title: Social and spatial heterogeneity in psychosis proneness in a multilevel case-prodrome-control study.
abstract: OBJECTIVE
  To test whether spatial and social neighbourhood patterning of people at ultra-high risk (UHR) of psychosis differs from first-episode psychosis (FEP) participants or controls and to determine whether exposure to different social environments is evident before disorder onset.
  
  
  METHODS
  We tested differences in the spatial distributions of representative samples of FEP, UHR and control participants and fitted two-level multinomial logistic regression models, adjusted for individual-level covariates, to examine group differences in neighbourhood-level characteristics.
  
  
  RESULTS
  The spatial distribution of controls (n = 41) differed from UHR (n = 48; P = 0.04) and FEP participants (n = 159; P = 0.01), whose distribution was similar (P = 0.17). Risk in FEP and UHR groups was associated with the same neighbourhood-level exposures: proportion of single-parent households [FEP adjusted odds ratio (aOR): 1.56 95% CI: 1.00-2.45; UHR aOR: 1.59; 95% CI: 0.99-2.57], ethnic diversity (FEP aOR: 1.27; 95% CI: 1.02-1.58; UHR aOR: 1.28; 95% CI: 1.00-1.63) and multiple deprivation (FEP aOR: 0.88; 95% CI: 0.78-1.00; UHR aOR: 0.86; 95% CI: 0.76-0.99).
  
  
  CONCLUSIONS
  Similar neighbourhood-level exposures predicted UHR and FEP risk, whose residential patterning was closer to each other's than controls. Adverse social environments are associated with psychosis before FEP onset.
authors.affiliation: Division of Psychiatry, UCL, London, UK.|Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: J B
authors.identifier: http://orcid.org/0000-0003-3401-0824
authors.initials: JB
authors.lastname: Kirkbride
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: J
authors.initials: J
authors.lastname: Stochl
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.|Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: J
authors.initials: J
authors.lastname: Zimbrón
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.|Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Crane
authors.affiliation: Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: A
authors.initials: A
authors.lastname: Metastasio
authors.affiliation: Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: E
authors.initials: E
authors.lastname: Aguilar
authors.affiliation: Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: R
authors.initials: R
authors.lastname: Webster
authors.affiliation: Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Theegala
authors.affiliation: Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kabacs
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.|Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: J
authors.initials: J
authors.lastname: Perez
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology*; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: epidemiology; population spatial distribution; prodromal symptoms; psychotic disorders; social environment