Drukker Marjan, Krabbendam Lydia, Driessen Ger, van Os Jim
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.
Soc Psychiatry Psychiatr Epidemiol. 2006 Aug;41(8):595-604. doi: 10.1007/s00127-006-0081-z. Epub 2006 Jun 2.
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.
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.
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.
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.
在一个地理界定区域内，研究邻里社会环境与个体社会经济地位之间的关联，以及与精神分裂症的治疗发病率和后续服务利用水平之间的关联。
对一个合并数据集进行多层次分析，该数据集包括：（i）有精神分裂症病例登记诊断的患者，以及（ii）人群对照，分析内容包括邻里暴露因素（邻里社会经济劣势和社会资本）和个体层面的混杂因素。以病例登记为指标，分别对住院和门诊精神科服务消费进行分析。
邻里社会经济劣势和邻里社会资本并未对精神分裂症的治疗发病率产生影响，但在社会控制水平较高的邻里（即邻居更有可能干预威胁邻里的情况的地方），住院服务消费数量更高。此外，个体社会经济地位较低的大多数指标与较高的治疗发病率相关，而个体教育程度较低时，治疗发病率较低。
社会控制水平高的邻里的居民可能会寻求更高水平地解决患者居民的精神障碍问题，因此可能会导致被诊断患有精神分裂症的患者的住院服务消费水平更高。社会劣势的个体层面指标与治疗性精神障碍的较高风险相关，但教育程度较低除外，鉴于存在精神障碍，教育程度较低可能导致治疗概率较低。
