Urbanicity: The need for new avenues to explore the link between urban living and psychosis

Abstract

Background: A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies. Method:A comprehensive literature survey on the main computerised medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted. Results:The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress". The latter may link urban upbringing to the development of psychosis through overlapping neuro-and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce. Conclusions: Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, This article is protected by copyright. All rights reserved.bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental wellbeing.

Explaining the association between urbanicity and psychotic-like experiences in pre-adolescence: The indirect effect of urban exposures

“…Meta-analytic estimates have shown that the risk for psychosis approximately doubles in urban environments (Castillejos et al, 2018;Kelly et al, 2010;Krabbendam, 2005;Vassos et al, 2012a), and population-based cohort studies have shown that urbanicity explains 30% or more of incident cases (Marcelis et al, 1998;Mortensen et al, 1999), making the impact of urbanicity on psychosis risk as large as or larger than other known non-genetic environmental risk factors (Tandon et al, 2008). Importantly, the association between urbanicity and psychosis remains after controlling for many potential confounding factors, including drug use and genetic risk, (Abrahamyan Empson et al, 2019;Kelly et al, 2010;Krabbendam, 2005;March et al, 2008), and can also not be explained by selective migration (Pedersen, 2015). These findings and others demonstrating that changes in urbanicity prospectively predict changes in psychosis risk later in life (Marcelis et al, 1999;Pedersen, 2001) have led to suggestions that the association between urbanicity and psychosis may in fact be causal in nature (Krabbendam, 2005;van Os, 2004), perhaps by way of an interaction between urbanicity and constitutional vulnerability factors (Krabbendam, 2005;van Os et al, 2010).…”

“…Despite the clear etiological importance of the urban environment for psychosis, one of the most critical issue related to this association remains poorly understood: what is the mechanism through which urbanicity impacts risk? Urban environments involve a wide variety of physical (e.g., pollution) and social (e.g., poverty) exposures, and it may be these exposures that explain, in part, why urban environments impact psychosis risk (Abrahamyan Empson et al, 2019;Brown, 2011;Lydia Krabbendam et al, 2020). To this point, a variety of urban-related physical exposures have been shown to increase risk for and exacerbate psychotic symptoms including air pollution (Antonsen, Mok, Webb, Mortensen, McGrath, Agerbo, Brandt, Geels, Christensen, & Carsten Bøcker Pedersen, 2020;Gao et al, 2017;Lary et al, 2015;Liang et al, 2019;Tong et al, 2016), and xenobiotic heavy metal (i.e., lead) exposure (Arinola et al, 2010;Opler et al, 2004Opler et al, , 2008.…”

Urban remediation: a new recovery-oriented strategy to manage urban stress after first-episode psychosis

“…While in many ways, cities are desirable because of their intense atmosphere and the resources they offer, they also confront urban dwellers with a hectic pace, high human density, noise, fear of crime and an often confusing built environment [5,6], which will impact on their wellbeing. The specific components of this 'urban stress' that are involved in increasing the risk for psychosis are not yet identified [7,8], but several factors have been proposed to explain this citypsychosis nexus, which can be classified into 'physical urban' and 'social urban factors' [9]. 'Physical urban factors' include urban design, pollution or lack of green spaces, while 'social urban factors' include cannabis exposure, migration, neighborhood deprivation and social capital, ethnic density and social defeat [8,9], all these factors acting and interacting at different scales and points in time [8,10].…”

“…The specific components of this 'urban stress' that are involved in increasing the risk for psychosis are not yet identified [7,8], but several factors have been proposed to explain this citypsychosis nexus, which can be classified into 'physical urban' and 'social urban factors' [9]. 'Physical urban factors' include urban design, pollution or lack of green spaces, while 'social urban factors' include cannabis exposure, migration, neighborhood deprivation and social capital, ethnic density and social defeat [8,9], all these factors acting and interacting at different scales and points in time [8,10]. To better understand the mechanisms at stake, we have proposed elsewhere that a change in perspective is needed, moving to a first person perspective and to an in situ experience-based approach [11].…”

Cenas públicas de uso de drogas e a produção do risco em cidades latino-americanas: consumo do espaço e efeitos sociais - aproximações entre São Paulo, Bogotá e Medellín

“…Abrahamyan Empson e colaboradores confirmam a consistência de diversos estudos que apontam como o ambiente urbano pode desempenhar papel significativo no funcionamento de nossos corpos e mentes, desde a insuficiência em vitamina D até profundas diferenças subjetivas, assim como facilitar o disparo de variados sofrimentos psíquicos (Abrahamyan Empson et al, 2019;Golembiewski, 2016). Segundo as autoras:…”