title: Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS].
abstract: BACKGROUND
  Little is known about associations between the social environment and risk for psychosis within rural settings. This study sought to investigate whether such associations exist within a rural context using a prospective dataset of unusual epidemiological completeness.
  
  
  METHODS
  Using the Cavan-Monaghan First Episode Psychosis Study database of people aged 16 years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban-rural classification across electoral divisions.
  
  
  RESULTS
  The primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR)=1.12, 95% CI (1.03-1.23)].
  
  
  CONCLUSIONS
  These findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban-rural gradient.
authors.affiliation: Department of Psychiatry, College of Medicine, University of Dammam, Saudi Arabia; Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: omersami@hotmail.com.
authors.forename: Sami
authors.initials: S
authors.lastname: Omer
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: James B
authors.initials: JB
authors.lastname: Kirkbride
authors.affiliation: Department of Geography and 3U Partnership, National University of Ireland Maynooth, Maynooth, Ireland.
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Pringle
authors.affiliation: Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; Department of Psychiatry and 3U Partnership, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Russell
authors.affiliation: DETECT Early Psychosis Service, Blackrock, Co. Dublin, Ireland.
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
authors.affiliation: Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: John L
authors.initials: JL
authors.lastname: Waddington
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012931:Social Environment; D014505:Urban Population; D055815:Young Adult
keywords: Environmental factors; First episode psychosis; Place at onset; Rurality; Social context