Objective and subjective neighbourhood characteristics and suicidality: a multilevel analysis

Neighborhood-level social determinants of suicidality in youth with schizophrenia: An EHR-based study

BACKGROUND

Suicidal thoughts and behaviors (STB) among youth with schizophrenia represent a significant public health concern. It is well-established that neighborhood-level social determinants of health (SDoHs) can impact health outcomes in individuals with schizophrenia. We aimed to investigate the effects of neighborhood-level social determinants on developing future STB in youth with schizophrenia.

METHODS

We conducted a retrospective cohort study using electronic health records from the INSIGHT Clinical Research Network, which contains >22 million unique patients across five healthcare systems in New York City. Patients' neighborhood-level SDoHs were measured at their residential ZIP Code Tabulation Area using a composite measure, Social Deprivation Index (SDI), as well as specific components derived from the American Community Survey. Survival analysis was used to study the association between neighborhood-level SDoHs and time to STB since the first schizophrenia diagnosis.

RESULTS

Between 10/1/2015 and 10/1/2022, we identified 1209 youth aged between 10 and 25 years with a schizophrenia diagnosis and no prior STB, among whom 176 developed STB during follow-up. SDI quintiles were not associated with the risk of future STB, whereas two specific neighborhood characteristics, Gini index and percentage of residents commuting by car/truck/van, were associated with a decreased risk of STB, after controlling for patients' demographic characteristics.

CONCLUSIONS

Although the overall neighborhood deprivation level was not associated with the risk of STB among youth with schizophrenia, specific neighborhood characteristics were. These findings underscore the need for more targeted community-based suicide prevention strategies. Further research is essential to better understand the underlying mechanism of these associations.

The Spatio-Temporal Distribution of Suicide-related Emergency Calls in a European City: Age and Gender Patterns, and Neighborhood Influences

Objective: The aim of this study was to conduct a comprehensive spatio-temporal analysis of suicide-related emergency calls in the city of Valencia (Spain) over a six-year period. To this end we first examined age and gender patterns and, second, the influence of neighborhood characteristics on general and gender-specific spatio-temporal patterns of suicide-related emergency calls. Method: Geocoded data on suicide-related emergency calls between 2017 and 2022 (N = 10,030) were collected from the 112 emergency service in Valencia. Data were aggregated at the census block group level, used as a proxy for neighborhoods, and trimesters were considered as the temporal unit. Two set of analyses were performed: (1) demographic (age and gender) and temporal descriptive analyses and (2) general and gender-specific Bayesian spatio-temporal autoregressive models. Results: Descriptive analyses revealed a higher incidence of suicide-related emergency calls among females and an increase in calls among the 18-23 age group from 2020 onwards. The general spatio-temporal model showed higher levels of suicide-related emergency calls in neighborhoods characterized by lower education levels and population density, and higher residential mobility, aging population, and immigrant concentration. Relevant gender differences were also observed. A seasonal effect was noted, with a peak in calls during spring for females and summer for males. Conclusions: These findings highlight the need for comprehensive mental health targeted interventions and preventive strategies that account for gender-specific disparities, age-related vulnerabilities, and the specific characteristics of neighborhoods.

Neighborhood Opportunity and Mortality Among Children and Adults in Their Households

BACKGROUND AND OBJECTIVES

Research has linked neighborhood opportunity to health outcomes in children and adults; however, few studies have examined neighborhood opportunity and mortality risk among children and their caregivers. The objective of this study was to assess associations of neighborhood opportunity and mortality risk in children and their caregivers over 11 years.

METHODS

Participants included 1 025 000 children drawn from the Mortality Disparities in American Communities study, a cohort developed by linking the 2008 American Community Survey to the National Death Index and followed for 11 years. Neighborhood opportunity was measured using the Child Opportunity Index, a measure designed to capture compounding inequities in access to opportunities for health.

RESULTS

Using hazard models, we observed inverse associations between Child Opportunity Index quintile and deaths among child and caregivers. Children in very low opportunity neighborhoods at baseline had 1.30 times the risk of dying over follow-up relative to those in very high opportunity neighborhoods (95% confidence interval [CI], 1.15-1.45), and this excess risk attenuated after adjustment for household characteristics (hazard ratio, 1.15; 95% CI, 0.98-1.34). Similarly, children in very low opportunity neighborhoods had 1.57 times the risk of experiencing the death of a caregiver relative to those in very high opportunity neighborhoods (95% CI, 1.50-1.64), which remained after adjustment (hazard ratio, 1.30; 95% CI, 1.23-1.38).

CONCLUSIONS

Our analyses advance understanding of the adverse consequences of inequitable neighborhood contexts for child well-being and underscore the potential importance of place-based policies for reducing disparities in child and caregiver mortality.

Neighborhood social context and suicide mortality: A multilevel register-based 5-year follow-up study of 2.7 million individuals

Previous studies have linked neighborhood social characteristics to suicide mortality. However, the effects of the operational definition of neighborhoods and the general importance of neighborhood context on suicide mortality have received little attention, with most studies using various administrative areas as neighborhood delineations. In this study, neighborhoods were delineated by micro-areas generated with an automated redistricting algorithm and divided by physical barriers, such as large roads. The geographic data were linked to register data on the Danish adult population in the age range of 20-59 years in December 2013 (N = 2,672,799 individuals nested into 7943 neighborhoods). This cohort was followed for five years to evaluate the association between suicide mortality and neighborhood socioeconomic deprivation, social fragmentation, and population density. We used the median hazard ratio (MHR) to quantify the general contextual effect (GCE) of neighborhoods on suicide mortality and hazard ratios to quantify the specific contextual effects (SCEs) using multilevel survival models stratified by age group. The results showed a larger GCE and larger SCEs of neighborhoods on suicide mortality for individuals aged 20-39 years compared with those aged 40-59 years. After controlling for individual characteristics, higher suicide mortality was observed for individuals living in the least densely populated neighborhoods and the most socially fragmented neighborhoods for both age groups. We found cross-level interactions between neighborhood population density and gender and ethnicity for those aged 40-59 years, as well as between neighborhood social fragmentation and ethnicity for those aged 20-39 years. The results indicate that beyond individual characteristics, the neighborhood social context may affect the risk of suicide, especially for people aged 20-39 years.