Epidemiologic Reviews Advance Access published online on July 30, 2008
Epidemiologic Reviews, doi:10.1093/epirev/mxn006
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article |
Psychosis and Place
1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
2 Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
3 Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, United Kingdom
4 Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
5 Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
6 New York State Psychiatric Institute, New York, NY
Correspondence to Dana March, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 (e-mail: dm2025{at}columbia.edu).
accepted for publication April 29, 2008.
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.
geography • incidence • psychotic disorders • residence characteristics • schizophrenia • social environment