Social and spatial heterogeneity in psychosis proneness in a multilevel case–prodrome–control study

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.

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

“…Our findings are also in keeping with those from recent studies documenting higher rates of psychotic phenomena, psychosis-proneness, and psychotic disorder among children, adolescents and young adults living in regions with higher fragmentation, disorder and crime as rated by independent or objective sources (Bhavsar et al, 2014; Kirkbride et al, 2015; Newbury et al, 2016; Newbury et al, 2017; Wilson et al, 2016). Here we identify a potential role for personal perceptions of threatening neighborhood conditions in early psychotic phenomena.…”

“…Given the potential bidirectional relationship between psychotic experiences and perceptions of threatening neighborhood conditions, psychological therapies could incorporate strategies to help young people understand whether their perceptions of threat in the neighborhood are rational, or whether these perceptions are contributing unnecessarily to a cycle of stress, fear and psychotic experiences. On the other hand, recent findings from this team (Newbury et al, 2016; Newbury et al, 2017; Odgers et al, 2015) and others (Bhavsar et al, 2014; Goldman-Mellor et al, 2016; Kirkbride et al, 2015; Polling et al, 2014; Wilson et al, 2016) suggest a need to address whether wider physical and social environmental conditions can be improved for the benefit of young people’s mental health. Within two or three decades, 70% of the world’s population will live in cities (Dye, 2008).…”

Neighbourhood communalities and ultra-high risk psychosis: An emergent literature

“…Given that single-parent household status was highly correlated with neighbourhood deprivation (r = 0.66) in our sample, we suggest that "[h]aving controlled for this, the counterintuitive negative association between multiple deprivation and psychosis proneness might indicate a nonlinear relationship." (Kirkbride et al, 2015). Interpreted in this light, our findings also accord with O'Donoghue et al (2015), given the presence of non-linearity between deprivation and the rate of UHR groups in their data (see their Table 1).…”

“…By contrast, we suggest that their findings are, in fact, consistent with those observed in our sample in the East of England (Kirkbride et al, 2015). Both studies, for example, used identical criteria to define UHR groups.…”

“…We hope that our reply comment adds some further insight into the results from both O' Donoghue et al (2015) and Kirkbride et al (2015), which represent an emergent, important area for further research. Our conclusion remains the same: taken together, these observations support the possibility that people with increased psychosis proneness are exposed to more adverse social environments during the at-risk period.…”