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The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

  • F. J. Oher (a1) (a2), A. Demjaha (a3), D. Jackson (a4), C. Morgan (a5), P. Dazzan (a3), K. Morgan (a6), J. Boydell (a3), G. A. Doody (a7), R. M. Murray (a3), R. P. Bentall (a8), P. B. Jones (a1) and J. B. Kirkbride (a1) (a9)...

Abstract

Background

The extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.

Method

We collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.

Results

Reality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).

Conclusions

In people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

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Copyright

The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .

Corresponding author

* Address for correspondence: J. B. Kirkbride Ph.D., Division of Psychiatry, 67-73 Riding House Street, London W1W 7EJ, UK. (Email: j.kirkbride@ucl.ac.uk)

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The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

  • F. J. Oher (a1) (a2), A. Demjaha (a3), D. Jackson (a4), C. Morgan (a5), P. Dazzan (a3), K. Morgan (a6), J. Boydell (a3), G. A. Doody (a7), R. M. Murray (a3), R. P. Bentall (a8), P. B. Jones (a1) and J. B. Kirkbride (a1) (a9)...

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