Does the urban environment independently increase the risk for both negative and positive features of psychosis?

Abstract

Psychotic disorders are more common in urban environments. It is not known whether the increase in risk applies to both the positive and negative dimensions of psychosis. In a random general population sample of 7076, measures of positive and negative symptoms of psychosis were constructed using Composite International Diagnostic Interview (CIDI) data. Three CIDI observed items of flat affect, retarded speech and retarded movement served as indicators of a negative symptom variable. Both negative and positive symptoms of psychosis were, independent of each other, associated with a five-level measure of population density of place of residence (adjusted OR negative symptoms: 1.42, 95 % CI: 1.18, 1.71; adjusted OR positive symptoms: 1.19, 95 % CI: 1.13, 1.24). These associations remained after exclusion of vulnerable individuals with any lifetime psychiatric disorder (n = 2910), any lifetime psychiatric treatment (n = 1352) and history of psychosis in the parents (n = 142). An environmental risk factor associated with urbanicity may act in early life to non-specifically influence risk for both negative and positive experience of psychosis, regardless of whether a formal psychiatric disorder is diagnosable.