Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders

From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States

“…The disproportionate number of marginalized and disadvantaged Black people represented among individuals with psychosis in U.S. clinical settings may reflect how these traumas, discrimination, and neighborhood violence are influencing the ability to receive adequate treatment and avoid traumatic pathways to and through care. Indeed, perceived neighborhood disorder in childhood and adolescence significantly predicted delays in identification and receipt of mental health services for people with a diagnosis of psychosis (66). Other marginalized groups, encompassing those in poor rural areas, the lesbian, gay, bisexual, transgender, queer, and intersex community (especially transgender people of color), and those with disabilities also suffer disproportional social determinants of health.…”

“…These findings suggest that growing up with the experience of stressful racial dynamics in an urban community may lead to increased risk for psychosis spectrum experiences. Additionally, Ku et al (66) reported that neighborhood-level residential instability, as measured by the percentage of people who lived in multiple homes within 1 year, predicted earlier psychosis onset, a proxy for more severe illness course. Future research in the United States could probe for a more refined understanding of the mechanisms that underlie the links between neighborhood-level factors and psychosis risk.…”

Neighborhood Predictors of Outpatient Mental Health Visits Among Persons With Comorbid Medical and Serious Mental Illnesses

“…Another explanation for this association is that individuals with serious mental illnesses living in residentially mobile neighborhoods may experience more social stress that limits their ability to follow up with outpatient visits. Prior studies have found that neighborhood residential mobility was associated with higher rates of schizophrenia, major depression, and psychosis (28, 37) and with earlier age at onset of psychosis (38). Just as urbanicity and individuallevel migration have been hypothesized to be related to the experience of social fragmentation (39), living in an area in which many people in the community are residentially mobile may also contribute to increased social stress, which may affect health at the biological level (40).…”

The associations between migrant status and ethnicity and the identification of individuals at ultra-high risk for psychosis and transition to psychosis: a systematic review

“…In any case, it is worth highlighting that variation in findings should be expected due to differing settings. Social and environmental factors, including access to health services, socioeconomic status, education levels and employment rates, are known to influence help-seeking and duration of untreated psychosis [39][40][41][42]. Thus, differences in these factors likely mediate the association between ethnicity (as well as migrant status) and UHR identification across studies.…”