Department of Psychiatry, University of Toronto, Ontario, Canada.
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Can J Psychiatry. 2022 Mar;67(3):216-225. doi: 10.1177/07067437211011852. Epub 2021 Apr 26.
There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario.
We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices.
There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs.
There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.
加拿大有关社会环境因素对精神病风险影响的证据有限。我们试图研究安大略省地区边缘化指标与精神病发病的关系。
我们使用健康管理数据对 1999 年居住在安大略省的所有 14 至 40 岁人群进行了回顾性队列研究，并在 10 年的随访期间确定了精神病发病的病例。为大城市行政区（CMA）计算了标准化发病率。基于 CMA 和区域边缘化指数，使用调整年龄和性别的泊松回归模型计算发病率比值（IRR）。
不同 CMA 的精神病发病率存在差异。我们的研究结果表明，在住宅不稳定程度最高的地区，精神病发病率更高（IRR=1.26，95%置信区间[CI]，1.18 至 1.35）、物质匮乏（IRR=1.30，95%CI，1.16 至 1.45）、种族集中（IRR=1.61，95%CI，1.38 至 1.89）和依赖（IRR=1.35，95%CI，1.18 至 1.54）。与边缘化程度最低的地区相比，边缘化程度越高，发病风险越高。边缘化在某些 CMA 中会降低风险。
安大略省精神病发病率存在地域差异。边缘化程度较高的地区精神病发病率较高，而边缘化程度会降低地理位置差异的风险。随着进一步的研究、复制和使用最新数据，可能需要考虑将社会政策干预作为预防措施，并将服务提供给风险最高的地区。未来的研究应研究边缘化与种族和移民等其他社会因素之间的相互作用。
