Social Science & Medicine 61 (2005) 2096–2105 A census-based socio-economic status (SES) index as a tool to examine the relationship between mental health services use and deprivation Juan Eduardo Tello, Julia Jones, Paola Bonizzato, Mariangela Mazzi, Francesco Amaddeo à , Michele Tansella Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi, P.le L. Scuro 10, 37134 Verona, Italy Available online 26 May 2005 Abstract This paper discusses the development and application of a socio-economic status (SES) index, created to explore the relationship between socio-economic variables and psychiatric service use. The study was conducted in a community- based mental health service (CMHS) in Verona, Northern Italy, utilising service use data from 1996. An ecological SES index was constructed through a factor analysis from 1991 Census data, at census block level. Three factors reflected the following domains: the educational-employment sector (with four components), the relational network (with three components) and the material conditions (with three components). All service users were assigned a SES value, according to their place of residence in 1996. When these data were explored spatially, using ArcView 8.3, an association was observed between socio-economic deprivation and psychiatric service use. The SES index was then successfully validated using occupational status at the individual level. This study confirms the usefulness of developing and validating an ecological census-based SES index, for service planning and resource allocation in an area with a community-based system of mental health care. r 2005 Elsevier Ltd. All rights reserved. Keywords: Community-based mental health services; Census-based socio-economic status (SES) index; Geography of Mental Health, Italy Introduction A well established ‘spatial ecology’ tradition in mental health has developed from the seminal work of Faris and Dunham (Faris & Dunham, 1939), who examined the distribution of patients admitted to psychiatric hospitals in Chicago in the 1930s. Early geographical studies of the distribution of mental illness in urban settings include work by Giggs (Giggs, 1973, 1986) conducted in Nottingham, Taylor (1974), cited by Scobie (1989) in Southampton, and Dean and James (1981) in Plymouth (all cities in England). All these studies focused upon the relationship between mental illness and the urban environment, with parti- cular attention to the spatial distribution of indivi- duals with mental health problems, who are in contact with mental health services, in different social areas of the cities. ARTICLE IN PRESS www.elsevier.com/locate/socscimed 0277-9536/$-see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.04.018 à Corresponding author. Tel.: +390458074929; fax: +390458074889. E-mail address: francesco.amaddeo@univr.it (F. Amaddeo).