Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses

Abstract

BackgroundSocial disorganisation, fragmentation and isolation have long been posited as influencing the rate of psychoses at area level. Measuring such societal constructs is difficult. A census-based index measuring social fragmentation has been proposed.AimsTo investigate the association between first-admission rates for psychosis and area-based measures of social fragmentation, deprivation and urban/rural index.MethodWe used indirect standardisation methods and logistic regression models to examine associations of social fragmentation, deprivation and urban/rural categories with first admissions for psychoses in Scotland for the 5-year period 1989–1993ResultsAreas characterised by high social fragmentation had higher first-ever admission rates for psychosis independent of deprivation and urban/rural status. There was a dose–response relationship between social fragmentation category and first-ever admission rates for psychosis. There was no statistically significant interaction between social fragmentation, deprivation and urban/ rural index.ConclusionsFirst-admission rates are strongly associated with measures of social fragmentation, independent of material deprivation and urban/rural category.