Mental health service use and local crime – how are they associated?

Living in neighbourhoods with higher crime rates is linked with a higher prevalence of mental health problems – but what is the relationship with mental health service use, especially with psychotropic medications? Also, are there any groups of people more vulnerable to the impact of crime, and how do changing crime levels help to understand this association? In this blog, Gergő Baranyi discusses new insights using data from the Scottish Longitudinal Study.

In the United Kingdom one adult in six is affected by common mental health disorders at any given time, and the cost associated with mental illnesses adds up to four per cent of the national gross domestic product. We know the physical and social environment plays a part: Residential areas with high levels of deprivation and social disorganisation tend to have more crime and violence, and that might impact the mental health of residents. Personal experience of being a victim or witness of crime and violence is more common in high-crime neighbourhoods. However, people in these areas might experience more stress, avoid public areas and reduce social interaction with others, even if they are not affected directly by crime – and that can influence their mental health.

We were able to use the Scottish Longitudinal Study (SLS), a five per cent sample of the Scottish population which enabled us to link participants’ census responses with levels of crime in their neighbourhood and with psychotropic medications prescribed through their GP. Our study captured people who responded to both the 2001 and 2011 censuses and who were aged 16 and over in 2001. Based on addresses available in the census and in other administrative records we linked information on neighbourhood crime to these participants. This included police-reported crimes and offences such as assaults, crimes of violence, domestic break-ins, drug offences and vandalism, which were aggregated across 6,500 small areas in Scotland with a population of 500-1000 individuals. Although the 2011 census in Scotland included a question on self-reported mental illness, the SLS enabled us to link NHS Scotland records on prescribed antidepressants and antipsychotics to our participants.

The findings showed that living in a higher crime area was linked to reporting mental illness in the census and receiving antidepressants or antipsychotic medication, and also extended our understanding of crime and mental health.

Psychotropic medication as a proxy for mental health problems

After excluding from the sample those with pre-existing mental health conditions – identified as receiving any psychotropic medications in the first six months of the study period – we had a sample of almost 130,000 adults with an average age of 51 in 2009.

During the follow-up period between 2009 and 2014, 22 per cent of our sample received at least one new prescription for antidepressant and two per cent at least one new prescription for antipsychotic medications.

After taking into account key personal characteristics, we found these proportions differed significantly according to crime levels in residential neighbourhoods. Those living in areas with high crime were at a significantly higher risk of having a new prescription for antidepressants. The odds were higher for people in young and middle adulthood, especially women. These associations were present even after we controlled for area disadvantage.

When we looked at antipsychotic medications we found a similar association, though the risk was higher among men and in middle adulthood. Area deprivation was not associated with antipsychotic prescription.

While we used antidepressants and antipsychotics as a proxy for mental health problems, they are often prescribed for other health problems and not all individuals with mental illnesses receive pharmacological treatment. Still, findings with self-reported mental illness led to similar conclusions.

Utilising changing crime levels to understand underlying mechanisms

Scotland experienced a significant drop in crime during the study period, but not all neighbourhoods benefitted equally from this drop and there were even areas where crime increased. In our second study, we used information on changing crime levels, adding neighbourhood crime rates between 2004 and 2013 to our dataset. Participants’ addresses during this time were available from GP registration records.

Our findings revealed that young adults who stayed in the same neighbourhood while crime levels were increasing were more likely to report mental illness in the 2011 census and to receive antidepressant prescriptions from their GPs. This provides stronger evidence for the impact of neighbourhood crime on individual mental health.

We also found that middle-aged adults who moved into higher-crime areas were more likely to report mental illnesses and have antipsychotics prescribed during the study period. Although it is difficult to tease out exact pathways, this can be due to people with more severe mental health conditions moving to more affordable but often disadvantaged and higher crime areas.

Our studies confirm that local crime is an important predictor of mental health service use, independent of other individual- or area-level risk factors, but the associations differ across type of medication, and between sex and age groups.

Crime and violence reduction programmes, targeting crime hotspots and rehabilitating deprived areas, might be beneficial for population mental health. Mental health promotion in local schools, prevention initiatives for high-risk individuals and enhanced mental health services in high-crime areas might provide opportunities for those most in need.

The project team included Gergő Baranyi, Mark Cherrie, Sarah Curtis, Chris Dibben and Jamie Pearce from the Centre for Research on Environment, Society and Health, University of Edinburgh. Gergő Baranyi presented this research at the UKCenLS conference in Cardiff on September 20. This blog post is based on two papers:

Baranyi G, Cherrie M, Curtis S, Dibben C, Pearce JR. Neighborhood Crime and Psychotropic Medications: A Longitudinal Data Linkage Study of 130,000 Scottish Adults. Am J Prev Med. 2020;58(5):638-647 https://doi.org/10.1016/j.amepre.2019.12.022;

Baranyi G, Cherrie M, Curtis S, Dibben C, Pearce JR. Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland

J Epidemiol Community Health 2020;74:806-814. https://jech.bmj.com/content/74/10/806;