Urbanisation as a risk indicator for complex psychiatric disorders and forced admissions

Abstract

Background To determine both prevalence and complexity of psychiatric disorders in the Amsterdam area in relation to other major cities and less urbanized areas in the Netherlands, and to assess whether this is related to higher levels of (coercive) admissions. Methods These associations were explored in a nationwide epidemiological study and the national admission register, and in a local study of the Amsterdam region examining health care use patterns. Results The admission rate for the whole of the Netherlands was twice as high in the group of most highly urbanized municipalities as in the group of least urbanized municipalities. The urban/rural variations in admission rates in the Netherlands are reflected in true psychiatric morbidity rates. The authors found an urban/rural difference in total annual prevalence figures for psychiatric disorders in the population. The difference was also found for the separate disorders, mood disorders and substance-induced disorders, but not for anxiety disorders. Both prevalence and complexity of psychopathology in terms of comorbidity and severity were significantly higher in Amsterdam compared to other larger cities in the Netherlands, as were the number of coercive admissions. Conclusion There is evidence regarding a link between urbanisation, the development of complex psychiatric disorders and the number of (forced) admissions to PICU's [1].