Those at High Risk for Psychosis More Likely From Deprived Neighborhoods

Ecological study finds being identified as "Ultra High Risk" for psychosis is related to health and barriers to housing and services


A recent study published in Schizophrenia Research examines the incidence individuals deemed “Ultra-High-Risk” (UHR) for psychosis and their neighborhood of residence. After controlling for numerous variables including, the density of the neighborhood, the percentage of non-white persons living in an area, and its proximity to resources, only the positive association between UHR detection rate and neighborhood deprivation remained. Looking closer, the researchers found an association between health deprivation and UHR detection rate and a negative association with barriers to housing and services.

“The distribution of UHR detection rates by neighbourhood is not random and may be explained in part by differences in the social environment between neighbourhoods,“ the authors write.

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The Ultra-High Risk (UHR) state intends to identify individuals who are at an elevated risk for developing a psychotic disorder. As previously reported, numerous studies have demonstrated that the presence of environmental risk factors is associated with an elevated risk of developing psychosis.

Moreover, the authors point out that previous studies have shown an association between psychosis incidence, neighborhood population density, and community neighborhood deprivation, even after accounting for individual confounders including ethnicity and occupational socioeconomic status. Further, the authors write that the connection between higher UHR incidence and communities could potentially be a result of certain areas experiencing more social deprivation through mechanisms of stress processing and stress liability.

The authors of this study examined the neighborhood variations in UHR rates over a fourteen-year period. They then compared this rate to the rate of referrals of UHR assessment and determined the effects of neighborhood deprivation and help-seeking as possible explanations for the variation in UHR identification. The authors then determined which domain of deprivation best predicted UHR identification rates.

The researchers utilized the dataset of help-seeking persons from the Outreach and Support in South London (OASIS) high-risk service, South London and Maudsley NHS Foundation Trust (SLaM). After clinical assessment, participants were designated as either UHR positive or UHR negative. Other variables collected included: gender, ethnicity, marital status, and place of residence to place persons into small geographic sectors.

Deprivation consisted of seven domains: employment, income, education, health, living conditions, and barriers to housing and services. These were based on the Index of Multiple Deprivations and census data on the proportion of households exposed to deprivation in each neighborhood. Other data included the percentage of non-White people, the percentage of single people between 16-36, and population density from census data.

Three hundred and thirty-six individuals were identified as UHR. They were mainly male, were an average age of 23. A higher percentage of those that have been designated as UHR lived in neighborhoods with the highest cumulative deprivation scores. Seventy-seven percent were single, and 48% were white. Also, there was an association between the UHR detection rate and the increasing proportion of non-white people in a neighborhood. When all characteristics were accounted for only neighborhood deprivation was associated with the UHR detection rate after adjusting for ethnicity, the proportion of young single people, population density, and referrals for UHR assessment. The neighborhoods experiencing the highest rate of deprivation had more than twice the rate of UHR detection compared to less deprived neighborhoods.

When all characteristics were accounted for only neighborhood deprivation was associated with the UHR detection rate after adjusting for ethnicity, the proportion of young single people, population density, and referrals for UHR assessment. The neighborhoods experiencing the highest rate of deprivation had more than twice the rate of UHR detection compared to less deprived communities.

The most interesting (albeit not surprising) finding from this study was that the rate of positive UHR labeling and referral for UHR assessment progressively increased across deprived neighborhoods. After adjusting for population density, proportion of young single people, the percentage of non-White people, and referrals for UHR assessment, only the association with neighborhood deprivation remained. A negative association was observed in the adjusted model between UHR detection rate and barriers to housing and services.

The lack of association between UHR detection rate and the other social variables accounted for (young single people living in an area, density, and proportion of non-white people) suggests that the deprivation factors within neighborhoods are have the most meaningful effect on rates of detection.

After adjusting for these variables, the only deprivation associations that remained were 1) a negative association with barriers to housing and services and 2) an association with health deprivation. These findings suggest that proximity to resources and better health are associated with higher rates of detecting UHR individuals.



Bhavsar, V., Fusar-Poli, P., & McGuire, P. Neighbourhood deprivation is positively associated with detection of the ultra-high risk (UHR) state for psychosis in South East London. Schizophrenia Research. (Abstract)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


  1. I think poverty only causes psychosis in cities, living in poverty in the countryside is a different experience.

    Does City Life Pose a Risk to Mental Health?
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    People living in rural areas of Britain are more optimistic about the future and happier about their quality of life than people in cities and towns, a new survey has found.

    The study is also somewhat flawed because it is part of the culture in Deprived Neighborhoods to get as much as you can from the system. I met a guy who faked mental illness to get SSI. He had this long phony tale based on astrology planets and dates and numerology he used to get a psychiatric diagnosis and the payments that go with it.

    Why not cheat them, at least it deprives the government of money they might use to build more prisons and do police state things. Ironically this was before the death of Eric Garner and the guy I met who cheated SSI with the mental illness tale was also in trouble for selling loose cigarettes.

