The island effect: Spatial effects on mental wellbeing and residence on remote Scottish islands

Abstract

BackgroundMental illness is the leading cause of disability in the UK, placing huge burden on individuals and society. This study explores how mental health outcomes relate to living in more geographically remote neighborhoods and the role of neighborhood-level social character. MethodsAdministrative, health and census databases were linked for a 5% sample of those aged 23–68 (n = 114,428) living in Scotland, between the years 2009–2014. Self-reported mental illness and prescriptions for psychotropic medications were modelled by residential level of remoteness, adjusting for individual level confounders and small area level measures of ‘social cohesion’ namely social fragmentation (SFI), social gifting (SGI) and income deprivation at the data zone level. ResultsMental ill health was lowest amongst residents in more remote/rural areas and particularly those living on islands. Difference in individual level factors such as ‘social grade’ and ethnicity did not explain this variation. Different levels of social cohesion appeared to explain a substantial proportion of the remoteness relationship with mental health. ConclusionRemote living is associated with lower odds of mental illness in Scotland. This may be partially due to neighborhood social structures shaped by geographical isolation. These findings contribute to understanding epidemiological and spatial inequalities of mental health, which could inform aspects of health and social policy.