Social and cognitive functioning, urbanicity and risk for schizophrenia

Weiser, Mark; Os, Jim van; Reichenberg, Abraham; Rabinowitz, Jonathan; Nahon, Daniella; Kravitz, Efrat; Lubin, Gad; Shmushkevitz, M.; Knobler, Haim Y.; Noy, Shlomo; Davidson, Michael

doi:10.1192/bjp.bp.106.031328

Cited by 65 publications

(47 citation statements)

References 33 publications

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“…In total, we identified 4 studies that met our strict inclusion criteria (diagnosis of schizophrenia, more than 2 levels of urbanicity exposure, and premorbid measurement) 9-13 and 4 additional studies [14][15][16][17] that met our broader criteria (see online supplementary material table 1). These were conducted between 1974 and 2007 in 6 Western industrialized countries with predominantly European populations and comprised a total of 46 820 cases with psychosis.…”

Section: Resultsmentioning

confidence: 99%

“…Because only 4 studies met our primary inclusion criteria (table 1), [9][10][11][12][13] we repeated the analysis with more liberal characteristics, which included studies with broader psychosis outcome, 2 comparison groups, and urbanicity exposure at the time of disease onset (see online supplementary material table 1). [14][15][16][17] The Danish studies 11,12 were supplemented with new, unpublished data provided by co-author Pedersen.…”

Section: Methodsmentioning

confidence: 99%

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Meta-Analysis of the Association of Urbanicity With Schizophrenia

Vassos

Pedersen

Murray

et al. 2012

Schizophrenia Bulletin

394

261

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The association between urbanicity and risk of schizophrenia is well established. The incidence of schizophrenia has been observed to increase in line with rising levels of urbanicity, as measured in terms of population size or density. This association is expressed as Incidence Rate Ratio (IRR), and the results are usually presented by comparing the most urban with the most rural environment. In this study, we undertook to express the effect of urbanicity on the risk of schizophrenia in a linear form and to perform a meta-analysis of all available evidence. We first employed a simple regression analysis of log (IRR) as given in each study on the urbanicity category, assuming a uniform distribution and a linear association. In order to obtain more accurate estimates, we developed a more sophisticated method that generates individual data points with simulation from the summary data presented in the original studies, and then fits a logistic regression model. The estimates from each study were combined with meta-analysis. Despite the challenges that arise from differences between studies as regards to the number and relative size of urbanicity levels, a linear association was observed between the logarithm of the odds of risk for schizophrenia and urbanicity. The risk for schizophrenia at the most urban environment was estimated to be 2.37 times higher than in the most rural environment. The same effect was found when studies measuring the risk for nonaffective psychosis were included.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Meta-Analysis of the Association of Urbanicity With Schizophrenia

Vassos

Pedersen

Murray

et al. 2012

Schizophrenia Bulletin

394

261

View full text Add to dashboard Cite

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“…This model has been presented as the social stress hypothesis. As schizophrenia occurs more commonly in children of parents with less education, such as in immigrant and/or urban families (Weiser et al, 2007; 2008), it is also possible that patients with schizophrenia grow up in low socio-economic status environments only to end up even lower. The typical hypothesis for these findings is that poverty and its consequences increase life stress, and is often associated with abuse and neglect, which in turn increase the risk for developing a variety of psychiatric conditions, including schizophrenia (Schafer and Fisher, 2011).…”

Section: Introductionmentioning

confidence: 99%

The course of vocational functioning in patients with schizophrenia: Re-examining social drift

Vargas¹,

Strassnig²,

Sabbag³

et al. 2014

Schizophrenia Research: Cognition

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Vocational functioning is markedly impaired in people with schizophrenia. In addition to low rates of employment, people with schizophrenia have been reported to be underachieved compared to other family members. Among the causes of this vocational impairment may be cognitive deficits and other skills deficits, as well as social factors impacting on opportunities for employment. In this study, we examined two separate samples of people with schizophrenia who differed in their educational and social backgrounds. We compared personal and maternal education in people with schizophrenia attending an outpatient rehabilitation facility (n = 57) or receiving outpatient services at a VA medical center (n = 39). The sample as a whole showed evidence of decline in vocational status from their best job to their most recent job. Patients attending a rehabilitation facility had completed less education than their mothers, while the VA patients completed more. Differences between personal and maternal education predicted the difference in status between best and latest jobs in the sample as a whole. VA patients were more likely to be living independently and performed better on a measure of functional capacity than the rehabilitation sample. These data implicate vocational decline in schizophrenia and also suggest that this decline may originate prior to the formal onset of the illness. At the same time, vocational outcomes appear to be related to social opportunities.

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“…It has been hypothesized that all three risk factors may be associated with the same underlying mechanism of behavioural ' sensitization ' over time (Collip et al 2008 ;van Winkel et al 2008 ;Lardinois et al 2011). Meta-analyses suggest that growing up in an urban environment is consistently associated, in a dose-response fashion, with increased psychosis risk (Krabbendam & van Os, 2005 ;March et al 2008 ;Kelly et al 2010), particularly if there is additional evidence of genetic risk (van Os et al 2003Weiser et al 2007). The aim of the present study was to investigate whether environmental factors associated with urbanicity moderate the strength of the cannabis-psychosis relationship.…”

Section: Introductionmentioning

confidence: 99%

Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study

Kuepper

Lieb

et al. 2011

Psychol. Med.

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Background. Cannabis use is considered a component cause of psychotic illness, interacting with genetic and other environmental risk factors. Little is known, however, about these putative interactions. The present study investigated whether an urban environment plays a role in moderating the effects of adolescent cannabis use on psychosis risk.Method. Prospective data (n=1923, aged 14-24 years at baseline) from the longitudinal population-based German Early Developmental Stages of Psychopathology cohort study were analysed. Urbanicity was assessed at baseline and defined as living in the city of Munich (1562 persons per km 2 ; 4061 individuals per square mile) or in the rural surroundings (213 persons per km 2 ; 553 individuals per square mile). Cannabis use and psychotic symptoms were assessed three times over a 10-year follow-up period using the Munich version of the Composite International Diagnostic Interview.Results. Analyses revealed a significant interaction between cannabis and urbanicity [10.9 % adjusted difference in risk, 95 % confidence interval (CI) 3.2-18.6, p=0.005]. The effect of cannabis use on follow-up incident psychotic symptoms was much stronger in individuals who grew up in an urban environment (adjusted risk difference 6.8 %, 95 % CI 1.0-12.5, p=0.021) compared with individuals from rural surroundings (adjusted risk difference x4.1 %, 95 % CI x9.8 to 1.6, p=0.159). The statistical interaction was compatible with substantial underlying biological synergism.Conclusions. Exposure to environmental influences associated with urban upbringing may increase vulnerability to the psychotomimetic effects of cannabis use later in life.

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Social and cognitive functioning, urbanicity and risk for schizophrenia

Abstract: Risk of schizophrenia may increase when people with a genetic liability to the disorder, expressed as poor social and cognitive functioning, need to cope with city life.

Cited by 65 publications

References 33 publications

Meta-Analysis of the Association of Urbanicity With Schizophrenia

Meta-Analysis of the Association of Urbanicity With Schizophrenia

The course of vocational functioning in patients with schizophrenia: Re-examining social drift

Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study

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