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

IF 3.6 2区医学 Q1 PSYCHIATRY

Schizophrenia Research Pub Date : 2025-05-03 DOI:10.1016/j.schres.2025.04.035

Jeonghyun Shin , Jialin Wu , Hyun Jung Kim , Wenna Xi

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Abstract

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.

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青少年精神分裂症自杀的社区社会决定因素：一项基于ehr的研究

青少年精神分裂症患者的自杀念头和行为（STB）是一个重要的公共卫生问题。众所周知，社区层面的健康社会决定因素（SDoHs）可以影响精神分裂症患者的健康结果。我们的目的是调查社区水平的社会决定因素对精神分裂症青年发展未来STB的影响。方法我们进行了一项回顾性队列研究，使用来自INSIGHT临床研究网络的电子健康记录，该网络包含纽约市五个医疗保健系统的2200万独特患者。患者的社区水平SDoHs在其居住的邮政编码制表区域使用复合测量，社会剥夺指数（SDI），以及来自美国社区调查的特定组成部分进行测量。生存率分析用于研究自首次精神分裂症诊断以来社区水平SDoHs与STB时间之间的关系。在2015年10月1日至2022年10月1日期间，我们确定了1209名年龄在10至25岁之间，诊断为精神分裂症且先前没有STB的年轻人，其中176人在随访期间出现了STB。SDI五分位数与未来STB的风险无关，而两个特定的社区特征，基尼指数和乘坐汽车/卡车/面包车通勤的居民百分比，在控制了患者的人口统计学特征后，与STB风险降低有关。结论虽然总体邻里剥夺水平与精神分裂症青少年性传播感染风险无关，但其特定邻里特征与性传播感染风险相关。这些发现强调需要更有针对性的以社区为基础的自杀预防策略。为了更好地理解这些关联的潜在机制，进一步的研究是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Schizophrenia Research 医学-精神病学

CiteScore

7.50

自引率

8.90%

发文量

429

审稿时长

10.2 weeks

期刊介绍： As official journal of the Schizophrenia International Research Society (SIRS) Schizophrenia Research is THE journal of choice for international researchers and clinicians to share their work with the global schizophrenia research community. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest readership! Schizophrenia Research''s time to first decision is as fast as 6 weeks and its publishing speed is as fast as 4 weeks until online publication (corrected proof/Article in Press) after acceptance and 14 weeks from acceptance until publication in a printed issue. The journal publishes novel papers that really contribute to understanding the biology and treatment of schizophrenic disorders; Schizophrenia Research brings together biological, clinical and psychological research in order to stimulate the synthesis of findings from all disciplines involved in improving patient outcomes in schizophrenia.