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Testing the association between the incidence of schizophrenia and social capital in an urban area

Published online by Cambridge University Press:  08 November 2007

J. B. Kirkbride*
Affiliation:
Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
J. Boydell
Affiliation:
Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK
G. B. Ploubidis
Affiliation:
Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
C. Morgan
Affiliation:
Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK
P. Dazzan
Affiliation:
Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK
K. McKenzie
Affiliation:
Department of Mental Health Sciences, UCL Hampstead Campus, London, UK
R. M. Murray
Affiliation:
Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
*
*Address for correspondence: Dr J. B. Kirkbride, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Hills Road, CambridgeCB2 2QQ, UK. (Email: jbk25@cam.ac.uk)

Abstract

Background

Social capital has been considered aetiologically important in schizophrenia but the empirical evidence to support this hypothesis is absent. We tested whether social capital, measured at the neighbourhood level, was associated with the incidence of schizophrenia (ICD-10 F20).

Method

We administered a cross-sectional questionnaire on social capital to 5% of the adult population in 33 neighbourhoods (wards) in South London (n=16 459). The questionnaire contained items relating to two social capital constructs: social cohesion and trust (SC&T) and social disorganization (SocD). Schizophrenia incidence rates, estimated using data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study, provided the outcome. We used multi-level Poisson regression to test our hypothesis while controlling for individual- and neighbourhood-level characteristics.

Results

We identified 148 cases during 565 576 person-years at-risk. Twenty-six per cent of the variation in incidence rates was attributable to neighbourhood-level characteristics. Response from the social capital survey was 25.7%. The association between SC&T and schizophrenia was U-shaped. Compared with neighbourhoods with medial levels of SC&T, incidence rates were significantly higher in neighbourhoods with low [incidence rates ratio (IRR) 2.0, 95% confidence interval (CI) 1.2–3.3] and high (IRR 2.5, 95% CI 1.3–4.8) levels of SC&T, independent of age, sex, ethnicity, ethnic density, ethnic fragmentation and socio-economic deprivation.

Conclusion

Neighbourhood variation in SC&T was non-linearly associated with the incidence of schizophrenia within an urban area. Neighbourhoods with low SC&T may fail to mediate social stress whereas high SC&T neighbourhoods may have greater informal social control or may increase the risk of schizophrenia for residents excluded from accessing available social capital.

