Social fragmentation may increase risk for psychosis

Areas with high levels of social fragmentation had higher rates of psychosis, according to results of a systematic review published in Journal of Clinical Psychiatry.

“The last review examining the relationship between social fragmentation and psychosis suggested that social fragmentation partially explained the geographic variation of schizophrenia rates, but it was still unclear what aspects of ‘area-level social fragmentation’ have clinical relevance to schizophrenia outcomes,” Benson S. Ku, MD, of the department of psychiatry and behavioral sciences at Emory University School of Medicine in Georgia, and colleagues wrote. “Since then, a growing number of studies have further investigated the individual (or combination of) components of social fragmentation in relation to schizophrenia rates and other outcomes.”

The investigators sought to assess the effects of social fragmentation on psychosis rates and other outcomes, such as prevalence, age at psychosis onset, psychotic symptom severity and duration of untreated psychosis. They searched three databases between inception and May 2, with no language restrictions. They used search terms that pinpointed the area-level orientation, social fragmentation, sample and outcome. Social environment examined at the area level with psychosis outcomes served as the inclusion criteria. They systematically reviewed 19 articles.

Data from 14 articles suggested an association between area-level characteristics that reflected social fragmentation and higher psychosis rates and other psychosis outcomes. The association remained after the researchers controlled for other area-level characteristics, such as deprivation, social capital, race/ethnicity and urbanicity and individual-level characteristics (ie, age, sex, migrant status and socioeconomic status).

“More longitudinal studies investigating the impact of social fragmentation, including area-level residential instability, on the development of psychosis and other psychosis outcomes are needed,” Ku and colleagues wrote. “Nevertheless, this research has potential public health implications for allocating mental health resources to areas with greater psychosis risk for early intervention, treatment and management.”