    “a negative association with barriers to housing and services”

    The city just sucks. Everyone thinks they have the political solution to fixing those areas but it is always an epic fail. Someone should create a detailed escape plan that people could use to get away from them. All the way back to antiquity people abandoned failed cities, many of the ancient ruins are still around, and I think today that migration is still the best solution.

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  2. It really makes me angry and sad, to think that someone would judge a person sanity for just surviving in his neighborhood! People seldom put thier selves in other people’s shoes, before judgement!! Now that is some psychological insane bigotry!! Now critic your higher educational statistics UHR, on that!!

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  3. With the news now shining a spotlight on the terrible plight of America’s deprived neighborhoods, some people say, “Why don’t they just move out ? Problem solved.”

    However, this is a perspective that fails to recognize that lack of upward mobility is one of the defining aspects of a deprived neighborhood. There are massive barriers that prevent people in poverty from creating their own businesses, or even working for other people even if they do move. These barriers come in the form of regulations, which require a long list of permits, licenses, and endless non stop expensive complicated bullshit paperwork to hire people and conduct any business except of course in the drug trade that thrives. Over-criminalization of things that are not actually crimes plays a huge role in this lack of upward mobility as well.

    We can’t solve problems by using the same kind of thinking we used when we created them. – Albert Einstein

    Gee thanks Mr Big Brain but how do you stop people from voting for Democrats who love making endless BS regulations and the Republicans who always want a police state ?

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  4. “a negative association with barriers to housing and services”

    I live back in the woods, you see
    My woman and the kids, and the dogs, and me
    I got a shotgun, a rifle, and a 4-wheel drive
    Country folks can survive

    I can catch catfish from dusk ’til dawn
    We make our own whiskey and our own smoke, too
    Ain’t too many things these old boys can’t do
    We grow good old tomatoes and homemade wine
    Country folks can survive

    Because you can’t starve us out
    And you can’t make us run…

    Most Americans think that miles of machine-planted row crops and crowded feedlots are required to feed everyone—that without large-scale, industrial agriculture, with its chemical inputs and GMOs, we would all starve to death.

    How much land do you need to feed a family?

    “a negative association with barriers to housing and services”

    That quote could easily describe my attitude of those screw the systems barriers trying to make me a debt slave but my attitude is also I don’t need those people and nobody does its just sad how schools teach zero real life skills such as how to fix simple machinery or how to do construction. I think it is intentional, I think the “new world order” absolutely wants a population of helpless retards dependent on the system where every little problem calls for a “professional” and “licensed installers”.

    I am not saying we should all be Alaska Bush People I am really really trying to express how the complete dependency on the system causes stress and mental health problems.

    This couple I know right now stressed out of their minds with money problems had the electricity cut off. I offered them a big deep cycle battery I have so they can run a decent fan, their laptop ect. It just takes a the cost of a few electric bills to buy a fat battery, a 12 volt fan and 2 standard solar panels and that’s it, done, for years you have a fan blowing on you at night when if its hot and you want to sleep and the next day it simply charges up again.

    They have a car that I just repaired by the way and so OK then use my battery to run your fan and use the cars charging system to charge it with jumper cables or charge it at a neighbors who has power and STOP having a damn neurotic mental breakdown over the power being shut off !!!

    Battery holds 210 amp hours, how much power do you need ??? Give me a break.

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    • I have lived in the city, the suburbs, and in the deep country. I am well aware of the things you mention. My fiancé and I just bought a tiny home on wheels and are in the process of selling our McMansion in the suburbs of Maryland for exactly the reasons you’ve mentioned. I crap in a bucket, I preserve food for later use, I can shoot a gun (though I’m vegan so I don’t hunt or fish, but I could survive if I needed to). I am not a libertarian but we are dropping out of the system because it is broken. You and I don’t entirely agree or disagree Cat. But I think that just suggesting everyone move out into the countryside and fend for themselves is not really seeing the whole picture. Most of the people currently living in cities wouldn’t survive a day if they had to fend for themselves. If there were a major societal collapse due to war or economic hardship, those folks in the city will be walking out to the countryside to take the food from the folks who have so diligently saved up and prepared. I doubt you have enough firepower to fend off a sustained assault of millions of hungry angry people. And railing on about the ‘retards’ won’t fix any of this.

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      • “in the process of selling our McMansion in the suburbs of Maryland” Cool !

        Have you ever considered this way of getting “off grid”

        Nothing is as self sufficient as a sailboat. They usually have those little electric windmill generators and a solar panel. A small reliable diesel and of course the sails. And even at the dock they are cool tiny homes.

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        • Boat life is a pretty common next step for THOW and full-time RV folks, so yes, the topic has come up, however I have experience with my mother’s and uncle’s sailboats when I was a kid and learned the hard way that I have a pretty extreme fear of water, so it’s an unlikely path for us. However, tiny mobile living is very similar to boat life and Since our little home doesn’t have leveling jacks, we’ve been known to fuss at each other for “rocking the boat”! 😀

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