Introduction Research shows conflict and racial/ethnic segregation leads to poor health. Northern Irelands emerging from over 30 years of civil disturbance but remains a society markedly segregated along religious lines with >70% population living in areas comprising >70% one religion. This study aims to determine if segregation is an independent predictor of psychological morbidity.
Methods A geographical information system was used to produce a dissimilarity index for the 890 super-output areas (SOA) in Northern Ireland (average pop. 1900), modelling residential segregation by measuring dissimilarity within a SOA compared to its surrounding SOAs. Population was divided into equally proportioned segregation deciles. Psychological morbidity was assessed using uptake of antidepressant and anxiolytic medication data from a population-wide electronic prescribing system over 14 months (2009/10). Multiple logistic regression of ∼1.2 million non-institutionalised patients aged 18–74 was executed, with adjustment for demographic factors, residential social fragmentation, deprivation, and multi-level modelling to adjust for variations in prescribing at general practice level.
Results Almost 20% patients were prescribed antidepressant and/or anxiolytic medication. Likelihood of antidepressant and anxiolytic use was higher in segregated than non-segregated areas (OR=1.45 95% CI 1.35 to 1.56 and OR=1.49 95% CI 1.32 to 1.68 respectively) after adjusting for age and gender. Further adjustment for fragmentation and income deprivation eliminated the relationship (OR=1.02 95% CI 0.96 to 1.08 and OR=1.00 95% CI 0.90 to 1.10 respectively).
Conclusion Segregation is related to poor mental health but only because the people living in the more segregated areas are economically disadvantaged. Further analysis is being undertaken to determine if this holds true for other measures of residential polarisation.
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