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The influence of social deprivation as measured by the CNI on psychiatric admissions

Department of Community Health Sciences Dalby/Lund, University of Lund, Lund, Sweden

Jan Sundquist

Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Stanford, CA, USA

Sven-Erik Johansson

Department of Community Health Sciences Dalby/Lund, University of Lund, Lund, Sweden

Leena Maria Johansson

Department of Clinical Neuroscience and Family Medicine, Psychiatry Department, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden

The purpose of this study was to examine the importance of social deprivation for psychiatric admissions and its correlation with two different deprivation scores. Care Need Index (CNI) and Townsend scores were calculated at the small area level in Malmö, a city in southern Sweden. Admission rates for all psychiatric inpatients from Malmö aged 20 - 79 years, admitted to the psychiatric and alcohol clinics from 1 January 1991 to 31 December 1994, were calculated. The relationship between the CNI and psychiatric admissions was analysed by applying a Poisson regression model. The results are shown as incidence density ratios (IDR) with 95% confidence intervals (CI). From the most deprived areas, the first psychiatric admission rate was more than four times higher than in the most affluent areas. The rates of second and third admission were even higher. Admissions to the alcohol clinic were similar to psychiatric admissions, but the most deprived areas had first admission rates about ten times higher than in the most affluent areas. About 27% of first admissions, including patients from both psychiatric and alcohol clinics, had a diagnosis of psychosis, and 43% were substance abusers. There were differences between the patients' diagnoses in different areas. The correlation between the CNI and Townsend scores was very high. The most important finding of this study is the strong correlation between social deprivation, based on different deprivation indices, and first admissions to psychiatric and alcohol clinics.

Key Words: Jarman indicators • primary healthcare • psychiatric admission • social deprivation • Townsend score.

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