Department of Psychiatry, Navarra University Hospital, Pamplona, Spain.
Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain.
Eur Arch Psychiatry Clin Neurosci. 2024 Sep;274(6):1497-1506. doi: 10.1007/s00406-023-01665-z. Epub 2023 Aug 23.
There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature.
We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates.
We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates.
Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.
有强有力的证据表明环境因素与非情感性精神病发病风险增加之间存在关联。然而，在文献中，很少使用健全的统计方法来解释与环境风险因素（如城市化、移民或贫困）相关的空间变化。
我们研究了西班牙北部（纳瓦拉）在 54 个月期间非情感性首次发作精神病（NA-FEP）的地理分布，考虑了区域社会经济指标作为可能的解释变量。我们使用了几种贝叶斯分层泊松模型来平滑标准化发病率比（SIR）。我们将邻里级别的变量作为协变量纳入空间模型中。
在 54 个月的时间里，我们确定了 430 例 NA-FEP 病例，风险人群为每年 365213 名居民。NA-FEP 的发病风险呈现出空间模式，与移民人口、失业以及抗焦虑药和抗抑郁药的使用存在显著的生态关联。高风险地区主要集中在城市边缘地区；在包含协变量的空间模型中，很少有农村地区的基本卫生部门被确定为高风险地区。
失业、移民人口以及抗焦虑药和抗抑郁药的使用增加率与 NA-FEP 的空间地理发病率存在显著关联。这些结果可能使我们能够针对特定地理区域提供预防干预措施，以解决可能影响 NA-FEP 的可改变的环境风险因素。需要进一步研究来了解环境风险因素与 NA-FEP 发病率之间关联的机制。
