Social and spatial heterogeneity in psychosis proneness in a multilevel case-prodrome-control study.

ABSTRACT

OBJECTIVE: To test whether spatial and social neighbourhood patterning of people at ultra-high risk (UHR) of psychosis differs from first-episode psychosis (FEP) participants or controls and to determine whether exposure to different social environments is evident before disorder onset. METHOD: We tested differences in the spatial distributions of representative samples of FEP, UHR and control participants and fitted two-level multinomial logistic regression models, adjusted for individual-level covariates, to examine group differences in neighbourhood-level characteristics. RESULTS: The spatial distribution of controls (n = 41) differed from UHR (n = 48; P = 0.04) and FEP participants (n = 159; P = 0.01), whose distribution was similar (P = 0.17). Risk in FEP and UHR groups was associated with the same neighbourhood-level exposures proportion of single-parent households [FEP adjusted odds ratio (aOR) 1.56 95% CI 1.00-2.45; UHR aOR 1.59; 95% CI 0.99-2.57], ethnic diversity (FEP aOR 1.27; 95% CI 1.02-1.58; UHR aOR 1.28; 95% CI 1.00-1.63) and multiple deprivation (FEP aOR 0.88; 95% CI 0.78-1.00; UHR aOR 0.86; 95% CI 0.76-0.99). CONCLUSION: Similar neighbourhood-level exposures predicted UHR and FEP risk, whose residential patterning was closer to each other's than controls. Adverse social environments are associated with psychosis before FEP onset.