Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses

Background Social disorganisation, fragmentation and isolation have long been posited as influencing the rate of psychoses at area level. Measuring such societal constructs is difficult. A census-based index measuring social fragmentation has been proposed. Aims To investigate the association between first-admission rates for psychosis and area-based measures of social fragmentation, deprivation and urban/rural index. Method We used indirect standardisation methods and logistic regression models to examine associations of social fragmentation, deprivation and urban/rural categories with first admissions for psychoses in Scotland for the 5-year period 1989-1993. Results Areas characterised by high social fragmentation had higher first-ever admission rates for psychosis independent of deprivation and urban/rural status. There was a close-response relationship between social fragmentation category and first-ever admission rates for psychosis. There was no statistically significant interaction between social fragmentation, deprivation and urban/rural index. Conclusions First-admission rates are strongly associated with measures of social fragmentation, independent of material deprivation and urban/rural category. Declaration of interest. None.