County variation in use of inpatient and ambulatory psychiatric care in New York State 1999-2001: need and supply influences in a structural model.

This study investigates the potential for ecological studies to contribute useful information on variations in service use, both across areas and across different types of psychiatric care. The analysis uses data for the 62 counties of New York State, which include both urbanised and rural areas, with widely differing social, household and ethnic structures. We analysed data on service use by patients aged 15-64 years for several psychiatric conditions combined.

A spatial structural equation modelling framework for health count responses.

A structural equation model is proposed for the impact on area health referral counts of spatially correlated latent constructs. One type of construct is indicator based and represents the underlying morbidity or health need; such constructs are derived in a normal errors measurement model involving a set of observed socio-economic indicators. Another set of residual constructs represents particularities of service configuration or spatially correlated risks that cannot be proxied by observed indicators.

The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders.

Geographical variation in acute psychiatric admissions within New York City 1990-2000: growing inequalities in service use?

The paper analyses geographical variations in use of acute psychiatric inpatient services within New York City and how these have changed from 1990 to 2000. We review literature suggesting reasons for the variations observed. Data from the New York State Department of Health Statewide Planning Research and Cooperative System were combined with population census data to produce age standardized ratio indicators of admissions and of bed days, as measures of use of general hospitals for psychiatric conditions, by males aged 15-64, in Zip Code Areas of New York City, in 1990 and 2000.