• Arjan W Braam, Omar W H R van Ommeren, Melissa L van Buuren, Wijnand Laan, Hugo M Smeets, and Iris M Engelhard.
• Department of Emergency Psychiatry and Department of Specialist Training, Altrecht Mental Health Care, Utrecht, The Netherlands.
• J Emerg Med. 2016 Mar 1; 50 (3): 449-57.

BackgroundAcute involuntary psychiatric admissions (AIPA) tend to be applied more often in urban areas.ObjectiveThe current study aims to describe AIPA prevalence differences between the subdistricts in an urban area, and to identify which district characteristics are associated with a higher AIPA district density.MethodsInformation was collected on consecutive AIPAs over a 64-month period (2005-2010) in 49 subdistricts in and around the city of Utrecht, the Netherlands, including 1098 AIPAs. District characteristics included several demographic and economical factors and health care characteristics such as number of sheltered living facilities.ResultsThe AIPA density (mean 4.4/10,000 inhabitants/y) was four to five times higher in the most urbanized subdistrict (around 12) compared to the suburban subdistricts (2.5-3). On the district level, the main correlates with AIPA density per district were unemployment rate and small household size. Other correlates were percentage of non-Western immigrants and number of facilities of sheltered living.ConclusionsThe considerable AIPA density variation between subdistricts in this urban environment reflects that people who are prone to psychiatric admissions live in economically less prosperous environments. Impaired social networks and economic concerns may also contribute to an environment representing social defeat, increased demoralization, or social fragmentation.Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

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