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

Oher, FJ; Demjaha, A; Jackson, D; Morgan, C; Dazzan, P; Morgan, K; Boydell, J; ... Kirkbride, JB; + view all (2014) The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study. Psychological Medicine , 44 (11) pp. 2419-2430. 10.1017/S0033291713003188. Green open access

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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.

Type: Article
Title: The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1017/S0033291713003188
Publisher version: http://dx.doi.org/10.1017/S0033291713003188
Language: English
Additional information: Copyright © Cambridge University Press 2014 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence <http://creativecommons.org/licenses/by/3.0/>.
Keywords: Epidemiology; neighbourhood; paranoia; positive symptoms; psychosis; symptom dimensions; symptomatology; social environment; urbanicity
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1437614
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