Deprivation: Different implications for forensic psychiatric need in urban and rural areas

Background Ecological relationships between deprivation and forensic psychiatric admission rates may differ in urban and rural areas. Aims The aim of the study was to compare the relationship between material deprivation and forensic admission rates in rural and urban areas for a whole-national service in Ireland over a 3-year period. Method All Irish forensic admissions from 1997 to 1999 were allocated to the appropriate small area. Material deprivation scores were calculated from census data. Mean annual admission rates and Bayesian standardised forensic admission ratios for small areas were aggregated by material deprivation score and population density. Results At small area level, there were significant non-linear increases in forensic admissions with increasing deprivation. The increases in urban areas (population density > 10/ hectare) were absent in less densely populated areas. Conclusions Deprivation alone may not be the key factor in predicting forensic service utilisation. Factors associated with specifically urban deprived areas may be of greater relevance in planning services.