Social fragmentation, severe mental illness and suicide
Journal
Social Psychiatry and Psychiatric Epidemiology
Date Issued
March 2004
DOI
10.1007/s00127-004-0733-9
Abstract
Background Geographic patterns of suicide
are associated with area levels of social fragmentation. It
is unknown whether this reflects higher levels of severe
mental illness in socially fragmented areas.Method Data
on psychiatric inpatient admissions and suicides
amongst people aged 15–64 living in the City of Bristol
[1991–1992] were postcode matched to the city’s 34 electoral
wards. Ecological associations of psychiatric admission
(used as a ‘proxy’ measure of prevalence of severe
mental illness) and suicide rates with levels of social
fragmentation were investigated using negative binomial
regression models. Results Psychiatric hospital admission
rates were higher in areas with high levels of socioeconomic
deprivation than in areas with high levels
of social fragmentation. In contrast, associations with
suicide were stronger in relation to social fragmentation
than socioeconomic deprivation.Association of suicide
with social fragmentation was only moderately attenuated
in models controlling for psychiatric admission
rate and socio-economic deprivation, RR 1.23 (95 % C. I.
1.09–1.38) per quartile increase in social fragmentation,
compared to 1.29 (95% C. I. 1.16–1.44) before adjustment.
Conclusion The association between social fragmentation
and suicide is not explained by socioeconomic
deprivation or the prevalence of severe mental
illness within socially fragmented areas as measured by
psychiatric admission rate.
are associated with area levels of social fragmentation. It
is unknown whether this reflects higher levels of severe
mental illness in socially fragmented areas.Method Data
on psychiatric inpatient admissions and suicides
amongst people aged 15–64 living in the City of Bristol
[1991–1992] were postcode matched to the city’s 34 electoral
wards. Ecological associations of psychiatric admission
(used as a ‘proxy’ measure of prevalence of severe
mental illness) and suicide rates with levels of social
fragmentation were investigated using negative binomial
regression models. Results Psychiatric hospital admission
rates were higher in areas with high levels of socioeconomic
deprivation than in areas with high levels
of social fragmentation. In contrast, associations with
suicide were stronger in relation to social fragmentation
than socioeconomic deprivation.Association of suicide
with social fragmentation was only moderately attenuated
in models controlling for psychiatric admission
rate and socio-economic deprivation, RR 1.23 (95 % C. I.
1.09–1.38) per quartile increase in social fragmentation,
compared to 1.29 (95% C. I. 1.16–1.44) before adjustment.
Conclusion The association between social fragmentation
and suicide is not explained by socioeconomic
deprivation or the prevalence of severe mental
illness within socially fragmented areas as measured by
psychiatric admission rate.