In the eye of the beholder: Perceptions of neighborhood adversity and psychotic experiences in adolescence

Abstract

Adolescent psychotic experiences increase risk for schizophrenia and other severe psychopathology in adulthood. Converging evidence implicates urban and adverse neighborhood conditions in the aetiology of adolescent psychotic experiences, but the role of young people’s personal perceptions of disorder (i.e., physical and social signs of threat) in their neighborhood is unknown. This was examined using data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative birth cohort of 2,232 British twins. Participants were interviewed at age 18 about psychotic phenomena and perceptions of disorder in the neighborhood. Multilevel, longitudinal, and genetically-sensitive analyses investigated the association between perceptions of neighborhood disorder and adolescent psychotic experiences. Adolescents who perceived higher levels of neighborhood disorder were significantly more likely to have psychotic experiences, even after accounting for objectively/independently measured levels of crime and disorder, neighborhood- and family-level socioeconomic status, family psychiatric history, adolescent substance and mood problems, and childhood psychotic symptoms (OR=1.62, 95% CI=1.27–2.05, p<0.001). The phenotypic overlap between adolescent psychotic experiences and perceptions of neighborhood disorder was explained by overlapping common environmental influences (rC=0.88, CI=0.26–1.00). Findings suggest that early psychological interventions to prevent adolescent psychotic experiences should explore the role of young people’s (potentially modifiable) perceptions of threatening neighborhood conditions.

Association of Air Pollution Exposure With Psychotic Experiences During Adolescence

“…As previously reported, 31 psychotic experiences were significantly more common among adolescents residing in the most urban vs rural neighborhoods at 18 years of age (OR, 1.93; 95% CI, 1.35-2.75). Table 3 displays mediation models of the association between the most urban residency and adolescent psychotic experiences, split into the direct pathway (the part of the association not explained by the specified air pollutant, plus measurement error) and indirect pathway (the part of the association that is statistically mediated via the specified air pollutant).…”

“… 27 Third, psychotic phenomena are also approximately twice as common among youth raised in cities. 28 , 29 , 30 , 31 , 32 Air pollution is a plausible component of this association. Finally, subclinical psychotic experiences are relatively common among children and adolescents, 33 thereby increasing our power to detect associations in the general population.…”

Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland

“…21 Moreover, the increased risk of antipsychotic medication among young adults staying in the same area may require further exploration, as there is evidence suggesting that growing up in high-crime neighbourhoods may increase the risk of presenting psychotic symptoms through increased social stress and crime victimisation. 33 34…”

Neighbourhood characteristics at birth and positive and negative psychotic symptoms in adolescence: findings from the ALSPAC birth cohort

“…Psychotic disorders may lie at one end of an "extended psychosis phenotype," 1,2 which includes transient symptoms and subthreshold psychotic experiences that may, for some, be a precursor for later clinical diagnoses. Accordingly, epidemiological and clinical research show that psychotic experiences share etiological overlap with clinical disorders, including neurodevelopmental, [3][4][5][6] pre-and perinatal, 7,8 and environmental [9][10][11][12][13][14] exposures. For example, schizophrenia is more common among individuals born in more densely populated and deprived areas, [15][16][17][18] exhibiting a dose-response relationship, 16 and some, although not all, 19 emerging evidence suggests that subthreshold psychotic experiences follow similar patterns with respect to urban birth [9][10][11] and residence.…”

“…For example, schizophrenia is more common among individuals born in more densely populated and deprived areas, [15][16][17][18] exhibiting a dose-response relationship, 16 and some, although not all, 19 emerging evidence suggests that subthreshold psychotic experiences follow similar patterns with respect to urban birth [9][10][11] and residence. [12][13][14] However, no study to date has investigated whether specific aspects of the social environment at birth (ie deprivation, social fragmentation, population density) are related to subclinical psychotic symptoms. Further, most studies of subclinical symptoms have focused on positive psychotic phenomena, with only 2 studies having investigated the effect of urban living on negative symptoms, finding equivocal results.…”