Area Characteristics and Admission Rates of People with Schizophrenia and Affective Disorders in a German Rural Catchment Area

Background Research on environmental risk factors for mental illness in rural areas is sparse, although the same risk factors as identified in urban areas may be present. Especially municipality characteristics reflecting economic uncertainties may have an impact on mental health. 

Methods From 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg (Bavaria – Germany), hospital admission rates from the years 2006 through 2009 were computed and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models. 

Results Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and percentage of green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and percentage of traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and percentage of agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and (percentage of green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and percentage of traffic-related areas. 

Conclusions Previously reported effects of wealth and economic inequality on psychiatric admission rates form urban areas also seem to apply to rural areas. This study once more shows that lack of financial security is a major risk factor for the occurrence of mental disorders. In contrast to findings in urban areas, the present study suggests that population density may have a ameliorating effect on mental health.