Gardener, CA; (2015) Current Urban Environment and Psychological Pathways to Psychosis. Doctoral thesis , UCL (University College London).

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Abstract

Background: Urban environment is a risk factor for psychosis, with literature assessing various conceptualisations of urbanicity, from deprivation to social capital. Cognitive models (Garety et al., 2007), propose the importance of affective and cognitive processes in the development and maintenance of psychosis; however research investigating the potential psychological pathways from urbanicity to psychosis are limited. The current study aims to assess the interplay between urban neighbourhood and psychological processes, on risk of psychosis. Method: This case-control study (134 first episode psychosis cases and 258 population controls), used the social environment assessment tool to elicit participant’s perceptions of their current neighbourhoods safety and social capital. The assessment of psychological variables included, anxiety, schematic beliefs and a jumping to conclusions bias (JTC). The interplay between the variables was assessed using logistic regression and multiple mediation and moderation analyses. Results: Anxiety, schematic beliefs and JTC were associated with increased risk for psychosis; and area safety and social capital was associated with a 1.71 increase in odds for psychosis, although this relationship appeared present for individuals within an intermediate social class. Positive other beliefs partially mediated the association between neighbourhood safety and social capital and psychosis, by reducing risk. Lastly an exploratory three-way interaction indicated the possible importance of a JTC bias in increasing odds for psychosis, in the context of low anxiety, within an environment with low safety and social capital. Conclusion: Similarly to wider literature, the importance of affective and cognitive processes in psychosis is reiterated. This study highlights the complex relationship between psychosis and urban neighbourhood safety and social capital, which is likely to interact with other individual variables in increasing risk. The clinical implications of the protective benefit of positive other beliefs is discussed, in relation to bolstering social support and the field of Community Psychology.

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