Abstract
BackgroundLittle is known about associations between the social environment and risk for psychosis within rural settings. This study sought to investigate whether such associations exist within a rural context using a prospective dataset of unusual epidemiological completeness. MethodUsing the Cavan–Monaghan First Episode Psychosis Study database of people aged 16years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban–rural classification across electoral divisions. ResultsThe primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR)=1.12, 95% CI (1.03–1.23)]. ConclusionsThese findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban–rural gradient.
Highlights
The past two decades have witnessed a revival of interest in the role of the social environment in the aetiology of psychotic disorders (Allardyce and Boydell, 2006; Cantor-Graae, 2007; Kirkbride et al, 2007)
DSM-IV diagnosis is made at inception, together with psychopathological and cognitive assessments, reported elsewhere (Owoeye et al, 2013; Kingston et al, 2013), with repeat DSM-IV diagnosis made at 6 months; there are no exclusion criteria other than a previously treated episode of psychosis or psychosis occurring with a prior, overriding diagnosis of gross neurodegenerative disease
Cases of non-functional psychosis [i.e. substance-induced psychosis or psychosis due to a general medical condition], those with no fixed address and those whose onset of illness was outside of Cavan–Monaghan were excluded from the study
Summary
The past two decades have witnessed a revival of interest in the role of the social environment in the aetiology of psychotic disorders (Allardyce and Boydell, 2006; Cantor-Graae, 2007; Kirkbride et al, 2007). Socio-environmental risk factors are generally studied at two levels: (1) area-based (contextual) characteristics such as deprivation, social fragmentation and more recently social capital, and (2) individual-level (compositional) factors such as ethnicity, social class, social adversity and cannabis use. Method: Using the Cavan–Monaghan First Episode Psychosis Study database of people aged 16 years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban–rural classification across electoral divisions. Results: The primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR) = 1.12, 95% CI (1.03–1.23)]. Conclusions: These findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban–rural gradient
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