Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Centre for Addiction and Mental Health, Toronto, Canada.
Psychol Med. 2023 Apr;53(6):2643-2651. doi: 10.1017/S003329172100458X. Epub 2021 Nov 23.
Studies have shown mixed results regarding social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. We sought to examine the relationship between neighbourhood-level marginalisation, social capital, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada.
We used a retrospective population-based cohort to identify incident cases of schizophrenia and schizoaffective disorder over a 10 year period and accounted for neighbourhood-level marginalisation and a proxy indicator of neighbourhood social capital. Mixed Poisson regression models were used to estimate adjusted incidence rate ratios (aIRRs).
In the cohort ( = 649 020) we identified 4841 incident cases of schizophrenia and schizoaffective disorder. A 27% variation in incidence was observed between neighbourhoods. All marginalisation dimensions, other than ethnic concentration, were associated with incidence. Compared to areas with low social capital, areas with intermediate social capital in the second [aIRR = 1.17, 95% confidence interval (CI) 1.03-1.33] and third (aIRR = 1.23, 95% CI 1.08-1.40) quintiles had elevated incidence rates after accounting for marginalisation. There was a higher risk associated with the intermediate levels of social capital (aIRR = 1.18, 95% CI 1.00-1.39) when analysed in only the females in the cohort, but the CI includes the possibility of a null effect.
The risk of developing schizophrenia and schizoaffective disorder in Toronto varies by neighbourhood and is associated with socioenvironmental exposures. Social capital was not linearly associated with risk, and risk differs by sex and social capital quintile. Future research should examine these relationships with different forms of social capital and examine how known individual-level risk factors impact these findings.
已有研究表明，社会资本与出现精神病障碍的风险之间存在复杂关系，而这一关系在北美尚未得到研究。我们试图在加拿大的多伦多研究社区边缘化程度、社会资本与精神分裂症和分裂情感性障碍发病之间的关系。
我们使用回顾性基于人群的队列研究来确定 10 年内精神分裂症和分裂情感性障碍的发病情况，并考虑了社区边缘化程度和社区社会资本的替代指标。我们使用混合泊松回归模型来估计调整后的发病率比值(aIRR)。
在队列中（=649020 人），我们发现了 4841 例精神分裂症和分裂情感性障碍的发病病例。社区之间的发病率差异为 27%。除了种族集中程度以外，所有边缘化维度都与发病率相关。与社会资本水平低的地区相比，社会资本处于第二（aIRR=1.17，95%置信区间（CI）为 1.03-1.33）和第三（aIRR=1.23，95%CI 为 1.08-1.40）五分位数的地区发病风险更高，这在考虑了边缘化因素后仍存在。在队列中的女性中，与社会资本处于中等水平相关的风险较高（aIRR=1.18，95%CI 为 1.00-1.39），但 CI 包含了可能为零的效应。
多伦多出现精神分裂症和分裂情感性障碍的风险因社区而异，与社会环境暴露有关。社会资本与风险之间并非线性相关，且风险在性别和社会资本五分位之间存在差异。未来的研究应使用不同形式的社会资本来检验这些关系，并研究已知的个体风险因素如何影响这些发现。
