Funding body: FCT – Fundação para a Ciência e a Tecnologia
Project reference: PTDC/ATP-GEO/4101/2012
Starting date: May 3, 2013
Duration in months: 24
Principal contractor: Universidade de Coimbra
Participating institutions: Centro Hospitalar de Lisboa Ocidental, EPE, Centro Hospitalar do Baixo Alentejo, EPE, Centro Hospitalar e Universitário de Coimbra, EPE, Escola Nacional de Saúde Pública – Universidade Nova de Lisboa, Nova School of Business and Economics, Hospital Distrital de Faro, Hospital Júlio de Matos, Hospital Magalhães Lemos, Hospital Professor Doutor Fernando Fonseca, EPE, Centro de Estudos de Geografia e Ordenamento do Território – Faculdade de Letras,, Universidade de Coimbra, Centro de Estudos de Doenças Crónicas – Faculdade de Ciências Médicas, Universidade Nova de Lisboa
Principal investigator: Paula Santana
Principal investigator at Nova School of Business and Economics: Pedro Pita Barros
Mental health is the complex result of multiple biological, psychological and social factors, also involving contextual factors beyond the individual. Empiric evidence suggests that certain characteristics of the environment may influence individual mental health beyond individual characteristics, i.e. the neighborhood/place effect. During the last decade, multilevel analyses have made possible to separate the individual effect from the neighborhood effect on health. The study of the associations between contextual socioeconomic status and mental health is a growing area of social epidemiology. Social environment varies widely across neighborhoods, along the dimensions of deprivation, residential stability (e.g., tenured housing and migration), family structure (e.g., living alone), social cohesion, quality of the built environment and ethnic composition. Furthermore, financial changes can be powerful determinants of health and economic crises are associated with mental disorders and mortality increase.
The National Psychiatric Survey-2009 has shown that Portugal is one of the European countries with a higher prevalence rate of mental disorders. The existing scientific evidence, mainly focused on treatment, supports cost-effective strategies to address this severe problem. There is, however, a lack of a deeper understanding on the impact of the residence local characteristics on mental health and mental disorders, particularly, during an economic crisis.
The goal of this project is to assess the effect of environmental and territorial health determinants on the mental health and on the use of mental health services in times of social and economic crises. This goal integrates specific objectives: 1 To study the associations between the evolution of contextual characteristics of a number of Portuguese municipalities in the last 10 years, and psychiatric morbidity and use of mental health services in these municipalities during the same period; 2 To understand how the mental health of individuals is affected by socioeconomic crises, depending on community support, social capital and urban planning; 3 To propose changes in the physical and social environment that may contribute, in periods of crisis, to promote mental health and reduce psychiatric morbidity of the populations.
The current study final recommendations will be aimed at orienting action, programs and policies with a possible impact on the negative effects on mental health and longevity of the more vulnerable groups to financial crises like the one we are currently experiencing in Portugal and in Europe.
To assess the evolution of the characteristics of the different places of residence we will consider groups of variables: measures of wealth in the municipality (economic activity, employment/unemployment, e.g.), community’s resources (green areas, social support networks, e.g.), accessibility to mental health care, level of safety (number of crimes, e.g.) and quality of lodging (overcrowded, e.g.).
Mental health of the populations will be assessed through: 1) Deaths by suicide (2010-2012, 2000-2002) by municipality; 2) Diagnosis Related Groups (DRGs) for mental disorders (2010-2012 and 2000-2002) by municipality; 3) Number and psychiatric diagnoses of all the catchment areas users with at least one contact (admission or outpatient psychiatric services) during 2012.
Information on 1) and 2) will be obtained through official sources (Serviço Nacional de Estatística and Administração Central do Sistema de Saúde) and will allow the calculation of standardized suicide rates and standardized residents with psychiatric admissions rates and the clusters identification of increased risk, before and during the financial crisis. Finally, information on 3) will be obtained by the medical charts review. Complementing this information, a representative sample of users and non-users (hospitals catchment areas population) will be surveyed with: a) A questionnaire aimed at assessing the relationship between the financial crisis consequences and changes on mental health perception and satisfaction with available resources in the place of residence; b) The Mental Health Inventory-5 to assess mental health perception. Mental health services utilization will be assessed with European Service Mapping Schedule.
Medical charts review will be submitted to the hospitals ethics committees before the start of the protocol. Confidentiality of all the information gathered and anonymization of the databases will be granted.
Therefore, and as already stated, as Mental Health is a multidimensional phenomenon linked to particular environments (places where individuals and groups interact), it requires a multivariate methodological approach, in the field of spatial epidemiology. Thus, after some descriptive approaches, correlation analysis, spatiotemporal clustering, risk areas, multivariate regression models and Geographical Information Systems will be used.