The stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim

Abstract

In 1965, Häfner et al. (1969) conducted an ecological study of the incidence of treated mental disorders in the industrial city of Mannheim. They found large variations in incidence rates in 20 urban areas: excess morbidity in the socially disorganized areas located mainly in the city center, and low rates in areas on the outskirts. This study incorporates additional data from the Cumulative Psychiatric Case Register established in Mannheim in 1973. It focuses on the short- and long-term stability of the spatial distribution of mental disorders comparing the year 1965 with the period 1974-80, and analysing the individual years from 1974-80. Despite marked changes between 1965 and the seventies (the increase in the number of guest workers; the development of extensive building and urban renewal programs; the establishment of the Central Institute of Mental Health and several community psychiatric services after 1975), the ecological correlation remained relatively high (r = 0.79). Prior to the establishment of the Central Institute of Mental Health, the spatial distribution of mental disorders in the year 1974 was also very similar to that in 1965 (r = 0.73). In general, the study revealed a highly stable ecological distribution of treated mental disorders not only on a long-term basis, but also for the individual years from 1974 to 1980.

Urbanicity, social adversity and psychosis

“…In line with the earlier study by Hare (10) in Bristol, and in contrast to what was found in Nottingham (13,14) and Mannheim (15,16), later studies investigating the incidence of psychosis at the neighbourhood level reported at least some variation across neighbourhoods within cities (39,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60). Standardized incidence ratios of schizophrenia (57,59,60), non-affective psychosis (56) and all psychotic disorders (47) have been shown to vary considerably across neighbourhoods.…”

“…Subsequent studies carried out in Nottingham (13,14) and Mannheim (15,16) also reported that rates of schizophrenia, but not affective psychosis, were elevated in inner-urban areas. However, in contrast to Hare (12), they found only limited variation within these areas across neighbourhoods.…”

“…However, in contrast to Hare (12), they found only limited variation within these areas across neighbourhoods. Notably, there was also evidence of higher rates of depression in inner-urban areas (13)(14)(15)(16).…”

“…Already in the early studies carried out in Chicago , Nottingham and Mannheim , geographical variation in incidence was sought to be explained by adverse social characteristics of areas for which higher rates of disorder had been reported. For example, Faris and Dunham explained their finding of higher rates of schizophrenia in the inner city of Chicago by decreasing levels of social disorganization as the distance from the centre increased.…”

Does internal migration affect criminal behavior in schizophrenia patients?

“…In two German studies results showed the impact of high density of population, increasing urbanization and less socially organizing on incidence and severity of schizophrenia (9,10). In another study, it was showed that the place of birth and the level of urbanization of the place one lived during the start of the illness increased the risk of schizophrenia for adults (11). Even though the result of this study suggests that internal migration does not affect the onset of schizophrenia, the number of studies on this issue is not satisfactory yet.…”