Urbanicity, social adversity and psychosis
Urbanicity, social adversity and psychosis
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DOI：
10.1002/wps.20056
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发表时间：
2013-10-01
期刊：
影响因子：
73.3
通讯作者：
Reininghaus, Ulrich
中科院分区：
文献类型：
--
作者：
Heinz, Andreas;Deserno, Lorenz;Reininghaus, Ulrich
近年来，人们对精神分裂症和其他精神疾病发病率的地理差异研究越来越感兴趣。在本文中，我们回顾了在精神分裂症和其他精神病的发病率变化的证据方面的地方，以及个人和地区水平的因素，说明这种变化。我们进一步回顾了不良城市环境与精神病之间的潜在机制。早期和最近的研究都有证据表明，城市化与精神分裂症和非情感性精神病的发病率增加有关。此外，已观察到这些疾病在不同社区的发病率有相当大的差异。研究结果表明，仅凭社会漂移不太可能完全解释发病率的地理差异。证据进一步表明，不利的社会环境（以人口密度、社会分裂和剥夺等区域暴露为索引）对精神病风险的影响可以通过个人层面的环境暴露（即大麻使用、社会逆境、排斥和歧视）来解释（混淆）或修正（相互作用）。在神经生物学层面上，一些研究表明，社会逆境、孤立和压力与单胺功能障碍之间存在密切联系，这与精神分裂症患者的研究结果相似。然而，迄今为止，直接评估城市压力或歧视与精神分裂症神经生物学改变之间相关性的研究尚缺乏。
In recent years, there has been increasing interest in research on geographical variation in the incidence of schizophrenia and other psychoses. In this paper, we review the evidence on variation in incidence of schizophrenia and other psychoses in terms of place, as well as the individual- and area-level factors that account for this variation. We further review findings on potential mechanisms that link adverse urban environment and psychosis. There is evidence from earlier and more recent studies that urbanicity is associated with an increased incidence of schizophrenia and non-affective psychosis. In addition, considerable variation in incidence across neighbourhoods has been observed for these disorders. Findings suggest it is unlikely that social drift alone can fully account for geographical variation in incidence. Evidence further suggests that the impact of adverse social contexts - indexed by area-level exposures such as population density, social fragmentation and deprivation - on risk of psychosis is explained (confounding) or modified (interaction) by environmental exposures at the individual level (i.e., cannabis use, social adversity, exclusion and discrimination). On a neurobiological level, several studies suggest a close link between social adversity, isolation and stress on the one hand, and monoamine dysfunction on the other, which resembles findings in schizophrenia patients. However, studies directly assessing correlations between urban stress or discrimination and neurobiological alterations in schizophrenia are lacking to date.