Psychiatry
Geographical variation in rates of common mental disorders in Britain
By British Journal of Psychiatry
Jul 5, 2005, 22:23

One of the first studies to estimate differences in rates of common mental disorders prospectively in Britain has found that:

* there is no significant geographical variation in rates of the most common disorders - anxiety and depression - at electoral ward level
* there is, however, substantial and statistically significant variation between households. This is not explained by the socio-economic or demographic characteristics of household members
* the most deprived individuals and households continue to be clustered together

Published in the July issue of the British Journal of Psychiatry, the study set out to estimate differences in rates of common mental disorders at individual, household and electoral ward levels.

Information was gathered during the first two waves of the British Household Panel Survey (BHPS), which was initially undertaken in 1991. The BHPS is an annual survey of people aged 16 and over in a representative sample of households in England, Wales and Scotland.

7659 people aged 16-74 in 4338 private households in 626 electoral wards were studied. Those who completed a questionnaire designed to detect the onset and maintenance of mental health problems at both waves 1 and 2 of the BHPS were included in this analysis.

Individual- and household-level risk factors, such as age, marital status, household income and overcrowding, were measured, and an assessment made of area-level socio-economic deprivation.

It was found that less than 1% of overall differences in the onset and maintenance of common mental disorders, and change in mental health questionnaire scores between waves, occurred at ward level.

However, 12% of variance, which is a statistically significant difference, was found at household level. These differences remained after taking into account the characteristics of individuals, households and wards.

The authors of the study comment that the view that place does not affect individual health is counter-intuitive. However, in line with previous cross-sectional studies, this study found little evidence that maintenance of mental health problems was greatest in the most deprived wards.

These results highlight the importance of studying the household as a distinct level, something that many studies overlook. The effect of household on maintenance of mental health problems becomes more apparent after taking into account the characteristics of individual household members.

The sharpest increase in household-level variance occurred when financial strain was taken into account.

These findings are consistent with evidence of similarity between spouses in depressive symptoms. Factors within the household following the onset of anxiety or depression in one or more members warrant closer scrutiny.

Given that the most deprived individuals and households continue to be clustered together, the authors conclude that interventions delivered in specific places may still have a role in reaching those at risk of common mental disorders.

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