income inequality and mortality in metropolitan areas of the United States. Am J Pub Health 88:1074–1080PubMedGoogle Scholar
  8. 8.
    Diez–Roux AV, Link BG, Northridge ME (2000) A multilevel analysis of income inequality and cardiovascular disease risk factors. Soc Sci Med 50:673–687CrossRefPubMedGoogle Scholar
  9. 9.
    Mackenbach JP (2002) Income inequality and population health. BMJ 324:1–2CrossRefPubMedGoogle Scholar
  10. 10.
    Weich S, Lewis G, Jenkins SP (2001) Income Inequality and the prevalence of common mental disorders in Britain. Br J Psychiatry 178:222–227CrossRefPubMedGoogle Scholar
  11. 11.
    Sturm R,Gresenz CR (2002) Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey. BMJ 324:20–23CrossRefPubMedGoogle Scholar
  12. 12.
    McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Arch Gen Psychiatry 48:764–770PubMedGoogle Scholar
  13. 13.
    Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 35:773–782PubMedGoogle Scholar
  14. 14.
    Williams J, Farmer AE, Ackenheil M, Kaufmann CA, McGuffin P (1996) A multicentre inter-rater reliability study using the OPCRIT computerised diagnostic system. Psychol Med 26:775–783PubMedGoogle Scholar
  15. 15.
    Department of the Environment Index of Local Conditions. Crown CopyrightGoogle Scholar
  16. 16.
    Castle D,Wessely S, Der G,Murray RM (1991) The incidence of operationally defined schizophrenia in Camberwell, 1965–84. Br J Psychiatry 159:790–794PubMedGoogle Scholar
  17. 17.
    Boydell J, van Os J, McKenzie K, Allardyce J, Goel R, McCreadie RG, Murray RM (2001) Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ 323:1336–1338CrossRefPubMedGoogle Scholar
  18. 18.
    Stata Corporation (1999) STATA Statistical Software, Release 6.0. College Station, TexasGoogle Scholar
  19. 19.
    Muler A (2002) Education, income inequality and mortality: a multiple regression analysis. BMJ 324:23–25CrossRefPubMedGoogle Scholar
  20. 20.
    Osler M, Prescott E, Gronbaek M, Christensen U, Due P, Engholm G (2002) Income inequality, individual income and mortality in Danish adults: analysis of pooled data from two cohort studies. BMJ 324:13–16CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • J. Boydell
    • 1
  • J. van Os
    • 4
    • 5
  • K. McKenzie
    • 2
    • 3
  • R. M. Murray
    • 1
  1. 1.Division of Psychological MedicineInstitute of Psychiatry De Crespigny Park, Denmark HillLondon, SE5 8AFUK
  2. 2.Dept. of Psychiatry & Behavioural SciencesRoyal Free & University College School of Medicine Royal Free CampusLondonUK
  3. 3.Barnet, Enfield and Haringey NHS Mental Health TrustBarnet General HospitalBarnet (Herts)UK
  4. 4.Dept. of Psychiatry & NeuropsychologyEuropean Graduate School Of Neuroscience Maastricht UniversityMaastrichtThe Netherlands
  5. 5.Institute of PsychiatryLondonUK

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