Perälä Jonna, Saarni Samuli I, Ostamo Aini, Pirkola Sami, Haukka Jari, Härkänen Tommi, Koskinen Seppo, Lönnqvist Jouko, Suvisaari Jaana
National Public Health Institute, Department of Mental Health and Alcohol Research, Helsinki, Finland.
Schizophr Res. 2008 Dec;106(2-3):337-47. doi: 10.1016/j.schres.2008.08.017. Epub 2008 Sep 18.
Geographical variation and sociodemographic characteristics may differ in affective and nonaffective psychotic disorders. We examined the geographical variation in the lifetime prevalence of psychotic disorders in a comprehensive general population study.
A nationally representative sample of 8028 Finns aged 30 or over was screened for psychotic and bipolar I disorders and interviewed with the Structured Clinical Interview for DSM-IV. Best-estimate DSM-IV diagnoses were formed by combining interview and case note data. Nationwide health care register data were used for the nonrespondents. Associations with sociodemographic features, place of birth and residence in urban or rural areas and in five regions, and migration between the regions were examined.
Schizophrenia and other nonaffective psychoses, but not affective psychoses, showed prominent regional variation, with highest odds found for schizophrenia among those born in the North (OR 7.72 95%CI 2.48-24.04) and the East (OR 3.99 95%CI 1.22-13.11). The risk of any psychotic disorder was lower for those born in urban areas (OR 0.73 95%CI 0.54-0.98), but no associations were found for separate diagnostic groups. Region of birth was the strongest determinant of geographical variation when both place of birth and residence were accounted for. Selective migration was not found. Education and income were higher and being employed more common in subjects with affective psychosis than in subjects with other psychotic disorders.
Large area variation is more important than urban-rural disparity in psychotic disorders in Finland. Affective psychoses were different from nonaffective psychoses in terms of both regional variation and sociodemographic features.
情感性和非情感性精神障碍的地域差异及社会人口学特征可能有所不同。我们在一项全面的普通人群研究中，对精神障碍的终生患病率的地域差异进行了研究。
对8028名年龄在30岁及以上具有全国代表性的芬兰人样本进行精神障碍和双相I型障碍筛查，并采用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈进行访谈。通过结合访谈和病例记录数据形成最佳估计的DSM-IV诊断。对于未回应者，使用全国医疗保健登记数据。研究了与社会人口学特征、出生地、城乡居住地以及五个地区的居住地，以及地区间迁移的关联。
精神分裂症和其他非情感性精神病，而非情感性精神病，呈现出显著的地区差异，在北方出生者中精神分裂症的优势比最高（优势比7.72，95%置信区间2.48 - 24.04），在东方出生者中也较高（优势比3.99，95%置信区间1.22 - 13.11）。城市出生者患任何精神障碍的风险较低（优势比0.73，95%置信区间0.54 - 0.98），但在不同诊断组中未发现关联。当同时考虑出生地和居住地时，出生地是地域差异的最强决定因素。未发现选择性迁移。情感性精神病患者的教育程度和收入较高，就业情况比其他精神障碍患者更为普遍。
在芬兰，精神障碍中大面积差异比城乡差异更为重要。情感性精神病在地域差异和社会人口学特征方面与非情感性精神病不同。
