Centre for Mental Health Research, The Australian National University, Canberra, Australia.
Visual and Decision Analytics (VIDEA) Lab, Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2019 Oct;54(10):1189-1198. doi: 10.1007/s00127-019-01712-y. Epub 2019 Apr 15.
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.
我们对社区结构如何影响常见精神疾病的风险知之甚少。本研究提出了一种新方法，将抑郁与社会碎片化联系起来，从而确定为正确的人在正确的地方提供精神卫生服务和预防计划的途径。
进行主成分分析（PCA）以开发拟议的澳大利亚邻里社会碎片化指数（ANSFI）。使用一般实践临床数据来识别诊断为抑郁症的病例。使用多层次逻辑回归探讨 ANSFI 与抑郁之间的关联。在统计区域 1（SA1）水平上检查抑郁流行和社会碎片化的空间热点（集群）。
出现了两个社会碎片化的组成部分，反映了与家庭结构和流动性有关的碎片化。在初级保健中接受治疗的抑郁症患者更有可能生活在社会经济地位较低且与家庭结构有关的社会碎片化程度较高的社区中。社会碎片化增加 1 个标准差与抑郁患病率增加 16%（95%CI 11%，20%）相关。然而，调整邻里社会经济地位后，这种关联减弱了。在社区之间观察到社会碎片化和抑郁模式的相当大的空间变化。
首次在澳大利亚以小区域水平开发社会碎片化指数，为社区结构对健康风险的影响提供了新的知识。研究结果可能会扩展我们对驱动常见精神障碍和精神卫生保健发病率地理差异的机制的理解。
