title: Socioeconomic status at birth and risk for first episode psychosis in rural Ireland: Eliminating the features of urbanicity in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS).
abstract: BACKGROUND
  There is a paucity of research on the relationship between social environment at birth and risk for psychosis in rural settings. This study examined the relationship between individual- and neighbourhood-level socioeconomic indicators proximal to the time of birth and risk for a first psychotic episode in a rural context using a prospective dataset of unusual epidemiological completeness.
  
  
  METHODS
  A matched case-control design was used. 186 cases were identified from the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS) and 679 age- and sex-matched controls from the same rural setting were identified and analysed for relationships with individual and neighbourhood-level socioeconomic indicators at the level of Electoral Divisions.
  
  
  RESULTS
  While neither the distribution nor the ordinal scale of parental social class differed between cases and controls, logistic regression revealed both parental social class III and increasing level of rurality to be associated (p≤0.05) with reduced risk for affective psychosis. There was a prominent relationship (p<0.001) between lower parental social class and older age at first presentation [mean age at first presentation for all psychoses: social class I, 22.8; social class VI, 44.3].
  
  
  CONCLUSIONS
  These findings indicate modest effects of individual- and neighbourhood-level socioeconomic indicators and risk for psychosis by place at birth within a rural environment. Thus, these factors are not confined to large urban settings and apply across the urban-rural continuum. The substantive finding in relation to age at first presentation may indicate that a gradient of socioeconomic position is influential on delay in presentation to mental health services.
authors.affiliation: Department of Psychiatry, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; Cavan-Monaghan Mental Health Service, Cavan Hospital & St. Davnet's Hospital, Monaghan, Ireland; Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: samomer@uaeu.ac.ae.
authors.forename: Sami
authors.initials: S
authors.lastname: Omer
authors.affiliation: Trinity College Dublin & St. Patrick's University Hospital, James's Street, Dublin, Ireland.
authors.forename: Martha
authors.initials: M
authors.lastname: Finnegan
authors.affiliation: Department of Geography, Centre for Health Geoinformatics and 3U Partnership, Maynooth University, Maynooth, Co., Kildare, Ireland.
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Pringle
authors.affiliation: Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kinsella
authors.affiliation: Trinity College Dublin & St. Patrick's University Hospital, James's Street, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Fearon
authors.affiliation: Cavan-Monaghan Mental Health Service, Cavan Hospital & St. Davnet's Hospital, Monaghan, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, 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 & St. Davnet's Hospital, Monaghan, Ireland; Molecular & Cellular Therapeutics and 3U Partnership, Royal College of Surgeons in Ireland, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders, Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
authors.forename: John L
authors.initials: JL
authors.lastname: Waddington
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008426:Maternal Deprivation; D008875:Middle Aged; D010290:Parents; D011618:Psychotic Disorders / Q000453:epidemiology*; D012111:Residence Characteristics; D012424:Rural Population; D012923:Social Class; D012931:Social Environment; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Case-control; Environmental factors; First episode psychosis; Rurality; Social class at birth; Social context