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.
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)