Table 1.

Social Ecological Studies of Schizophemia Over the Last Decade

Reference	Geographical Area	Area Measure of Social Environmenta	Individual Risk Factors Included	Outcome Psychosis Measureb	Statistical Analysisc	Effect Measured	Results/Conclusionse
Curtis et al18	Zip codes (New York) Electoral wards (London)	D: index of multiple deprivation SFI EPB	None	SARs, all admissions, ICD 9/10 schizophrenia, 15–64 age group	Bayesian Poisson regression	Mean values of beta coefficient	Deprivationf +, 0.73 (0.61, 0.85) SFI +, 0.34 (0.19, 0.45) EPB NSS −0.09 (−0.20, −0.037) EPB +, in New York
Allardyce et al4	Postcode sectors (all of Scotland)	D: Carstairs scores SFI	None	SARs, first ever admissions, ICD 9 psychosis, 15–64 age group Dichotomized into high/low rates at 75th percentile	Logistic regression	OR High rate category	SFI +OR for the most fragmented category, 12.84 (5.71, 28.88) Carstairs scores +OR for the most deprived category, 5.29 (1.49, 18.75)
Boydell et al25	Electoral wards in London	Index of inequality D: categories of absolute deprivation Proportion of ethnic minorities	Age Sex Member of nonwhite ethnic minorities Ethnicity × area proportion of ethnic minorities	Treated incidence of RDC schizophrenia	Multilevel Poisson regression	SIRs	Inequality: NSS for whole sample Interaction with absolute deprivation and inequality demonstrated that in the most derived areas there was an inequality +, most deprived areas IRR, 3.79 (1.25, 11.49)
Logdberg et al26	87 administrative units in Sweden	Community questionnaire of fear of crime Factor 1: characterized social cohesion and victimization and fear of property crime Factor 2: victimization and fear of crime to the person	None	I year prevalence, DSM (IV) schizophrenia	Product moment correlation of factors and prevalence rates of schizophrenia	Correlation and partial correlation	Factor 1 +, r = 0.63, P < .001 Factor 2 +, r = 0.47 P < .47 Both were correlated Partial correlation Factor 1, 0.51 P < .001 Factor 2, 0.19 P < .001
Silver et al16	Census tracts in 4 US cities	D: factor analyses of census variables created 2 factors Neighborhood disadvantage Residential mobility Racial homogeneity (>90% ethnic same proportions)	Sex Age Race Education Marital status Household income	Prevalence of schizophrenia, DIS-interviewed DSM (III) schizophrenia, 18–96 age group	Binomial hierarchical linear regression	OR presence of schizophrenia in year of interview with 1 SD change in predictor variable	Neighborhood disadvantage was NSS 1.16 (0.92, 1.46) After adjustment for individual, education, household income, and marital status Social mobility +, 1.27 (1.02, 1.59) Ethnic mix NSS 0.90 (0.73, 1.11)
Boydell et al21	Electoral wards in London	Proportion of nonwhite ethnic minorities Deprivation: composite Index of local conditions	Age Sex Self-assigned nonwhite ethnic minority	All new cases, RDC schizophrenia	Multilevel Poisson regression	SIRs	Proportion of ethnic minorities NSS 0.83 (0.63, 1.1) However, evidence cross-level interaction ethnicity Stratified analysis: IRR 4.4 (2.49, 7.75) areas with lowest ethnic density Deprivation NSS 1.05 (0.98, 1.13)
Peen and Dekker14	81 neighborhoods in Amsterdam	D: EFA identified Housing factor Socioeconomic deprivation	None	First admissions rates, ICD 9 schizophrenia, 4-year period	Categories of area deprivation generated 1 least-deprived to 4 most deprived ANOVA Pearson's correlation factor scores with SARs	SARs	1-way ANOVA 1 < 2, 3, 4 and 2, 3 < 4 f = 17.18 df = 3, P < .001 r = 0.54 (P < .001)
van Os et al22	Small traditional neighborhoods in Maastricht	Proportion of single and divorced Area-level proportions of rental support Nonvoters Welfare dependent Foreign born Unemployed Residential mobility New housing	Gender Age Marital status	Incidence of clinically diagnosed schizophrenia, age, 15–64	Multilevel Poisson regression	SIRs	Neighborhood proportion single +, IRR 1.02 (1, 1.03) Proportion divorced +, IRR 1.12 (1.04, 1.21) per 1% increase Individual-level single risk conditioned on the cross-level interaction with neighborhood single proportions
Croudace et al13	Electoral wards in Nottingham	D: Mental Illness Needs Index	None	Treated incidence of ICD 10 psychosis	Generalized linear models, generalized additive models Poisson regression	Rank correlation SIRs	Deprivation +, correlation Spearman's ρ 0.44 (z = 4.52, P < .01) Nonlinear
Koppel et al20	Electoral wards in South Glamorgan	D: Jarman, Carstairs, Townsend Single census variables	None	Episode-based admissions, ICD 9 schizophrenia	Product moment correlation Linear regression to determine which single wards-level indicator best predicted for crude rates of schizophrenia	Crude admission rates	Deprivation + Jarman 0.74 Townsend 0.69 Carstairs r = 0.68 Single-level no car best predicted admissions for schizophrenia
Goldsmith et al15	Census tracts in 5 US cities	D: median household income Proportion of nonwhite	Age Gender Marital status Race Education	Prevalence of schizophrenia, DIS-interviewed DSM (III) schizophrenia	Main-effects logistic multiple regression model	OR presence of schizophrenia in year of interview	Deprivation +, 2.14 (1.01, 4.53) in the most deprived category compared with least Ethnic proportion NSS
Boardman et al17	Electoral wards in North Staffordshire	D: Jarman, Townsend Single census variables	None	Episode-based admissions, ICD 9 schizophrenia, nonaffective psychosis	Pearson correlation Linear regression	SARs	Deprivation +, r ranged from 0.24 to 0.59
Harvey et al19	Electoral wards in Camden	D: Jarman Single-component variables	None	All cases in contact with service Broad Feigner DSM (III R) schizophrenia	Normal linear regression Logistic regression	Point prevalence	Deprivation + Unemployment NLR: t = 4.74, P < .0005 Predictive error > Narrow definitions of schizophrenia

^aD: deprivation; EPB: ethnic proportion black; EFA: exploratory factor analysis.

^bSAR: standardized admission ratio; ICD: international classification of diseases; RDC: research diagnostic criteria; DIS: diagnostic interview schedule; DSM: diagnosis and statistical manual of mental disorders.

^cANOVA: analysis of variance.

^dOR: odds ratio; SIR: standardized incidence ratio; SD: standard deviation.

^eIRR: incident rate ratio; +: positive association, which is statistically significant; NSS: no statistically significant association; NLR: normal linear regression.

^fEffect size only shown for London males.