Shin Jeonghyun, Wu Jialin, Kim Hyun Jung, Xi Wenna
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Schizophr Res. 2025 Jul;281:74-81. doi: 10.1016/j.schres.2025.04.035. Epub 2025 May 3.
Suicidal thoughts and behaviors (STB) among youth with schizophrenia represent a significant public health concern. It is well-established that neighborhood-level social determinants of health (SDoHs) can impact health outcomes in individuals with schizophrenia. We aimed to investigate the effects of neighborhood-level social determinants on developing future STB in youth with schizophrenia.
We conducted a retrospective cohort study using electronic health records from the INSIGHT Clinical Research Network, which contains >22 million unique patients across five healthcare systems in New York City. Patients' neighborhood-level SDoHs were measured at their residential ZIP Code Tabulation Area using a composite measure, Social Deprivation Index (SDI), as well as specific components derived from the American Community Survey. Survival analysis was used to study the association between neighborhood-level SDoHs and time to STB since the first schizophrenia diagnosis.
Between 10/1/2015 and 10/1/2022, we identified 1209 youth aged between 10 and 25 years with a schizophrenia diagnosis and no prior STB, among whom 176 developed STB during follow-up. SDI quintiles were not associated with the risk of future STB, whereas two specific neighborhood characteristics, Gini index and percentage of residents commuting by car/truck/van, were associated with a decreased risk of STB, after controlling for patients' demographic characteristics.
Although the overall neighborhood deprivation level was not associated with the risk of STB among youth with schizophrenia, specific neighborhood characteristics were. These findings underscore the need for more targeted community-based suicide prevention strategies. Further research is essential to better understand the underlying mechanism of these associations.
精神分裂症青年中的自杀念头和行为（STB）是一个重大的公共卫生问题。众所周知，邻里层面的健康社会决定因素（SDoHs）会影响精神分裂症患者的健康结局。我们旨在研究邻里层面的社会决定因素对精神分裂症青年未来发生STB的影响。
我们使用INSIGHT临床研究网络的电子健康记录进行了一项回顾性队列研究，该网络包含纽约市五个医疗系统中的超过2200万独特患者。使用综合指标社会剥夺指数（SDI）以及源自美国社区调查的特定组成部分，在患者居住的邮政编码分区对其邻里层面的SDoHs进行测量。生存分析用于研究邻里层面的SDoHs与自首次精神分裂症诊断以来发生STB的时间之间的关联。
在2015年10月1日至2022年10月1日期间，我们确定了1209名年龄在10至25岁之间、诊断为精神分裂症且既往无STB的青年，其中176人在随访期间出现了STB。在控制了患者的人口统计学特征后，SDI五分位数与未来发生STB的风险无关，而两个特定的邻里特征，基尼系数和乘坐汽车/卡车/货车通勤的居民百分比，与STB风险降低相关。
虽然邻里总体剥夺水平与精神分裂症青年发生STB的风险无关，但特定的邻里特征与之相关。这些发现强调了需要更有针对性的基于社区的自杀预防策略。进一步的研究对于更好地理解这些关联的潜在机制至关重要。
