Abstract
BackgroundFamily involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important. MethodsDUP was estimated for all cases of first-episode psychoses identified over 2 years in 33 Southeast London neighbourhoods (n=329). DUP was positively skewed and transformed to the natural logarithm scale. We fitted various hierarchical models, adopting different assumptions with regard to spatial variability of DUP, to assess whether there was evidence of neighbourhood heterogeneity in DUP, having accounted for a priori individual-level confounders. ResultsNeighbourhood-level variation in DUP was negligible compared to overall variability. A non-hierarchical model with age, sex and ethnicity covariates, but without area-level random effects, provided the best fit to the data. DiscussionNeighbourhood factors do not appear to be associated with DUP, suggesting its predictors lie at individual and family levels. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis.
Highlights
Emerging evidence from social epidemiology suggests that the incidence of schizophrenia and other non-affective psychoses varies spatially (March et al, 2008), implicating societal-level stressors in their aetiology
One recent study has shown that the probability of hospital admission for a psychotic disorder was associated with neighbourhood-level informal social control (Drukker et al, 2006)—defined as the “willingness of local residents to intervene for the common good...–...depends in large part on conditions of mutual trust and solidarity among neighbours”. (Sampson et al, 1997, p. 919) This raises the possibility that DUP may be associated with neighbourhood-level social factors, since people exhibiting deviant behaviour may come to the attention of services more quickly in socially cohesive areas
All subjects presenting to the Southeast London centre of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses [ÆSOP] study, over a 2-year period, with a suspected firstepisode psychosis were included in the current study
Summary
Emerging evidence from social epidemiology suggests that the incidence of schizophrenia and other non-affective psychoses varies spatially (March et al, 2008), implicating societal-level stressors in their aetiology. The relationship between urbanicity and schizophrenia risk has been shown to extend back as far as birth (Mortensen et al, 1999), making reverse causality – social drift – insufficient to explain this variation alone. Many of these societallevel factors appear to be related to an absence of social cohesion or support (Allardyce and Boydell, 2006). Whether other aspects of psychotic disorders, such as the duration of untreated psychosis [DUP], are associated with societal-level factors is not known. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis
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