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Social environment may influence psychosis risk

Nonaffective psychoses were more common among individuals living in economically deprived and socially isolated rural areas, according to recent findings.

“People born and raised in urban environments face elevated risk of psychotic disorders such as schizophrenia compared with people living in rural areas. This is not explained by family history of psychiatric illness or other potential confounders, such as paternal age, age, sex or race/ethnicity,” Lucy Richardson, MSc, of University College London, and colleagues wrote. “However, much less research has investigated whether risk in rural areas varies according to exposure to such social adversities, in part because of the difficulty of conducting studies of rare outcomes in sparse population settings.”

To determine neighborhood-level factors associated with first-episode psychosis in rural populations, researchers analyzed data from the Social Epidemiology of Psychoses in East Anglia naturalistic cohort study for referrals for treatment of potential first-episode psychosis at six Early-Intervention Psychosis services. The study cohort included 631 individuals aged 16 to 35 years who presented to Early-Intervention Psychosis services and met criteria for nonaffective psychoses and affective psychoses. Median age at first contact was 23.8 years.

Crude incidence of first-episode psychosis was 31.2 per 100,000 person-years (95% CI, 28.9-33.7).

After adjusting for age, sex, race/ethnicity and socioeconomic status, incidence significantly varied between neighborhoods.

Incidence of nonaffective psychoses was higher in neighborhoods that were more economically deprived (IRR = 1.13; 95% CI, 1.06-1.2) and socially isolated (IRR = 1.11; 95% CI, 1.04-1.19).

Incidence of nonaffective psychoses was lower in more racially/ethnically diverse neighborhoods (IRR = 0.94; 95% CI, 0.87-1).

Higher intragroup racial/ethnic density (IRR = 0.97; 95% CI, 0.94-1) and lower intragroup racial/ethnic fragmentation (IRR = 0.98; 95% CI, 0.96-1) were associated with lower risk for affective psychosis.

“We found evidence of variation in the incidence of [first-episode psychosis] across the rural-urban continuum, associated with deprivation, social isolation and racial/ethnic composition. Social adversities, or failure to assuage the negative consequences of such adversities, may increase risk, but carefully designed longitudinal studies are required to determine causality,” the researchers concluded. – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.