Psychosis and Place

Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
Epidemiologic Reviews (Impact Factor: 6.67). 08/2008; 30(1):84-100. DOI: 10.1093/epirev/mxn006
Source: PubMed


One important line of epidemiologic inquiry implicating social context in the etiology of psychosis is the examination of spatial variation in the distribution of psychotic illness. The authors conducted a systematic review of evidence from urbanicity and neighborhood studies regarding spatial variation in the incidence of psychosis in developed countries since 1950. A total of 44 studies (20 of urbanicity and 24 of neighborhood) were culled from three databases with similar time frames: Medline (1950-2007), PsychInfo (1950-2007), and Sociological Abstracts (1952-2007). With a special emphasis on social factors potentially relevant to etiology, the authors elucidated contributions, limitations, and issues related to study design, measurement, and theory. Evidence from both arenas supports a possible etiologic role for social context. Studies of urbanicity indicate that early-life exposure may be important; dose-response relations, spatial patterning of schizophrenia, and interactions with other factors may exist. Neighborhood studies indicate heterogeneity in rates, hint at spatial patterning of schizophrenia, and offer intriguing evidence implying more proximal social (as opposed to physical) exposures. The authors encourage the exploration of social pathways engaging theory, methodological advances, and the life-course perspective. They also propose a conceptual shift from studies of spatial variation in outcomes to research addressing the etiologic effect of exposures shaped by place as a reservoir of risk or resilience.

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    • "Pharmacotherapy of schizophrenia is commonly grouped into two classes, typical and atypical antipsychotics. It is known that there are differences in the prevalence of schizophrenia between latitudes (Davies et al., 2003) and rural versus urban areas (Pedersen and Mortensen, 2001; Krabbendam and van Os, 2005; March et al., 2008). However , only limited evidence is available on the potentially modifying effect of geographic factors on the efficacy of pharmacological compounds in schizophrenia. "
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    ABSTRACT: Generalizability of efficacy results from medication trials across geographic regions is disputed. Geographic differences in factors such as patient characteristics, treatment practices and disease definitions might lead to differences in effect sizes across regions. This study examined geographic variation in efficacy results of schizophrenia trials with atypical antipsychotics using individual-patient data meta-analysis. Twenty-two studies including in total 5,233 patients from three regions (North America, Europe, and the rest of the world) were included in the random effects meta-analysis. The effect size in North American patients was smaller in terms of mean change from baseline and in terms of responders (Hedge's G=0.37, 95% CI 0.28–0.46; OR 1.71, 95% CI 1.35–2.17) as compared to patients in Europe (Hedge's G=0.56, 95% CI 0.34–0.79; OR 2.25, 95% CI 1.62–3.12) and the rest of the world (Hedge's G=0.53, 95% CI 0.12–0.75; OR 2.61, 95% CI 1.66–4.17). The differences were not statistically significant. The observed differences remained when the confounding effect of unequal distribution of compounds was controlled for by analyzing separately the compounds that were studied across all three regions. Based on these results it cannot be excluded that there are differences in efficacy results of atypical antipsychotics trials across geographic regions. Thβe observed trend towards differential efficacy across geographic regions warrants further examination of the determinants of these differences.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 07/2014; 24(7). DOI:10.1016/j.euroneuro.2014.02.006 · 4.37 Impact Factor
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    • "Several studies and reviews have analysed the incidence of schizophrenia in different settings and the factors influencing it [2]. The incidence of schizophrenia shows important geographical variation across countries, between rural and urban sites and even at a single city level, between neighbourhoods [4]. "
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    ABSTRACT: The aim of our study is to provide data on the incidence of psychotic disorders in France and compare the incidence rates in populations with different levels of urbanization. We prospectively included the incident cases of psychotic disorders from two catchment areas with contrasted levels of urbanization. In the more rural area we also calculated incidence rates in three different groups of population defined by the size of towns in which they live (small, medium and large towns). The annual incidence of psychosis was greater in the urban area (36.02/100000 person-year at risk) than in the rural area (17.2/100000 person-year at risk).Non-affective psychoses were the majority of cases and their incidence was greater in males and younger subjects. The affective psychoses were slightly more frequent in women and showed less variation with age. In the rural centre, greater levels of urbanicity were associated with an increase in the incidence of all psychoses (affective and non-affective). Our study confirms previous observations of increased incidence rates for non-affective psychoses in the more urbanized areas and suggests that a similar pattern might be present for affective psychoses.
    BMC Psychiatry 03/2014; 14(1):78. DOI:10.1186/1471-244X-14-78 · 2.21 Impact Factor
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    • "For example, schizophrenia risk is increased for people raised in an urban environment (Pedersen and Mortensen, 2006). Sub-optimal social conditions have been identified as important mediating factors, in particular low social capital and high social fragmentation (Allardyce et al., 2005; March et al., 2008). Immigrants also suffer from higher risk of psychosis (reviewed in Cantor-Graae and Selten, 2005); two potential explanations of this phenomenon are immigrants' experiences of discrimination and exposure to social defeat, both chronically stressful conditions. "
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    ABSTRACT: DISC1 was discovered in a Scottish pedigree in which a chromosomal translocation that breaks this gene segregates with psychiatric disorders, mainly depression and schizophrenia. Linkage and association studies in diverse populations support DISC1 as a susceptibility gene to a variety of neuropsychiatric disorders. Many Disc1 mouse models have been generated to study its neuronal functions. These mouse models display variable phenotypes, some of them relevant to schizophrenia, others to depression. The Disc1 mouse models are popular genetic models for studying gene-environment interactions in schizophrenia. Five different Disc1 models have been combined with environmental factors. The environmental stressors employed can be classified as either early immune activation or later social paradigms. These studies cover major time points along the neurodevelopmental trajectory: prenatal, early postnatal, adolescence, and adulthood. Various combinations of molecular, anatomical and behavioral methods have been used to assess the outcomes. Additionally, three of the studies sought to rescue the resulting abnormalities. Here we provide background on the environmental paradigms used, summarize the results of these studies combining Disc1 mouse models with environmental stressors and discuss what we can learn and how to proceed. A major question is how the genetic and environmental factors determine which psychiatric disorder will be clinically manifested. To address this we can take advantage of the many Disc1 models available and expose them to the same environmental stressor. The complementary experiment would be to expose the same model to different environmental stressors. DISC1 is an ideal gene for this approach, since in the Scottish pedigree the same chromosomal translocation results in different psychiatric conditions.
    Frontiers in Behavioral Neuroscience 09/2013; 7:113. DOI:10.3389/fnbeh.2013.00113 · 3.27 Impact Factor
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