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Social Deprivation and Rates of Treated Mental Disorder

Developing Statistical Models to Predict Psychiatric Service Utilisation

Published online by Cambridge University Press:  03 January 2018

Graham Thornicroft
Graham Thornicroft*
Affiliation:
MRC Social and Community Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
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Abstract

A review of the literature shows that there are strong associations of treated prevalence rates of psychiatric disorder with social class, sex, marital status, ethnic group and living alone; and moderate associations with living in inner-city areas and a high degree of residential mobility. The Jarman-8 index of social deprivation correlates with psychiatric admission rates for patients aged less than 65 years (R2–0.38). Individual census variables can themselves account for up to 0.71 of the variance in the admission rates, while combined in a stepwise multiple regression the census variables will account for over 0.95 of this variation. Multiple regression models using individual census variables and derived indices should be applied next on a wider geographical basis, and to narrower age, sex and diagnosis-specific psychiatric morbidity rates.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 158 , Issue 4 , April 1991 , pp. 475 - 484
Copyright
Copyright © Royal College of Psychiatrists, 1991 

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References

Acorn, (1986) An Allowance for Social Factors in RAWP. Bexhill-on-Sca: South East Thames Regional Health Authority.Google Scholar
Armitage, P. & Berry, G. (1987) Statistical Methods in Medical Research. Oxford: Blackwell.Google Scholar
Bebbington, A. & Davies, B. (1980) Territorial need indicators: a new approach. Journal of Social Policy, 9, 145–168.Google Scholar
Bickler, G. (1988) Social indicators, small area statistical and primary care planning: a critique of the Jarman score. Submission for Part II of Membership of the Faulty of Community Medicine, London.Google Scholar
Brewin, C., Wing, J., Mangen, S., et al (1987) Principles and practice of measuring needs in the long-term mentally ill. Psychological Medicine, 17, 971–981.CrossRefGoogle ScholarPubMed
Cagle, L. & Banks, S. (1985) The validity of assessing health needs with social indicators. Evaluation and program planning, 9, 127–142.CrossRefGoogle Scholar
Carpenter, L., & Brockington, I. (1980) A study of mental illness in Asians, West Indians and Africans living in Manchester. British Journal of Psychiatry, 137, 201–205.CrossRefGoogle ScholarPubMed
Carr-Hill, R. (1988) Revising the RAWP Formula: Indexing Deprivation and Modelling Demand. York: Centre for Health Economics.Google Scholar
Carstairs, V. (1981) Multiple deprivation and health state. Community Medicine, 3, 4–13.Google Scholar
Charlton, J. & Lakhani, A. (1985) Is the Jarman underprivileged area score valid? British Medical Journal, 290, 1714–1716.Google Scholar
Cochrane, R. (1977) Mental illness in immigrants to England and Wales: an analysis of mental hospital admissions 1971. Social Psychiatry, 12, 25–35.Google Scholar
Cooper, B. (1961) Social class and prognosis in schizophrenia, part 1. British Journal of Preventative and Social Medicine, 15, 17–30.Google Scholar
Coopers & Lybrand (1988) Integrated Analysis for the Review of RAWP. London: Coopers & Lybrand.Google Scholar
Dean, G. (1981) First admission of native-born and immigrants to psychiatric hospitals in South East England 1976. British Journal of Psychiatry, 139, 506–512.Google Scholar
Dear, M. & Wolch, J. (1987) Landscapes of Despair. Oxford: Polity. Department of the Environment (1983) Information Note No. 2: Urban Deprivation. London: Inner Cities Directorate. Department of Health and Social Security (1976) Sharing Resources for Health in England. London: HMSO.Google Scholar
Dear, M. (1980) Inequalities in Health. London: DHSS.Google Scholar
Dear, M. (1984) In-patient Statistics from the Mental Health Enquiry for England 1981. London: HMSO.Google Scholar
Dear, M. (1985) The Facilities and Services of Mental Illness and Mental Handicap Hospitals in England 1982. London: HMSO.Google Scholar
Dohrenwend, B. (1975) Socio-cultural and social-psychological factors in the genesis of mental disorders. Journal of Health and Social Behaviour, 16, 365–392.Google Scholar
Dohrenwend, B. & Dohrenwend, B. (1969) Social status and Psychological Disorder: A Causal Enquiry. New York: Wiley.Google Scholar
Dunham, W. (1965) Community and Schizophrenia. Detroit: Wayne State University Press.Google Scholar
Eaton, W. W. (1974) Residence, social class and schizophrenia. Journal of Health and Social Behaviour, 15, 289–299.Google Scholar
Eaton, W. W. (1975) Marital status and schizophrenia. Acta Psychiatrica Scandinavica, 52, 320–329.Google Scholar
Eaton, W. W. (1980) A formal theory of selection for schizophrenia. American Journal of Sociology, 86, 149–158.Google Scholar
