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Associations between residence at birth and mental health disorders: a spatial analysis of retrospective cohort data.

Hoffman K, Aschengrau A, Webster TF, Bartell SM, Vieira VM - BMC Public Health (2015)

Bottom Line: We observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61-3.07, P = 0.03).Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58-1.17, P = 0.82).However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.

View Article: PubMed Central - PubMed

Affiliation: Nicholas School of the Environment, Duke University, Durham, NC, USA. kate.hoffman@duke.edu.

ABSTRACT

Background: Mental health disorders impact approximately one in four US adults. While their causes are likely multifactorial, prior research has linked the risk of certain mental health disorders to prenatal and early childhood environmental exposures, motivating a spatial analysis to determine whether risk varies by birth location.

Methods: We investigated the spatial associations between residence at birth and odds of depression, bipolar disorder, and post-traumatic stress disorder (PTSD) in a retrospective cohort (Cape Cod, Massachusetts, 1969-1983) using generalized additive models to simultaneously smooth location and adjust for confounders. Birth location served as a surrogate for prenatal exposure to the combination of social and environmental factors related to the development of mental illness. We predicted crude and adjusted odds ratios (aOR) for each outcome across the study area. The results were mapped to identify areas of increased risk.

Results: We observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61-3.07, P = 0.03). Similar geographic patterns were seen for the crude odds of PTSD; however, these patterns were no longer present in the adjusted analysis (aOR range: 0.49-1.36, P = 0.79), with family history of mental illness most notably influencing the geographic patterns. Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58-1.17, P = 0.82).

Conclusion: Spatial associations exist between residence at birth and odds of PTSD and depression, but much of this variation can be explained by the geographic distributions of available risk factors. However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.

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Related in: MedlinePlus

Residential location at the time of birth for 1256 study participants born on Upper Cape Cod, MA from 1969 to 1983. Locations have been altered to preserve confidentiality
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Fig1: Residential location at the time of birth for 1256 study participants born on Upper Cape Cod, MA from 1969 to 1983. Locations have been altered to preserve confidentiality

Mentions: Our study population consisted of 1,256 adults born to women living on upper Cape Cod, Massachusetts between 1969 and 1983. At the time of interview, participants were on average in their late 20s (mean age 29.4 ± 3.8 years), college educated (60.0 %), and employed (87.6 %). Table 1 presents the distribution of characteristics included in the final analysis. Participants were more likely to be female (59.8 %) and the vast majority were of white race (98.4 %). Residential locations at birth are displayed in Fig. 1, with the locations altered slightly to protect confidentiality. Overall, 279 (22.2 %) of participants reported a diagnosis of depression, bipolar disorder, or PTSD (46 participants reported multiple mental illness diagnoses). Depression was, by far, the most commonly reported diagnosis, with 17.4 % of participants reporting that they had been told by a doctor or health care professional that they had this diagnosis. Bipolar disorder and PTSD impacted far fewer participants (3.5 and 4.9 %, respectively).Table 1


Associations between residence at birth and mental health disorders: a spatial analysis of retrospective cohort data.

Hoffman K, Aschengrau A, Webster TF, Bartell SM, Vieira VM - BMC Public Health (2015)

Residential location at the time of birth for 1256 study participants born on Upper Cape Cod, MA from 1969 to 1983. Locations have been altered to preserve confidentiality
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4508761&req=5

Fig1: Residential location at the time of birth for 1256 study participants born on Upper Cape Cod, MA from 1969 to 1983. Locations have been altered to preserve confidentiality
Mentions: Our study population consisted of 1,256 adults born to women living on upper Cape Cod, Massachusetts between 1969 and 1983. At the time of interview, participants were on average in their late 20s (mean age 29.4 ± 3.8 years), college educated (60.0 %), and employed (87.6 %). Table 1 presents the distribution of characteristics included in the final analysis. Participants were more likely to be female (59.8 %) and the vast majority were of white race (98.4 %). Residential locations at birth are displayed in Fig. 1, with the locations altered slightly to protect confidentiality. Overall, 279 (22.2 %) of participants reported a diagnosis of depression, bipolar disorder, or PTSD (46 participants reported multiple mental illness diagnoses). Depression was, by far, the most commonly reported diagnosis, with 17.4 % of participants reporting that they had been told by a doctor or health care professional that they had this diagnosis. Bipolar disorder and PTSD impacted far fewer participants (3.5 and 4.9 %, respectively).Table 1

Bottom Line: We observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61-3.07, P = 0.03).Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58-1.17, P = 0.82).However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.

View Article: PubMed Central - PubMed

Affiliation: Nicholas School of the Environment, Duke University, Durham, NC, USA. kate.hoffman@duke.edu.

ABSTRACT

Background: Mental health disorders impact approximately one in four US adults. While their causes are likely multifactorial, prior research has linked the risk of certain mental health disorders to prenatal and early childhood environmental exposures, motivating a spatial analysis to determine whether risk varies by birth location.

Methods: We investigated the spatial associations between residence at birth and odds of depression, bipolar disorder, and post-traumatic stress disorder (PTSD) in a retrospective cohort (Cape Cod, Massachusetts, 1969-1983) using generalized additive models to simultaneously smooth location and adjust for confounders. Birth location served as a surrogate for prenatal exposure to the combination of social and environmental factors related to the development of mental illness. We predicted crude and adjusted odds ratios (aOR) for each outcome across the study area. The results were mapped to identify areas of increased risk.

Results: We observed spatial variation in the crude odds ratios of depression that was still present even after accounting for spatial confounding due to geographic differences in the distribution of known risk factors (aOR range: 0.61-3.07, P = 0.03). Similar geographic patterns were seen for the crude odds of PTSD; however, these patterns were no longer present in the adjusted analysis (aOR range: 0.49-1.36, P = 0.79), with family history of mental illness most notably influencing the geographic patterns. Analyses of the odds of bipolar disorder did not show any meaningful spatial variation (aOR range: 0.58-1.17, P = 0.82).

Conclusion: Spatial associations exist between residence at birth and odds of PTSD and depression, but much of this variation can be explained by the geographic distributions of available risk factors. However, these risk factors did not account for all the variation observed with depression, suggesting that other social and environmental factors within our study area need further investigation.

Show MeSH
Related in: MedlinePlus