Ethnic Density of Neighborhoods and Incidence of Psychotic Disorders Among Immigrants

Parnassia Psychiatric Institute, Mangostraat 15, 2552 KS, The Hague, the Netherlands.
American Journal of Psychiatry (Impact Factor: 12.3). 02/2008; 165(1):66-73. DOI: 10.1176/appi.ajp.2007.07030423
Source: PubMed


A high incidence of psychotic disorders has been reported in immigrant ethnic groups in Western Europe. Some studies suggest that ethnic density may influence the incidence of schizophrenia. The authors investigated whether this increased incidence among immigrants depends on the ethnic density of the neighborhoods in which they live.
This was a prospective first-contact incidence study of psychotic disorders in The Hague, by ethnicity and neighborhood of residence. Over a 7-year period, individuals who made contact with a physician for a suspected psychotic disorder underwent diagnostic interviews and received DSM-IV diagnoses. A comprehensive municipal registration system provided the denominator for incidence rates. Data were sufficient to examine incidence rates in native Dutch and in first- and second-generation immigrants from Morocco, Suriname, and Turkey. The ethnic density of a neighborhood was computed for each immigrant group as the proportion of residents belonging to that group. Multilevel regression analyses predicted the incidence of psychotic disorders as a function of individual ethnicity and neighborhood ethnic density. Models were fitted for all immigrants together and for each immigrant group separately.
A total of 226 native Dutch and 240 immigrants were diagnosed as having a psychotic disorder. Compared with native Dutch, the adjusted incidence rate ratio for immigrants was significantly increased in low-ethnic-density neighborhoods (2.36) but not in high-ethnic-density neighborhoods (1.25). There was a strong interaction between individual ethnicity and neighborhood ethnic density as predictors of incidence of illness. These findings were consistent across all immigrant groups.
The incidence of psychotic disorders was elevated most significantly among immigrants living in neighborhoods where their own ethnic group comprised a small proportion of the population.

  • Source
    • "For example, the presence of many families with young children may increase interaction among neighbours and feelings of responsibility for the neighbourhood. Conversely, neighbourhood social cohesiveness may be undermined by demographic or ethnic heterogeneity, and by large socioeconomic inequalities [36,37]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Evidence on the effect of community social capital on suicide mortality rates is fragmentary and inconsistent. The present study aims to determine whether geographic variations in suicide mortality across the Netherlands were associated with community social capital. We included 3507 neighbourhoods with 6207 suicide deaths in the period 1995--2000. For each neighbourhood, we measured perceived social capital using information from interview surveys, and we measured structural aspects of social capital using population registers. Associations with mortality were determined using Poisson regression analysis with control for confounders at individual level (age, sex, marital status, country of origin) and area level (area income, population density, religious orientation). Suicide mortality rates were related to the measure of perceived social capital. Mortality rates were 8 percent higher (95% confidence interval (CI): 2 to 16 percent) in areas with low capital. In stratified analyses, this difference was found to be significantly larger among men (12 percent, CI: 2 to 22) than women (1 percent, CI: -9 to 13), larger among those age 0--50 (18 percent, CI: 8 to 29) than older residents (-2 percent, CI: -12 to 8), and larger among the unmarried (30 percent, CI: 16--45) than the married (-2 percent, CI: -12 to 9). Associations with the structural aspect of social capital were in the same direction, but weaker, and not statistically significant. This study contributed some evidence to assume a modest effect of community social capital on suicide mortality rates. This effect may be restricted to specific population groups such as younger unmarried men.
    Full-text · Article · Oct 2013 · BMC Public Health
  • Source
    • "The authors concluded that this perception of disadvantage was not related to negative self-esteem or to the presence of psychotic symptoms, and queried whether it resulted from actual discriminatory experiences. Veling et al. (2008) and Cantor-Graae and Selten (2005) argue that these effects can be found in all immigrant groups, and specifically related to discrimination or perceived discrimination—or something closely associated with perceived discrimination , in some ways closing the historical loop and reintroducing discrimination in the UK as a focus of further attention. Although studies of the prevalence of schizophrenia have focused on people over 18 years old, one study suggests that Black children may have an increased prevalence of risk factors. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research.
    Full-text · Article · Oct 2013 · Transcultural Psychiatry
  • Source
    • "This study suggests that the perception of discrimination may contribute to increased risk for psychosis (Veling et al., 2007). Similarly, in a prospective study of the incidence of psychosis, immigrants living in neighborhoods where their own ethnic group comprised only a small percent of the population had higher incidence, suggesting that social isolation and the experience of exclusion may also play a role in the development of psychosis (Veling et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper briefly reviews the social science on "neighborhood effects" as an independent force in shaping poor outcomes, specifically mental illness and criminal behavior, before discussing the implications of that research for understanding the relationship between neighborhoods, race and class. Neighborhood effects research has proliferated in recent years with extensive attention again being focused on the social context of family and individual development and life course. Moreover, recent work has suggested the need to consider the developmental effects of neighborhoods that persist across life-span. This paper will focus specifically on mental illness and criminal behavior as outcomes for understanding neighborhood effects, but will also consider what the structural causes of individual behavior and functioning mean for clinical assessment, especially forensic assessment.
    Full-text · Article · Sep 2013
Show more