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Geographical analysis of the risk of psychiatric hospitalization in Hamburg from 1988 – 1994

Published online by Cambridge University Press:  30 September 2020

E. Maylath ,
J. Seidel ,
B. Werner  and
P. Schlattmann
E. Maylath
Affiliation:
Medical Services department of the Hamburg statutory health insurance authority, Hamburg
J. Seidel
Affiliation:
Medical Services department of the Mecklenburg-Vorpommern statutory health insurance authority, Schwerin
B. Werner
Affiliation:
Medical Services department of the Hamburg statutory health insurance authority, Hamburg
P. Schlattmann
Affiliation:
Institute for Social Medicine, Department of Epidemiology, Berlin, and Department of Psychiatry, Free University Berlin, Berlin, Germany
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Summary

The analysis of the geographical distribution of hospital cases is obviously important for the purpose of planning hospital services, but it is of even greater significance in the planning of psychiatric services. This concern motivated our seven-year-long study, which examined hospitalization risks among various categories of psychiatric disorders in the major German city of Hamburg. Our database encompassed 77% (n = 64,000) of all psychiatric admissions in a total of 41 hospitals, most of which are general hospitals. In order to carry out the geographical analysis we employed a new statistical method based on a mixture distribution model. According to our findings, the strongest indications of an increased frequency were among male cases of schizophrenia, drug abuse and organic psychoses, and female cases of neurotic disorders, personality disorders, drug abuse and schizophrenia. We found that some areas are exposed to a risk of hospitalization for these diagnostic categories which is more than 50% above the reference. Contrary to other authors we did not identify an increased frequency of admission concentrated in the inner-city area for any of the diagnostic groups. The risk of hospitalization for schizophrenics was almost entirely associated with the close proximity of psychiatric units, while the risks for neuroses and personality disorders, as well as alcohol and drug abuse, appeared to be concentrated in areas of low social status. However, a statistically relevant correlation between an increased risk of hospitalization and low social status could be determined only for drug abuse and alcoholism. In the end, we did identify two areas in which there was an increased risk of hospitalization for several diagnostic groups, and this information will undoubtedly facilitate the planning of hospital and psychiatric services. The fact that our findings deviate to some extent from other authors – especially with respect to neuroses and personality disorders, but also to addiction – can be attributed to the inclusion of psychiatric cases from general hospitals in our geographic analysis.

Keywords

psychiatric hospitalization riskspsychiatric servicessocial statusspatial distribution
Type
Original article
Information
European Psychiatry , Volume 14 , Issue 8 , December 1999 , pp. 414 - 425
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 1999

