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Urban–rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy

Published online by Cambridge University Press:  09 July 2009

Graham Thornicroft ,
Giulia Bisoffi ,
Domenico De Salvia  and
Michele Tansella
Graham Thornicroft*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona; Dipartimento di Psichiatria, ULSS N.14, Regione Veneto, Portogruaro, Italy; and PRiSM, Institute of Psychiatry, London
Giulia Bisoffi
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona; Dipartimento di Psichiatria, ULSS N.14, Regione Veneto, Portogruaro, Italy; and PRiSM, Institute of Psychiatry, London
Domenico De Salvia
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona; Dipartimento di Psichiatria, ULSS N.14, Regione Veneto, Portogruaro, Italy; and PRiSM, Institute of Psychiatry, London
Michele Tansella
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona; Dipartimento di Psichiatria, ULSS N.14, Regione Veneto, Portogruaro, Italy; and PRiSM, Institute of Psychiatry, London
*
1Address for correspondence: Dr Graham Thornicroft, PRiSM, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.
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Synopsis

Service utilization measures from the psychiatric case registers for urban South-Verona and rural Portogruaro in North East Italy for the period 1983–9 were used to identify associations with socio-demographic variables from the 1981 census in schizophrenia and related disorders as well as in all diagnoses. The patterns of service use were broadly similar, except that Portogruaro has significantly more community contacts, and has about twice the treated incidence and prevalence of schizophrenia. The census data showed that unmarried and unemployed people were more likely to live alone in the urban than in the rural area. In South-Verona the most strongly associated predictor variables, both for schizophrenia and all diagnoses, are: living alone, unemployment, percentage of the total population who are dependents and the percentage who are divorced, separated or widowed. In contrast, in Portogruaro there were no consistent associations between census and service use variables. Stepwise multiple regression models using three census predictor variables accounted for over 85% of the variance in South-Verona utilization rates. The results indicate that the strongly predictive associations previously described in England hold in urban South-Verona, but not in rural Portogruaro, and may be related to the effect of cities in clustering seriously disabled psychiatric patients in areas of low-cost housing where they live in relative social isolation.

Type
Original Articles
Information
Psychological Medicine , Volume 23 , Issue 2 , May 1993 , pp. 487 - 496
Copyright
Copyright © Cambridge University Press 1993