Eaton, W. W. (1985) Epidemiology of schizophrenia. Epidemiologic Reviews, 7, 105–126.CrossRefGoogle ScholarPubMed
Faris, R. & Dunham, H. (1939) Mental Disorders in Urban Areas. Chicago: University of Chicago Press.Google Scholar
Giggs, J. & Cooper, J. (1987) Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. British Journal of Psychiatry, 151, 627–633.Google Scholar
Glover, G. (1989) The pattern of admissions of Caribbean-born immigrants in London. Social Psychiatry, 24, 49–56.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community. London: Tavistock.Google Scholar
Goldberg, E. & Morrison, S. (1963) Schizophrenia and social class. British Journal of Psychiatry, 109, 785–802.Google Scholar
Goldman, H., Gatzionni, A. & Taube, C. (1981) Defining and counting the chronically mentally ill. Hospital and Community Psychiatry, 32, 21–27.Google Scholar
Goodman, A., Siegal, C., Craig, T., et al (1983) The relationship between socioeconomic class and prevalence of schizophrenia, alcoholism and affective disorders treated by in-patients in a suburban area. American Journal of Psychiatry, 140, 166–170.Google Scholar
Hall, G. (1988) Monitoring and predicting community mental health centre utilisation in Auckland, New Zealand. Social Science and Medicine, 26, 55–70.Google Scholar
Hare, E. (1956) Mental illness and social conditions in Bristol. Journal of Mental Science, 102, 349–357.Google Scholar
Harrison, G. (1988) A prospective study of severe mental disorder in afro-caribbean patients. Psychological Medicine, 18, 643–657.Google Scholar
Harrison, G., Ineichen, B. & Morgan, H. (1984) Psychiatric hospital admissions in Bristol. II. Social and clinical aspects of compulsory admission. British Journal of Psychiatry, 145, 605–611.Google Scholar
Heller, P., Rivera-Worley, M. & Chalfant, H. (1979) Socioeconomic class, classification of ‘abnormal’ behaviour, and perceptions of mental health care. Sociology of Health and Illness, 1, 108–121.Google Scholar
Hemsi, L. (1967) Psychiatric morbidity of West Indian immigrants. Social Psychiatry, 2, 95–100.Google Scholar
Hirsch, S. (1988) Psychiatric Beds and Resources: Factors Influencing Bed Use and Service Planning. London: Gaskell/Royal College of Psychiatrists.Google Scholar
Hollingshead, A. & Redlich, F. (1958) Social Class and Mental Illness. London: Wiley.Google Scholar
Hughes, D. (1973) Morbidity statistics from population surveys. In Roots of Evaluation (eds J. K. Wing & H. Haefner). London: Oxford University Press.Google Scholar
Ineichen, B., Harrison, G. & Morgan, H. (1984) Psychiatric hospital admission in Bristol. 1. Geographical and ethnic factors. British Journal of Psychiatry, 145, 500–504.Google Scholar
Irving, D. & Rice, P. (1984) Information for Health Services Planning from the 1981 Census. London: London School of Economics.Google Scholar
Jablensky, A. (1986) Epidemiology of schizophrenia: a European perspective. Schizophrenia Bulletin, 12, 52–73.CrossRefGoogle ScholarPubMed
Jablensky, A. (1988) Schizophrenia and the environment. In Handbook of Social Psychiatry (eds A. Henderson & G. Burrows). Amsterdam: Elsevier.Google Scholar
Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal, 286, 1705–1709.CrossRefGoogle ScholarPubMed
Jarman, B. (1984) Underprivileged areas: validation and distribution of scores. British Medical Journal, 289, 1587–1592.Google Scholar
Johnstone, I. & Milner, P. (1988) Is the Jarman score better than social class at assessing the need for prevention and primary care? Family Practice, 5, 105–110.Google Scholar
Keatinge, C. (1989) Psychiatric admissions for alcoholism, neuroses, and schizophrenia in rural and urban Ireland. International Journal of Social Psychiatry, 34, 58–69.CrossRefGoogle Scholar
Kessler, R. (1982) A disaggregation of the relationship between socio-economic status and psychological distress. American Sociological Review, 47, 752–764.CrossRefGoogle Scholar
Kohn, M. (1976) The interaction of social class and other factors in the etiology of schizophrenia. American Journal of Psychiatry, 133, 177–180.Google Scholar
Kramer, M. & Taube, C. (1973) The role of a national statistics programme in the planning of community psychiatric services in the United States. In The Roots of Evaluation (eds J. K. Wing & H. Haefner). London: Oxford University Press.Google Scholar
Lavik, N. (1983) Utilisation of mental health services over a given period. Acta Psychiatrica Scandinavica, 67, 404–413.Google Scholar
Leavy, R. & Wood, J. (1985) Does the underprivileged area index work? British Medical Journal, 291, 709–710.Google Scholar
Liberatos, P., Link, B., & Lelsey, J. (1988) The measurement of social class in epidemiology. Epidemiologic Reviews, 10, 87–121.Google Scholar
Link, B. & Dohrenwend, B. (1980) Formulation of hypotheses about the ratio of untreated to treated cases in the true prevalence studies of functional psychiatric disorders in adults in the United States. In Mental Illness in the United States (eds B. Dohrenwend & B. Dohrenwend). New York: Praeger.Google Scholar