Type
Original Articles
Copyright
Copyright © 2007 Cambridge University Press

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References

Allardyce, J, Boydell, J (2006). Environment and schizophrenia: review: the wider social environment and schizophrenia. Schizophrenia Bulletin 32, 592598.CrossRefGoogle ScholarPubMed
Allardyce, J, Gilmour, H, Atkinson, J, Rapson, T, Bishop, J, McCreadie, RG (2005). Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. British Journal of Psychiatry 187, 401406.CrossRefGoogle ScholarPubMed
Almedom, AM (2005). Social capital and mental health: an interdisciplinary review of primary evidence. Social Science and Medicine 61, 943964.CrossRefGoogle ScholarPubMed
Baum, F (1999). Social capital: is it good for your health? Issues for a public health agenda. Journal of Epidemiology and Community Health 53, 195196.CrossRefGoogle ScholarPubMed
Boydell, J, McKenzie, K, van Os, J, Murray, R (2002). The social causes of schizophrenia: an investigation into the influence of social cohesion and social hostility – report of a pilot study. Schizophrenia Research 53, 264264.Google Scholar
Boydell, J, van Os, J, McKenzie, K, Allardyce, J, Goel, R, McCreadie, RG, Murray, RM (2001). Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. British Medical Journal 323, 13361338.CrossRefGoogle ScholarPubMed
De Silva, MJ, McKenzie, K, Harpham, T, Huttly, SR (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology and Community Health 59, 619627.CrossRefGoogle ScholarPubMed
Diez-Roux, AV, Nieto, FJ, Muntaner, C, Tyroler, HA, Comstock, GW, Shahar, E, Cooper, LS, Watson, RL, Szklo, M (1997). Neighborhood environments and coronary heart disease: a multilevel analysis. American Journal of Epidemiology 146, 4863.CrossRefGoogle ScholarPubMed
Diez Roux, AV (2004). The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiologic Reviews 26, 104111.CrossRefGoogle Scholar
Drukker, M, Buka, SL, Kaplan, C, McKenzie, K, Van Os, J (2005). Social capital and young adolescents' perceived health in different sociocultural settings. Social Science and Medicine 61, 185198.CrossRefGoogle Scholar
Drukker, M, Krabbendam, L, Driessen, G, van Os, J (2006). Social disadvantage and schizophrenia: a combined neighbourhood- and individual-level analysis. Social Psychiatry and Psychiatric Epidemiology 41, 595604.CrossRefGoogle ScholarPubMed
Durkheim, E (1952). Suicide: A Study in Sociology. Routledge & Kegan Paul: London.Google Scholar
Edwards, P, Roberts, I, Clarke, M, DiGuiseppi, C, Pratap, S, Wentz, R, Kwan, I (2002). Increasing response rates to postal questionnaires: systematic review. British Medical Journal 324, 11831185.CrossRefGoogle ScholarPubMed
Electoral Commission (2005). Understanding Electoral Registration: The Extent and Nature of Non-Registration in Britain. The Electoral Commission: London (www.electoralcommission.org.uk/about-us/2005researchreport.cfm). Accessed 27 July 2007.Google Scholar
ESRI (2001). ArcView. ESRI Press: Redlands, CA.Google Scholar
Henderson, S, Whiteford, H (2003). Social capital and mental health. Lancet 362, 505506.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry 63, 250258.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB (2007). Neighbourhood-level effects on psychoses: re-examining the role of context. Psychological Medicine 37, 14131425.CrossRefGoogle ScholarPubMed
Krabbendam, L, van Os, J (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.CrossRefGoogle Scholar
Lambeth Borough Council (2005). Lambeth Community Strategy 2004–5. Lambeth Borough Council: London (http://www.lambeth.gov.uk/services/communityliving/lambethcommunitystrategy.htm). Accessed 15 October 2007.Google Scholar
Lambeth Borough Council (2006). Regeneration. Lambeth Borough Council: London (http://www.lambeth.gov.uk/services/environment/regeneration/). Accessed 15 October 2007.Google Scholar
Lochner, KA, Kawachi, I, Brennan, RT, Buka, SL (2003). Social capital and neighborhood mortality rates in Chicago. Social Science and Medicine 56, 17971805.CrossRefGoogle ScholarPubMed
Marcelis, M, Takei, N, van Os, J (1999). Urbanization and risk for schizophrenia: does the effect operate before or around the time of illness onset? Psychological Medicine 29, 11971203.CrossRefGoogle ScholarPubMed
March, D, Susser, E (2006). Invited commentary: taking the search for causes of schizophrenia to a different level. American Journal of Epidemiology 163, 979981.CrossRefGoogle ScholarPubMed
McCulloch, A (2001). Social environments and health: cross-sectional national survey. British Medical Journal 323, 208209.CrossRefGoogle ScholarPubMed
McCulloch, A (2003). An examination of social capital and social disorganisation in neighbourhoods in the British household panel study. Social Science and Medicine 56, 14251438.CrossRefGoogle ScholarPubMed
McKenzie, K, Harpham, T (2006). Social Capital and Mental Health. Jessica Kingsley: London.Google Scholar
McKenzie, K, Whitley, R, Weich, S (2002). Social capital and mental health. British Journal of Psychiatry 181, 280283.CrossRefGoogle ScholarPubMed
Mortensen, PB, Pedersen, CB, Westergaard, T, Wohlfahrt, J, Ewald, H, Mors, O, Andersen, PK, Melbye, M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603608.CrossRefGoogle ScholarPubMed
Muthén, B, Muthén, L (2006). Mplus. Muthén & Muthén: Los Angeles.Google ScholarPubMed
Neeleman, J, Wilson-Jones, C, Wessely, S (2001). Ethnic density and deliberate self harm; a small area study in south east London. Journal of Epidemiology and Community Health 55, 8590.CrossRefGoogle ScholarPubMed
Portes, A (1998). Social capital: its origins and applications in modern sociology. Annual Review of Sociology 24, 124.CrossRefGoogle Scholar
Putnam, R (1993). Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press: Princeton, NJ.Google Scholar
Sampson, RJ, Raudenbush, SW, Earls, F (1997). Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 277, 918924.CrossRefGoogle ScholarPubMed
Sartorius, N (2003). Social capital and mental health. Current Opinion in Psychiatry 16, S101S105.CrossRefGoogle Scholar
Selten, JP, Cantor-Graae, E (2005). Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101102.CrossRefGoogle ScholarPubMed
Silver, E, Mulvey, EP, Swanson, JW (2002). Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science and Medicine 55, 14571470.CrossRefGoogle ScholarPubMed
StataCorp (2005). Stata. StataCorp: College Station, TX.Google Scholar
Takei, N, Sham, PC, O'Callaghan, E, Glover, G, Murray, RM (1995). Schizophrenia: increased risk associated with winter and city birth – a case-control study in 12 regions within England and Wales. Journal of Epidemiology and Community Health 49, 106107.CrossRefGoogle Scholar
van Os, J, Driessen, G, Gunther, N, Delespaul, P (2000). Neighbourhood variation in incidence of schizophrenia. Evidence for person–environment interaction. British Journal of Psychiatry 176, 243248.CrossRefGoogle ScholarPubMed
Whitley, R, McKenzie, K (2005). Social capital and psychiatry: review of the literature. Harvard Review of Psychiatry 13, 7184.CrossRefGoogle ScholarPubMed