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References

Blazer, D., George, L., Landerman, R., Pennybacker, M., Melville, M., Woodbury, M., Manton, K., Jordan, K. & Locke, B. (1985). Psychiatric disorders: a rural/urban comparison. Archives of General Psychiatry 42, 651–656.CrossRefGoogle ScholarPubMed
Cagle, L. & Banks, S. (1986). The validity of assessing health needs with social indicators. Evaluation and Program Planning 9, 127–142.CrossRefGoogle ScholarPubMed
De Salvia, D. (1987). Rapporto dal Registro Psichiatrico dei Casi di Portogruaro. Quinquennio 1982–1986. Rivista Sperimentale di Freniatria 111, Supplementum to issue 4, 879–976.Google Scholar
Dohrenwend, B. (1975). Socio-cultural and social-psychological factors in the genesis of mental disorders. Journal of Health and Social Behaviour 16, 365–392.CrossRefGoogle Scholar
Eaton, W. W. (1974). Residence, social class and schizophrenia. Journal of Health and Social Behaviour 15, 289–299.CrossRefGoogle ScholarPubMed
Faccincani, C., Mignolli, G. & Platt, S. (1990). Service utilisation, social support and psychiatric status in a cohort of patients with schizophrenic psychoses. Schizophrenia Research 3, 139–146.CrossRefGoogle Scholar
Faris, R. & Dunham, H. (1939). Mental Disorders in Urban Areas. University of Chicago Press: Chicago.Google Scholar
Giggs, J. (1986). Mental disorders and ecological structure in Nottingham. Social Science and Medicine 23, 945–961.CrossRefGoogle ScholarPubMed
Giggs, J. & Cooper, J. (1987). Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. British Journal of Psychiatry 151, 627–633.CrossRefGoogle ScholarPubMed
Goodman, A., Siegal, C., Craig, T. & Shang, P. (1983). The relationship between socioeconomic class and prevalence of schizophrenia, alcoholism and affective disorders treated by inpatients in a suburban area. American Journal of Psychiatry 140, 166–170.Google Scholar
Hare, E. (1956). Mental illness and social conditions in Bristol. Journal of Mental Science 102, 349–357.CrossRefGoogle ScholarPubMed
Hirsch, S. (1988). Psychiatric Beds and Resources: Factors Influencing Bed Use and Service Planning. Gaskell/Royal College of Psychiatrists: London.Google Scholar
Hughes, D. (1973). Morbidity statistics from population surveys. In Roots of Evaluation (ed. Wing, J. K. and, Haefner, H.), pp. 87–97. Oxford University Press: London.Google Scholar
Jarman, B. (1983). Identification of underprivileged areas. British Medical Journal 286, 1705–1709.CrossRefGoogle ScholarPubMed
Jarman, B. (1984). Under privileged areas: validation and distribution of scores. British Medical Journal 289 1587–1592.CrossRefGoogle Scholar
Keatinge, C. (1989). Psychiatric admissions for alcoholism, neuroses, and schizophrenia in rural and urban Ireland. International Journal of Social Psychiatry 34, 58–69.CrossRefGoogle Scholar
Krupinski, J. (1979). Urbanisation and mental health. Australian and New Zealand Journal of Psychiatry 13, 139–145.CrossRefGoogle Scholar
Lavik, N. (1983). Utilisation of mental health services over a given period. Acta Psychiatrica Scandinavica 67, 404–413.CrossRefGoogle Scholar
Lesage, A. & Tansella, M. (1989). Mobility of schizophrenic patients, non-psychotic patients and general population in a case-register area. Social Psychiatry and Psychiatric Epidemiology 24, 271–274.CrossRefGoogle Scholar
Maylath, E., Weyerer, S. & Haefner, H. (1989). Spatial concentration of the incidence of treated psychiatric disorders in Mannheim. Acta Psychiatrica Scandinavica 80, 650–656.CrossRefGoogle ScholarPubMed
Mueller, D. (1981). The current status of urban–rural differences in psychiatric disorder: an emerging trend for depression. Journal of Nervous and Mental Disorders 169, 18–27.CrossRefGoogle ScholarPubMed
Romans-Clarkson, S., Walton, V., Herbison, P. & Mullen, P. (1990). Psychiatric morbidity and women in urban and rural New Zealand: psycho-social correlates. British Journal of Psychiatry 156, 84–91.CrossRefGoogle Scholar
Shapiro, S., Skinner, E., Kramer, M., Steinwachs, D. & Regier, D. (1985). Measuring need for mental health services in a general population. Medical Care 23, 1033–1043.CrossRefGoogle ScholarPubMed
Sytema, S., Giel, R., ten Horn, G., Balestrieri, M. & Davies, N. (1989). The reliability of diagnostic coding in psychiatric case registers. Psychological Medicine 19, 999–1006.CrossRefGoogle ScholarPubMed
Tansella, M. (ed.) (1991). Community-based Psychiatry: Long-term Patterns of Care in South-Verona. Psychological Medicine Monograph Supplement 19. Cambridge University Press: Cambridge.Google Scholar
Tansella, M. & De Salvia, D. (1986). Case registers in comprehensive community psychiatric service areas in Italy. In Psychiatric Case Registers in Public Health (ed. ten Horn, G., Giel, R., Gulbinat, W. and Henderson, J.), pp. 140–145. Elsevier: Amsterdam.Google Scholar
Thornicroft, G. (1991 a). Social deprivation and rates of treated mental disorder: developing statistical models to predict psychiatric service utilization. British Journal of Psychiatry 158, 465–484.CrossRefGoogle Scholar
Thornicroft, G. (1991 b). The TAPS project (6). New long-stay psychiatric patients and social deprivation. British Journal of Psychiatry 161, 621–624.CrossRefGoogle Scholar
Tischler, G., Henisz, J., Myers, J. & Boswell, P. (1975). Utilisation of mental health services. Archives of General Psychiatry 32, 411–415.CrossRefGoogle ScholarPubMed
Tischler, G., Leaf, P., Benham, L., Cottler, L. & Regier, D. (1984). Utilisation of health and mental health services: three epidemiologic catchment area sites. Archives of General Psychiatry 41, 971–978.Google Scholar
Viscogliosi Calabrese, L., Micciolo, R. & Tansella, M. (1990). Patterns of care for chronic patients after the Italian reform. A longitudinal case register study. Social Science and Medicine 31, 815–822.CrossRefGoogle Scholar
Weyerer, S. & Haefner, H. (1989). The stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim. Social Psychiatry 24, 57–62.Google ScholarPubMed
White, W. (1903). The geographical distribution of insanity in the United States. Journal of Nervous and Mental Disease 30, 257–279.CrossRefGoogle Scholar