Proxy measures

Another approach is to avoid making prevalence estimates by using proxy measures of need, such as social and demographic indices. The association between lower socio-economic class and higher prevalence rates of psychiatric disorders has been demonstrated repeatedly. (3 33 and 34 It has also been demonstrated that admission rates from specific geographical areas are correlated with indicators of social disadvantage in the area. It can thus be argued that, for practical purposes, indices of social disadvantage provide easily accessible and adequate indicators of the overall level of mental health service need in specific areas or districts. This argument is most persuasive within the boundaries of a single health service system and a fairly uniform clinical culture, as is the case, for example, in the United Kingdom. Planners therefore use social indices based on census data to provide broad indicators of relative needs for service. (3.5,,39 The Eight Item Under-Privileged Area Scale (UPA-8) is one of the best known of these indicators. The index is derived by an algorithm incorporating eight factors ( Bo.x .4) and can be computed for any population for which the data are available. (3Z> This index has been demonstrated to be a good predictor of health service utilization in the United Kingdom and has been widely used as a basis for planning and for comparing districts or sectors.

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