RESEARCH REPORT

Contextual risk factors for the common mental disorders in Britain: a multilevel investigation of the effects of place

S Weich¹, L Twigg², G Holt², G Lewis³ and K Jones⁴

¹ Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK
² Institute for the Geography of Health, Department of Geography, University of Portsmouth, Portsmouth, UK
³ Division of Psychiatry, University of Bristol, Bristol, UK
⁴ School of Geographical Sciences, University of Bristol

Correspondence to:
Correspondence to:
Dr S Weich, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK;
s.weich{at}rfc.ucl.ac.uk

Study objective: To test hypotheses about associations between area level exposures and the prevalence of the most common mental disorders (CMD) in Britain. A statistically significant urban-rural gradient was predicted, but not a socioeconomic gradient, in the prevalence of CMD after adjusting for characteristics of individual respondents. The study tested the hypothesis that the effects of area level exposures would be greatest among those not in paid employment.

Design: Cross sectional survey, analysed using multilevel logistic and linear regression. CMD were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised using the Carstairs index, the Office of National Statistics (ONS) Classification of Wards, and population density.

Setting: England, Wales, and Scotland.

Participants: Nearly 9000 adults aged 16–74 living in 4904 private households, nested in 642 electoral wards.

Main results: Little evidence was found of statistically significant variance in the prevalence of CMD between wards, which ranged from 18.8% to 29.5% (variance 0.035, SE 0.026) (p=0.11). Associations between CMD and characteristics of wards, such as the Carstairs index, only reached statistical significance among those who were economically inactive (adjusted odds ratio for top v bottom Carstairs score quintile 1.58, 95% CI 1.08 to 2.31) (p<0.05).

Conclusions: There may be multiple pathways linking socioeconomic inequalities and ill health. The effects of place of residence on mental health are greatest among those who are economically inactive and hence more likely to spend the time at home.

Keywords: common mental disorders; multilevel modelling; context

Abbreviations: CMD, common mental disorders; BHPS, British Household Panel Survery; GHQ, General Health Questionnaire

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

MENTAL HEALTH, UNEMPLOYMENT, TOBACCO, WASTE, AND PIGS

John R Ashton and Carlos Alvarez-Dardet
J Epidemiol Community Health 2003 57: 545. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Mair, C, Roux, A V D., Galea, S (2008). Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J. Epidemiol. Community Health 62: 940-946 [Abstract] [Full Text]  
• Pearce, J, Mason, K, Hiscock, R, Day, P (2008). A national study of neighbourhood access to gambling opportunities and individual gambling behaviour. J. Epidemiol. Community Health 62: 862-868 [Abstract] [Full Text]  
• Nicholson, L. A. (2008). Rural mental health. Adv. Psychiatr. Treat. 14: 302-311 [Abstract] [Full Text]  
• O'Reilly, D., Rosato, M., Connolly, S., Cardwell, C. (2008). Area factors and suicide: 5-year follow-up of the Northern Ireland population. Br. J. Psychiatry 192: 106-111 [Abstract] [Full Text]  
• De Maio, F. G (2007). Income inequality measures. J. Epidemiol. Community Health 61: 849-852 [Abstract] [Full Text]  
• Fone, D., Dunstan, F., Lloyd, K., Williams, G., Watkins, J., Palmer, S. (2007). Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. Int J Epidemiol 36: 338-345 [Abstract] [Full Text]  
• Middleton, N., Sterne, J. A C, Gunnell, D. (2006). The geography of despair among 15-44-year-old men in England and Wales: putting suicide on the map.. J. Epidemiol. Community Health 60: 1040-1047 [Abstract] [Full Text]  
• Lofors, J., Ramirez-Leon, V., Sundquist, K. (2006). Neighbourhood income and anxiety: a study based on random samples of the Swedish population. Eur J Public Health 16: 633-639 [Abstract] [Full Text]  
• Zimmerman, F. J, Bell, J. F (2006). Income inequality and physical and mental health: testing associations consistent with proposed causal pathways.. J. Epidemiol. Community Health 60: 513-521 [Abstract] [Full Text]  
• Chaix, B., Leyland, A. H, Sabel, C. E, Chauvin, P., Rastam, L., Kristersson, H., Merlo, J. (2006). Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmo, Sweden, in 2001. J. Epidemiol. Community Health 60: 427-435 [Abstract] [Full Text]  
• WEICH, S., TWIGG, L., LEWIS, G. (2006). Rural/non-rural differences in rates of common mental disorders in Britain: Prospective multilevel cohort study. Br. J. Psychiatry 188: 51-57 [Abstract] [Full Text]  
• Chaix, B., Merlo, J., Subramanian, S. V., Lynch, J., Chauvin, P. (2005). Comparison of a Spatial Perspective with the Multilevel Analytical Approach in Neighborhood Studies: The Case of Mental and Behavioral Disorders due to Psychoactive Substance Use in Malmo, Sweden, 2001. Am J Epidemiol 162: 171-182 [Abstract] [Full Text]  
• WEICH, S., TWIGG, L., LEWIS, G., JONES, K. (2005). Geographical variation in rates of common mental disorders in Britain: prospective cohort study. Br. J. Psychiatry 187: 29-34 [Abstract] [Full Text]  
• Skapinakis, P., Lewis, G., Araya, R., Jones, K., Williams, G. (2005). Mental health inequalities in Wales, UK: multi-level investigation of the effect of area deprivation. Br. J. Psychiatry 186: 417-422 [Abstract] [Full Text]  
• Weich, S. (2005). Absence of spatial variation in rates of the common mental disorders. J. Epidemiol. Community Health 59: 254-257 [Full Text]  
• Cummins, S., Stafford, M., Macintyre, S., Marmot, M., Ellaway, A. (2005). Neighbourhood environment and its association with self rated health: evidence from Scotland and England. J. Epidemiol. Community Health 59: 207-213 [Abstract] [Full Text]  
• Chandola, T., Clarke, P., Wiggins, R. D, Bartley, M. (2005). Who you live with and where you live: setting the context for health using multiple membership multilevel models. J. Epidemiol. Community Health 59: 170-175 [Abstract] [Full Text]