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References

Böhning, D.Schlattmann, P.Lindsay, BGC.A. MAN-computer assisted analysis of mixtures: Statistical algorithms. Biometrics 48 1992 283–303CrossRefGoogle ScholarPubMed
Clayton, D.Kaldor, J.Empirical Bayes estimates for age-standardized relative risks. Biometrics 43 1987 671–81CrossRefGoogle ScholarPubMed
Dauncey, K.Giggs, J.Baker, K.Harrison, G.Schizophrenia in Nottingham: Lifelong residental mobility of a cohort. Br J Psychiatry 163 1993 613–19CrossRefGoogle Scholar
Dunham, HW.Community and schizophrenia. An epidemiological analysis. Wayne State University Press: Detroit 1965Google Scholar
Dunham, H.W.Epidemiology of psychiatric disorders as a contribution to medical ecology. Arch Gen Psychiatry 14 1966 1–18CrossRefGoogle ScholarPubMed
Farris, R.E.L.Dunham, H.W.Mental disorders in urban areas. An ecological study of schizophrenia and other psychoses. New York: Hafner 1960Google Scholar
Gerard, D.L.Houston, L.G.Family setting and the social ecology of schizophrenia. Psychiatr Q (NY) 27 1953 90–101CrossRefGoogle Scholar
Giggs, J.A.Schizophrenia and ecological structure in Nottingham. In: McGlashan, N.DBlunden, J.RGeographical aspects of health. London: Academic Press 1983 197–222Google Scholar
Giggs, J.Mental disorders: an ecological structure in Nottingham. Soc Sci Med 23 1986 945–61CrossRefGoogle ScholarPubMed
Giggs, J.Cooper, J.Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. Br J Psychiatry 1987 151 627–33CrossRefGoogle ScholarPubMed
Hall, G.Monitoring and predicting community mental health centre utilisation in Auckland New Zealand. Soc Sci Med 1988 26 55–70CrossRefGoogle Scholar
Hare, E.H.Mental illness and social conditions in Bristol. J Ment Sci 1956 102 349–57CrossRefGoogle ScholarPubMed
Harvey, C.A.Pantelis, C.Taylor, J.McCabe, P.J.Lefevre, K.Campbell, P.G. et al. The Camden schizophrenia surveys II. High prevalence of schizophrenia in an inner London borough and its relationship to socio-demographic factors. Br J Psychiatry 1996 168 418–26CrossRefGoogle Scholar
Holley, H.I.Geography and mental health: a review. Soc Psychiatry Psychiatr Epidemiol 33 1998 535–42CrossRefGoogle ScholarPubMed
Jarman, B.Identification of underprivileged areas. Br Med J 286 1983 1705–8CrossRefGoogle ScholarPubMed
Jarman, B.Hirsch, S.Statistical models to predict district psychiatric morbidity. In: Thornicroft, GBrewin, C.RWing, J eds. Measuring mental health needs 1992 London: Gaskell 63–80Google Scholar
Jarman, B.Hirsch, S.White, P.Driscoll, R.Predicting psychiatric admission rates. Br Med J 304 1992 1146–51CrossRefGoogle ScholarPubMed
Klee, G.D.Spiro, E.Bahn, A.K.Gorwitz, K.An ecological analysis of diagnosed mental illness in Baltimore. In: Monroe, R.RKlee, G.DBrody, E.BPsychiatric epidemiology and mental health planning. Psychiatric research reports of the American Psychiatric Association. 1967 Washington: APA Press 107–48Google Scholar
Joseph, A.E.Hollet, R.G.On the use of sociodemographic indicators in local health planning: a Canadian non-metropolitan perspective. Soc Sci Med 37 1993 813–22CrossRefGoogle Scholar
Klusmann, D.Angermeyer, M.C.Urban ecology and psychiatric admission rates. Results from a study in the city of Hamburg. In: Angermeyer, M.CFrom social class to social stress. 1987 Berlin: Springer 17–45Google Scholar
Kontny, E.L.Jones, S.Cooper, J.E.An example from the Nottingham case register: the design of a zoning system. In: ten Hom, G.H.M.MGiel, RGulbinat, W.HHenderson, J.H eds. Psychiatric Case Register in Public Health, A worldwide inventory 1960–1985. 1986 Amsterdam: Elsevier 39–43Google Scholar
Levy, L.Rowitz, L.The ecology of mental disorders. 1973 New York: Behavioral PublicationsGoogle Scholar
Lewis, G.David, A.Andreasson, S.Allebeck, P.Schizophrenia and city life. Lancet 340 1992 137–40CrossRefGoogle ScholarPubMed
Loll, B.E.Müller, J.Sozialräumliche Gliederung Hamburgs 1987. Hamburg in Zahlen 3 1990 72–9Google Scholar
Löffler, W.Häfner, H.Die ökologische Verteilung schizophrener Ersterkrankungen in zwei deutschen Grossstädten (Mannheim und Heidelberg). Fundam Psychiatrica 8 1994 103–15Google Scholar
Magaziner, J.Living and psychopathology: a reexamination of the negative model. Psycholog Med 18 1988 419–31CrossRefGoogle Scholar
Maylath, E.Seidel, J.Analyse der psychiatrischen Krankenhausfâlle in Hamburg1988-1994 - Entwicklungstrends, Versorgungslücken und -perspektiven. Das Gesundheitswesen 59 1997 423–33Google Scholar
Maylath, E.Weyerer, S.Häfner, H.Spatial concentration of the incidence of treated psychiatric disorders in Mannheim. Acta Psychiatr Scand 80 1989 650–6CrossRefGoogle ScholarPubMed
Mezey, A.G.Evans, E.Psychiatric admissions from North London related to demographic and ecological characteristics. Br J Psychiatry 117 1970 187–93CrossRefGoogle ScholarPubMed
Möller, I.Hamburg. 1985 Hamburg: Klett/LänderprofileGoogle Scholar
Nieminen, H.Life circumstances and the use of mental health services. A five year follow-up. Soc Psychiatry Psychiatr Epidemiol 21 1986 123–8Google ScholarPubMed
Schlattmann, P.The computer package Dismap Win. Stat Med 15 1996 9313.0.CO;2-E>CrossRefGoogle Scholar
Schlattmann, P.Böhning, D.Mixture models and disease mapping. Stat Med 12 1993 1943–50CrossRefGoogle ScholarPubMed
Schlattmann, P.Böhning, D.Disease mapping with a hidden structure using mixture models. In: Lawson, ABiggeri, ABöhning, DLesaffre, EViel, J.FDisease mapping and risk assessment for public health decision making 1998 Chichester: Wiley 1–13Google Scholar
Stefansson, C.G.Map analysis of psychiatric services. The application of a computerized psychiatric case register to geographical analysis. Acta Psychiatr Scand 70 1984 515–22CrossRefGoogle ScholarPubMed
Thornicroft, G.Social deprivation and rates of treated mental disorder. Developing statistical models to predict psychiatric service utilisation. Br J Psychiatry 158 1991 475–84CrossRefGoogle ScholarPubMed
Weyerer, S.Maylath, E.Pfeifer-Kurda, M.Krumm, B.TenHorn, G.H.M.M.Die Stabilität der ökologischen Verteilung psychiatrisch behandelter Ersterkrankungen in der Stadt Mannheim. Nervenheilkunde 6 1987 14–22Google Scholar
Weyerer, S.Häfner, H.The high incidence of psychiatrically treated disorders in the inner city of Mannheim. Susceptibility of German and foreign residents. Soc Psychiatry Psychiatr Epidemiol 27 1992 142–6Google ScholarPubMed
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