Driessen G, Gunther N, Van Os J
Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):606-12. doi: 10.1007/s001270050100.
We examined associations, in terms of relative and population-attributable risks, between shared social environment at the neighbourhood level and (1) treated incidence of non-psychotic, non-organic disorders, and (2) subsequent level of service consumption. The multilevel analysis used linked records of all individuals in contact for the first time with any catchment area mental health service for non-psychotic, non-organic disorder over various specified time periods between 1981 and 1995. Socioeconomic indicators of 36 neighbourhoods in the city of Maastricht yielded a multivariately defined neighbourhood deprivation score. There were significant linear trends in the association between level of deprivation and treated incidence, especially in the population under 35 years of age (adjusted rate ratio for linear trend 1.17, 95% confident interval 1.11-1.23), who constituted around half of the patient population. The fraction of the incidence of psychiatric disorder attributable to deprivation was 17.8%. Multilevel analyses of rates of a second cohort, with cases divided according to level of service use over a standardised follow-up of 5 years after first contact with psychiatric services, revealed that the effect of deprivation scores on rates declined with intensity of out-patient service use, but increased with level of in-patient use. Up to 50% of in-patient episodes in this group could be attributed to neighbourhood level of deprivation. The increase in risk conferred by neighbourhood deprivation remained after adjustment for the individual-level equivalent. The findings therefore suggest that elements in the shared social environment influence both incidence and severity of non-psychotic, non-organic disorders, over and above any individual-level effect.
我们从相对风险和人群归因风险的角度，研究了社区层面共享社会环境与（1）非精神病性、非器质性疾病的治疗发病率，以及（2）后续服务消费水平之间的关联。多层次分析使用了1981年至1995年期间不同特定时间段内首次与任何集水区精神卫生服务机构接触的所有非精神病性、非器质性疾病患者的关联记录。马斯特里赫特市36个社区的社会经济指标得出了一个多变量定义的社区贫困得分。贫困水平与治疗发病率之间存在显著的线性趋势，尤其是在35岁以下人群中（线性趋势的调整率比为1.17，95%置信区间为1.11 - 1.23），该人群约占患者总数的一半。可归因于贫困的精神疾病发病率比例为17.8%。对第二个队列的发病率进行多层次分析，根据首次接触精神科服务后5年标准化随访期间的服务使用水平对病例进行划分，结果显示贫困得分对发病率的影响随着门诊服务使用强度的增加而下降，但随着住院服务使用水平的增加而增加。该组中高达50%的住院病例可归因于社区贫困水平。在对个体层面的等效因素进行调整后，社区贫困带来的风险增加仍然存在。因此，研究结果表明，共享社会环境中的因素在个体层面影响之外，还会影响非精神病性、非器质性疾病的发病率和严重程度。
