Abstract
Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13–18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6 %). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.
Highlights
In everyday life, adolescents are exposed to a multitude of different social contexts and their mental health and development will be affected by these collective contexts in which they interact [1]
The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization
6.5 percent of the adolescents received some type of treatment for mental health problems in the course of 2005
Summary
Adolescents are exposed to a multitude of different social contexts and their mental health and development will be affected by these collective contexts in which they interact [1]. A growing body of research has focused interest on the importance of the neighbourhood context for our understanding of health inequalities [2,3,4], and on the identification of the contextual boundaries that affect health and health-related behaviour [5,6,7,8]. When planning interventions to improve adolescent mental health or access to health care, it is important to identify the contextual characteristics that are associated with these outcomes. We need to recognize the contexts in which individuals interact, and to disentangle the relative relevance of these different contexts for our understanding of individual differences in mental health and psychiatric care utilisation [8]
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