Link, B., Dohrenwend, B. & Skodol, A. (1986) Socio-economic status and schizophrenia: noisome occupational characteristics as a risk factor. American Sociological Review, 51, 242–258.Google Scholar
Littlewood, R. & Lipsedge, M. (1981) Some social and phenomenological characteristics of psychotic immigrants. Psychological Medicine, 11, 289–302.Google Scholar
Lomas, G., Ross, G., Watson, C., et al (1973) Poverty and Schizophrenia. London: Psychiatric Rehabilitation Association.Google Scholar
London, M. (1986) Mental illness among immigrant minorities in the United Kingdom. British Journal of Psychiatry, 149, 265–273.Google Scholar
Mollica, R. & Milic, M. (1986a) Social class and psychiatric practice: a review of the Hollingshead and Redlich model. American Journal of Psychiatry, 143, 12–17.Google Scholar
Mollica, R. & Milic, M. (1986b) Social class and psychiatric in-patients care: a twenty-five year perspective. Social Psychiatry, 21, 106–112.Google Scholar
Myers, J. & Bean, L. (1968) A Decade Later: A Follow-up of Social Class and Mental Illness. New York: Wiley.Google Scholar
Office of Population Censuses and Surveys (1981) Census 1981. London: HMSO.Google Scholar
Office of Population Censuses and Surveys (1986) Key Population and Vital Statistics. London: HMSO.Google Scholar
Rice, P., Irving, D. & Davies, G. (1984) Information about District Health Authorities in England from the 1981 Census. London: Kings Fund Centre.Google Scholar
Richman, A. & Barry, A. (1985) More and more is less and less: the myth of massive psychiatric need. British Journal of Psychiatry, 146, 164–168.Google Scholar
Rweglera, G. (1977) Psychiatric morbidity among West Africans and West Indians living in London. Psychological Medicine, 7, 317–329.Google Scholar
Sartorius, N. & Jablensky, A. (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909–928.CrossRefGoogle ScholarPubMed
Scott-Samuel, A. (1984) Need for primary health care: an objective indicator. British Medical Journal, 288, 457–458.Google Scholar
Shur, E. (1988) The epidemiology of schizophrenia. British Journal of Hospital Medicine, 41, 38–45.Google Scholar
Shapiro, S., Skinner, E., Kessler, L., et al (1984) Utilisation of health and mental health services in three ECA sites. Archives of General Psychiatry, 41, 971–978.Google Scholar
Shapiro, S., Skinner, E., Kramer, M., et al (1985) Measuring need for mental health services in a general population. Medical Care, 23, 1033–1043.Google Scholar
South East Thames Regional Health Authority (1989) Acute Psychiatric Beds. Bexhill-on-Sea: SETRHA.Google Scholar
Srole, L. (1975) Measurement and classification in socio-psychiatric epidemiology: midtown Manhattan study (1954) and midtown Manhattan restudy (1974). Journal of Health and Social Behaviour, 16, 347–364.Google Scholar
Stampfer, H., Reymond, J., Burvill, P., et al (1984) The relationship between distance from in-patients facilities and the rate of psychiatric admissions in Western Australia. Social Science and Medicine, 19, 879–884.Google Scholar
Thornicroft, G. & Bebbington, P. (1989) Deinstitutionalisation: from hospital closure to service development. British Journal of Psychiatry, 155, 739–753.Google Scholar
Tischler, G., Henisz, J., Myers, J., et al (1975) Utilisation of mental health services. Archives of General Psychiatry, 32, 411–415.Google Scholar
Tischler, G., Leaf, P., Benham, L., et al (1984) Utilisation of health and mental health services: three epidemiologic catchment area sites. Archives of General Psychiatry, 41, 971–978.Google Scholar
Townsend, P., Simpson, P. & Tibbs, N. (1985) Inequalities in health in the city of Bristol: a preliminary review of the statistical evidence. International Journal of Health Services, 15, 637–663.Google Scholar
Turner, R. & Wagenfeld, M. (1967) Occupation mobility and schizophrenia an assessment of the social causation and social selection hypothesis. American Sociological Review, 32, 104–113.Google Scholar
Warr, P. (1987) Work Unemployment and Mental Health. Oxford: Oxford University Press.Google Scholar
Weyerer, S. & Haefner, H. (1989) The stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim. Social Psychiatry, 24, 57–62.Google Scholar
Weyerer, S., Dilling, H., Kohl, R., et al (1982) Social class and mental disorders. Social Psychiatry, 17, 133–141.Google Scholar
Wiersma, D., Giel, R., De Jong, A., et al (1983) Social class and schizophrenia in a Dutch cohort. Psychological Medicine, 13, 141–150.Google Scholar
Wilkin, D., Metcalfe, D., Hallam, L., et al (1984) Area variations in the process of care in urban general practice. British Medical Journal, 289, 229.CrossRefGoogle ScholarPubMed
Wyatt, R., Alexander, R., Egan, M., et al (1988) Schizophrenia, just the facts. What do we know, how well do we know it? Schizophrenia Research, 1, 3–18.Google Scholar
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