Abstract
BackgroundMental health disorders impact approximately one in four US adults. While their causes are likely multifactorial, prior research has linked the risk of certain mental health disorders to prenatal and early childhood environmental exposures, motivating a spatial analysis to determine whether risk varies by birth location.MethodsWe investigated the spatial associations between residence at birth and odds of depression, bipolar disorder, and post-traumatic stress disorder (PTSD) in a retrospective cohort (Cape Cod, Massachusetts, 1969–1983) using generalized additive models to simultaneously smooth location and adjust for confounders. Birth location served as a surrogate for prenatal exposure to the combination of social and environmental factors related to the development of mental illness. We predicted crude and adjusted odds ratios (aOR) for each outcome across the study area. The results were mapped to identify areas of increased risk.ResultsWe observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61–3.07, P = 0.03). Similar geographic patterns were seen for the crude odds of PTSD; however, these patterns were no longer present in the adjusted analysis (aOR range: 0.49–1.36, P = 0.79), with family history of mental illness most notably influencing the geographic patterns. Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58–1.17, P = 0.82).ConclusionSpatial associations exist between residence at birth and odds of PTSD and depression, but much of this variation can be explained by the geographic distributions of available risk factors. However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.
Highlights
Mental health disorders impact approximately one in four US adults
To determine whether prenatal exposures to these and other geographically distributed factors in Cape Cod impact the development of mental illness, we investigate geographic birth location as a surrogate for exposure to a mix of social and environmental exposures
Using individual-level data collected as part of a larger retrospective cohort study [17], we investigated the spatial associations between residence at birth and odds of depression, bipolar/manic-depressive disorder, and post-traumatic stress disorder (PTSD)
Summary
Mental health disorders impact approximately one in four US adults While their causes are likely multifactorial, prior research has linked the risk of certain mental health disorders to prenatal and early childhood environmental exposures, motivating a spatial analysis to determine whether risk varies by birth location. One in four US adults suffers from a diagnosable mental illness such as depression, bipolar disorder, or post-traumatic stress disorder (PTSD) [1, 2] Their causes are likely multifactorial; research indicates that adverse prenatal events increase the risk of mental disorders [3]. Children exposed to PCE prenatally and during early-life were at increased risk of PTSD and bipolar disorder as an adult [17] These results motivated the current spatial analyses whose goal was to determine whether residence at birth was associated with mental health disorders
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