title: Psychosis and place.
abstract: One important line of epidemiologic inquiry implicating social context in the etiology of psychosis is the examination of spatial variation in the distribution of psychotic illness. The authors conducted a systematic review of evidence from urbanicity and neighborhood studies regarding spatial variation in the incidence of psychosis in developed countries since 1950. A total of 44 studies (20 of urbanicity and 24 of neighborhood) were culled from three databases with similar time frames: Medline (1950-2007), PsychInfo (1950-2007), and Sociological Abstracts (1952-2007). With a special emphasis on social factors potentially relevant to etiology, the authors elucidated contributions, limitations, and issues related to study design, measurement, and theory. Evidence from both arenas supports a possible etiologic role for social context. Studies of urbanicity indicate that early-life exposure may be important; dose-response relations, spatial patterning of schizophrenia, and interactions with other factors may exist. Neighborhood studies indicate heterogeneity in rates, hint at spatial patterning of schizophrenia, and offer intriguing evidence implying more proximal social (as opposed to physical) exposures. The authors encourage the exploration of social pathways engaging theory, methodological advances, and the life-course perspective. They also propose a conceptual shift from studies of spatial variation in outcomes to research addressing the etiologic effect of exposures shaped by place as a reservoir of risk or resilience.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA. dm2025@columbia.edu
authors.forename: Dana
authors.initials: D
authors.lastname: March
authors.forename: Stephani L
authors.initials: SL
authors.lastname: Hatch
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.forename: James B
authors.initials: JB
authors.lastname: Kirkbride
authors.forename: Michaeline
authors.initials: M
authors.lastname: Bresnahan
authors.forename: Paul
authors.initials: P
authors.lastname: Fearon
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
mesh_terms: D006801:Humans; D011618:Psychotic Disorders / Q000453:epidemiology*; D012111:Residence Characteristics; D012307:Risk Factors; D014505:Urban Population