Abstract
ObjectiveTo test whether spatial and social neighbourhood patterning of people at ultra‐high risk (UHR) of psychosis differs from first‐episode psychosis (FEP) participants or controls and to determine whether exposure to different social environments is evident before disorder onset.MethodWe tested differences in the spatial distributions of representative samples of FEP, UHR and control participants and fitted two‐level multinomial logistic regression models, adjusted for individual‐level covariates, to examine group differences in neighbourhood‐level characteristics.ResultsThe spatial distribution of controls (n = 41) differed from UHR (n = 48; P = 0.04) and FEP participants (n = 159; P = 0.01), whose distribution was similar (P = 0.17). Risk in FEP and UHR groups was associated with the same neighbourhood‐level exposures: proportion of single‐parent households [FEP adjusted odds ratio (aOR): 1.56 95% CI: 1.00–2.45; UHR aOR: 1.59; 95% CI: 0.99–2.57], ethnic diversity (FEP aOR: 1.27; 95% CI: 1.02–1.58; UHR aOR: 1.28; 95% CI: 1.00–1.63) and multiple deprivation (FEP aOR: 0.88; 95% CI: 0.78–1.00; UHR aOR: 0.86; 95% CI: 0.76–0.99).ConclusionSimilar neighbourhood‐level exposures predicted UHR and FEP risk, whose residential patterning was closer to each other's than controls. Adverse social environments are associated with psychosis before FEP onset.
Highlights
The incidence of schizophrenia and other nonaffective psychotic disorders is elevated in more densely populated urban areas [1,2,3], often characterised by greater social and economic disadvantage [4,5,6,7,8,9,10]
We reported odds ratios (OR) and 95% confidence intervals
Excluded first episode of psychosis (FEP) participants did not differ by median age (Mann–Whitney U-test P = 0.21), sex (v2-test P = 0.74), ethnic status, marital status (v2-test P = 0.69), or highest participant (Fisher’s Exact test P = 0.94) or parental (Fisher’s Exact test P = 0.30) socioeconomic status
Summary
The incidence of schizophrenia and other nonaffective psychotic disorders is elevated in more densely populated urban areas [1,2,3], often characterised by greater social and economic disadvantage [4,5,6,7,8,9,10]. Evidence that urban birth and childhood upbringing increase schizophrenia risk in adulthood is consistent with an aetiological role for environment factors [8,9,10], downward social drift of people in their first episode of psychosis (FEP) into lower socio-economic positions or communities, as a consequence of disorder, has not been entirely refuted. As both causal and consequential factors may explain a degree of the social and spatial patterning of schizophrenia, further investigation of their respective roles is putatively important for both prevention and management of clinical services for people with FEP. No study has compared the spatial distribution and detailed characteristics of the social environment amongst people with FEP, UHR and populationbased control subjects in a single epidemiological sample, which forms the focus of the present investigation
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