Abstract
Background:Urban upbringing is associated with a 2-fold adulthood psychosis risk, and this association replicates for childhood psychotic symptoms. No study has investigated whether specific features of urban neighborhoods increase children’s risk for psychotic symptoms, despite these early psychotic phenomena elevating risk for schizophrenia and other psychiatric disorders in adulthood.Methods:Analyses were conducted on over 2000 children from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of UK-born twins. Neighborhood-level characteristics were assessed for each family via: a geodemographic discriminator indexing neighborhood-level deprivation, postal surveys of over 5000 residents living alongside the children, and in-home interviews with the children’s mothers. Children were interviewed about psychotic symptoms at age 12. Analyses were adjusted for important family-level confounders including socioeconomic status (SES), psychiatric history, and maternal psychosis.Results:Urban residency at age-5 (OR = 1.80, 95% CI = 1.16–2.77) and age-12 (OR = 1.76, 95% CI = 1.15–2.69) were both significantly associated with childhood psychotic symptoms, but not with age-12 anxiety, depression, or antisocial behavior. The association was not attributable to family SES, family psychiatric history, or maternal psychosis, each implicated in childhood mental health. Low social cohesion, together with crime victimization in the neighborhood explained nearly a quarter of the association between urbanicity and childhood psychotic symptoms after considering family-level confounders.Conclusions:Low social cohesion and crime victimization in the neighborhood partly explain why children in cities have an elevated risk of developing psychotic symptoms. Greater understanding of the mechanisms leading from neighborhood-level exposures to psychotic symptoms could help target interventions for emerging childhood psychotic symptoms.
Highlights
Urban vs rural upbringing doubles a child’s odds of developing schizophrenia in adulthood.[1]
We draw from sociological theory and evidence illustrating that neighborhood-level social processes mediate the effect of neighborhood structural features on a range of health outcomes.[52,53,54]. Guided by this theory and adult psychosis findings, the current study focuses on 4 neighborhood-level social processes: (1) social cohesion, describing the cohesiveness and supportiveness of relationships between neighbors[52]; (2) social control, describing the likelihood that neighbors would intervene in problems in the neighborhood[52]; (3) neighborhood disorder, describing physical and social evidence of disorder/threat within the neighborhood[53]; and (4) crime victimization, representing more direct experiences of victimization in the neighborhood
In our sample there was a tendency for urban neighborhoods to be more deprived (OR = 2.57, 95% CI = 1.99–3.32, P < .001), half of urban neighborhoods were relatively affluent (ACORN categories 1–3; 50.3%), and over a quarter of nonurban neighborhoods were considered deprived (ACORN categories 4 and 5; 27.8%)
Summary
Urban vs rural upbringing doubles a child’s odds of developing schizophrenia in adulthood.[1]. Childhood psychotic symptoms could shed light on the urbanicity-psychosis association: a handful of studies have shown that these symptoms occur more frequently[29] and are more likely to persist into adulthood among youth living in urban vs nonurban settings.[34,35] no studies have tested whether specific aspects of the urban environment increase risk for psychotic symptoms among children. No study has investigated whether specific features of urban neighborhoods increase children’s risk for psychotic symptoms, despite these early psychotic phenomena elevating risk for schizophrenia and other psychiatric disorders in adulthood. Together with crime victimization in the neighborhood explained nearly a quarter of the association between urbanicity and childhood psychotic symptoms after considering family-level confounders. Conclusions: Low social cohesion and crime victimization in the neighborhood partly explain why children in cities have an elevated risk of developing psychotic symptoms. Greater understanding of the mechanisms leading from neighborhood-level exposures to psychotic symptoms could help target interventions for emerging childhood psychotic symptoms
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