Abstract
Background: Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences. Methods: Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins who were interviewed about adolescent psychotic experiences at age 18. Urbanicity, neighborhood characteristics, and personal victimization by violent crime were measured during childhood and adolescence via geocoded census data, surveys of over 5000 immediate neighbors of the E-Risk participants, and interviews with participants themselves. Results: Adolescents raised in urban vs rural neighborhoods were significantly more likely to have psychotic experiences (OR = 1.67, 95% CI = 1.21–2.30, P = .002). This association remained significant after considering potential confounders including family socioeconomic status, family psychiatric history, and adolescent substance problems (OR = 1.43, 95% CI = 1.01–2.03, P = .042), but became nonsignificant after considering adverse social conditions in urban neighborhoods such as low social cohesion and high neighborhood disorder (OR = 1.35, 95% CI = 0.94–1.92, P = .102). The combined association of adverse neighborhood social conditions and personal crime victimization with adolescent psychotic experiences (adjusted OR = 4.86, 95% CI = 3.28–7.20, P < .001) was substantially greater than for either exposure alone, highlighting a potential interaction between neighborhood conditions and crime victimization (interaction contrast ratio = 1.81, 95% CI = −0.03 to 3.65) that was significant at the P = .054 level. Conclusions: Cumulative effects of adverse neighborhood social conditions and personal victimization by violent crime during upbringing partly explain why adolescents in urban settings are more likely to report psychotic experiences. Early intervention efforts for psychosis could be targeted towards victimized youth living in urban and socially adverse neighborhoods.
Highlights
Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences
This association remained significant after considering potential confounders including family socioeconomic status, family psychiatric history, and adolescent substance problems (OR = 1.43, 95% CI = 1.01–2.03, P = .042), but became nonsignificant after considering adverse social conditions in urban neighborhoods such as low social cohesion and high neighborhood disorder (OR = 1.35, 95% CI = 0.94–1.92, P = .102)
The combined association of adverse neighborhood social conditions and personal crime victimization with adolescent psychotic experiences was substantially greater than for either exposure alone, highlighting a potential interaction between neighborhood conditions and crime victimization that was significant at the P = .054 level
Summary
Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences. Most prior research on the emergence of adolescent psychotic experiences has focused on individuallevel risk factors[10] and little is currently known about the potential impact of macro-level structures such as urbanicity and neighborhood-level social processes like social fragmentation and crime These common forms of wider environmental exposures have been implicated in adult psychotic disorder,[11,12,13,14,15,16,17,18,19,20,21] and adult psychosis shares similar social and behavioral risk factors as early psychotic phenomena.[10,22] Early expressions of psychosis are more likely to persist and reach clinical significance among urban vs nonurban youth,[23,24] but the reasons for this are unclear. Elucidating the role of macro- and neighborhood-level exposures in adolescent psychotic experiences could be informative for earlyintervention efforts, because the clinical relevance of psychotic phenomena increases later in adolescence.[26]
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