背景:研究表明,关于社会资本和发展为精神病的风险的结果参差不齐,这还没有在北美进行研究。我们试图研究邻里层面边缘化之间的关系,社会资本,以及多伦多精神分裂症和分裂情感障碍的发病率,加拿大。
方法:我们使用了一个以人群为基础的回顾性队列研究,以确定10年期间精神分裂症和分裂情感障碍的事件病例,并解释了邻里层面的边缘化和邻里社会资本的代理指标。使用混合泊松回归模型来估计调整后的发病率比率(aIRR)。
结果:在队列中(n=649020),我们确定了4841例精神分裂症和分裂情感障碍的事件。在邻里之间观察到发生率有27%的变化。所有边缘化维度,除了种族集中,与发病率有关。与社会资本较低的地区相比,在第二[aIRR=1.17,95%置信区间(CI)1.03-1.33]和第三(aIRR=1.23,95%CI1.08-1.40)的中间社会资本地区,在考虑边缘化后,发病率升高.仅在队列中的女性中进行分析时,与社会资本的中等水平相关的风险较高(aIRR=1.18,95%CI1.00-1.39),但是CI包括无效效果的可能性。
结论:多伦多发生精神分裂症和分裂情感障碍的风险因社区而异,并与社会环境暴露相关。社会资本与风险不是线性相关的,风险因性别和社会资本而异。未来的研究应该检查这些与不同形式的社会资本的关系,并检查已知的个人层面的风险因素如何影响这些发现。
Studies have shown mixed results regarding social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. We sought to examine the relationship between neighbourhood-level
marginalisation, social capital, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada.
We used a retrospective population-based cohort to identify incident cases of schizophrenia and schizoaffective disorder over a 10 year period and accounted for neighbourhood-level
marginalisation and a proxy indicator of neighbourhood social capital. Mixed Poisson regression models were used to estimate adjusted incidence rate ratios (aIRRs).
In the cohort (n = 649 020) we identified 4841 incident cases of schizophrenia and schizoaffective disorder. A 27% variation in incidence was observed between neighbourhoods. All
marginalisation dimensions, other than ethnic concentration, were associated with incidence. Compared to areas with low social capital, areas with intermediate social capital in the second [aIRR = 1.17, 95% confidence interval (CI) 1.03-1.33] and third (aIRR = 1.23, 95% CI 1.08-1.40) quintiles had elevated incidence rates after accounting for
marginalisation. There was a higher risk associated with the intermediate levels of social capital (aIRR = 1.18, 95% CI 1.00-1.39) when analysed in only the females in the cohort, but the CI includes the possibility of a null effect.
The risk of developing schizophrenia and schizoaffective disorder in Toronto varies by neighbourhood and is associated with socioenvironmental exposures. Social capital was not linearly associated with risk, and risk differs by sex and social capital quintile. Future research should examine these relationships with different forms of social capital and examine how known individual-level risk factors impact these findings.