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Social disadvantage and schizophrenia

A combined neighbourhood and individual-level analysis

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Abstract

Objective

To study, in a geographically defined area, associations between the neighbourhood social environment and individual socioeconomic status on the one hand, and treated incidence of schizophrenia and level of subsequent service use on the other.

Method

A combined data set of (i) patients with a case register diagnosis of schizophrenia and (ii) population controls was subjected to multilevel analyses, including neighbourhood exposures (neighbourhood socioeconomic disadvantage and social capital) and individual level confounders. Separate analyses were conducted for inpatient and outpatient psychiatric service consumption as indexed by the case register.

Results

Neighbourhood socioeconomic disadvantage and neighbourhood social capital did not impact on the treated incidence of schizophrenia, but quantity of inpatient service consumption was higher in neighbourhoods with higher level of social control (i.e. where it is more likely that neighbours intervene in neighbourhood-threatening situations). In addition, most indicators of lower individual socioeconomic status were associated with higher treated incidence, while treated incidence was lower when individual educational status was low.

Conclusion

Residents of high social control neighbourhoods may seek greater levels of resolution of psychiatric disorder in patient-residents, and by consequence may induce greater levels of inpatient service consumption in patients diagnosed with schizophrenia. Individual-level indicators of social disadvantage are associated with higher risk of treated psychotic disorder, with the exception of lower educational status, which may confer a lower probability of treatment given the presence of psychotic disorder.

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Acknowledgements

We gratefully acknowledge the financial support by the Maastricht local authorities. The authors are grateful to Frans van Kan, Sandra van Wijk and Nicole Peters of the Maastricht local authorities for their assistance in the control group data-collection. Special thanks to Margo van Sambeek, Anny Dassen and Alfons Schroten (MEMIC) for the collection and management of the MHCR data and to Kristin Hoebergen for her assistance in the collection of house prices per postal code.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, P.O. Box 616 (Vijverdal), 6200, MD, Maastricht, The Netherlands

    Marjan Drukker PhD, Lydia Krabbendam PhD, Ger Driessen MA & Jim van Os MD, PhD

  2. Youth Health Care Division, Municipal Health Centre South-Limburg, Location Maastricht, Maastricht, The Netherlands

    Marjan Drukker PhD

  3. Division of Psychological Medicine, Institute of Psychiatry, London, UK

    Jim van Os MD, PhD

Authors
  1. Marjan Drukker PhD
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  2. Lydia Krabbendam PhD
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  3. Ger Driessen MA
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  4. Jim van Os MD, PhD
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Corresponding author

Correspondence to Marjan Drukker PhD.

Appendix: translation of the Dutch ISC and SC & T items

Appendix: translation of the Dutch ISC and SC & T items

1) ISC

What is the likelihood that your neighbours can be counted on to intervene in the following situations: (very likely, likely, neither likely nor unlikely, unlikely, very unlikely)?

  1. a.

    If neighbours throw out garbage on the street (added item)

  2. b.

    If one of the houses constantly produces noise pollution (added item)

  3. c.

    If children were skipping school and hanging out on the street corner (original item)

  4. d.

    If children get into mischief, are being naughty (added item)

  5. e.

    If children were spray-painting graffiti on a local building? (original item)

  6. f.

    If children were showing disrespect to an adult? (original item)

  7. g.

    If children were showing disrespect to an elderly person (added item)

  8. h.

    If a fight broke out in front of their house? (original item)

  9. i.

    If the fire station closest to their home was threatened with budget cuts (in Dutch not the fire station but the ambulance)

  10. j.

    If someone is planning to open a sex club (added item)

ISC all items

2) SC & T

How strongly do you agree or disagree with the following statements? (a 5-point Likert scale from strongly agree to strongly disagree)

  1. a.

    People are willing to help their neighbours (original item)

  2. b.

    This is a close-knit neighbourhood (original item)

  3. c.

    People in this neighbourhood can be trusted (original item)

  4. d.

    People in this neighbourhood generally do not get along with each other (original item)

  5. e.

    People in this neighbourhood do not share the same values (original item)

  6. f.

    Children in this neighbourhood are close-knit

  7. g.

    Children in this neighbourhood are heading for trouble

  8. h.

    Children in this neighbourhood play together a lot

  9. i.

    This neighbourhood is unsafe for children (traffic)

  10. j.

    I do not send my children to the neighbourhood school

  11. k.

    There are many children in this neighbourhood which I do not want my child to play with

SC & T: items a–h, j and k

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Drukker, M., Krabbendam, L., Driessen, G. et al. Social disadvantage and schizophrenia. Soc Psychiat Epidemiol 41, 595–604 (2006). https://doi.org/10.1007/s00127-006-0081-z

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