Identifying social, environmental, and genetic mechanisms linking the urban environment to the emergence of psychotic phenomena during adolescence

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Psychotic disorders (e.g., schizophrenia) are among the leading global causes of disability, and place a huge functional and economic burden on individuals and society more broadly. Studies have shown that psychotic disorders are twice as common among adults raised in urban settings such as cities. With 70% of the world's population predicted to live in cities by 2050, this association is increasingly important to understand.My PhD explored the role of the urban environment in the onset of subclinical psychotic symptoms among children and adolescents, such as extreme paranoia and hearing voices that others cannot. These early symptoms are associated with an increased adulthood risk for psychotic disorder and other severe mental health problems such as anxiety and depression. Early psychotic symptoms are therefore a very useful target for intervention, and may inform us about early risk factors for adult mental health problems. My PhD research showed that children and teenagers raised in cities were twice as likely to have psychotic symptoms, and this was partly explained by urban neighbourhoods having less trust and support between neighbours, and more crime and problems. In an increasingly urban world, it is crucial that we uncover other pathways linking the urban environment to the onset of early subclinical psychotic symptoms. The aim of my ESRC fellowship is to investigate the combined roles of air pollution, neighbourhood social conditions, and genetic risk in the association between urban upbringing and early psychotic symptoms. Air pollution is a major problem in cities around the world, where levels regularly exceed international health guidelines. During the ESRC Postdoctoral Fellowship, I will prepare novel findings from my PhD as an academic paper, which showed that air pollution and neighbourhood crime together explained 84% of the association between urbanicity and adolescent psychotic symptoms. Psychotic symptoms are thought to arise from a combination of environmental and genetic influences. During the ESRC fellowship, I will conduct a study using geographic and genetic data to explore the urban-rural distribution of genetic risk for schizophrenia. This will highlight whether young people at higher genetic risk for schizophrenia are more likely to live in cities, which could help to target interventions with greater precision. Research spanning multiple fields is vital to uncover the complex basis of mental health problems. To support my fellowship research and facilitate my transition to an independent mental health researcher, I will receive training from geographic and genetic disciplines. During the ESRC fellowship I will learn how to create detailed measures of neighbourhood environments such as crime. I will also learn how to use genetic data to create risk scores for schizophrenia. In addition, I will meet with leading mental health, epidemiology, and genetic research groups to build collaborations for my future research proposal. For this future research, I plan to explore a wider range of factors linking the urban environment to psychosis across the lifespan, including noise pollution. Noise pollution (e.g., road traffic) is a major problem in cities, and has been linked to stress and sleep problems. However, we know very little about the potential impact of noise pollution on mental health. During the ESRC fellowship, I will apply for further funding to use larger datasets (e.g., ALSPAC and UK Biobank) to explore the roles of noise and air pollution, neighbourhood social factors, and genetic risk in the onset of psychotic symptoms and disorders across the lifespan. Findings from the ESRC fellowship research will be published in leading mental health journals and presented at international conferences. To ensure findings reach a wider audience, I will prepare press releases, and blog articles and podcasts to share via key urban policy and mental health websites, such as CityLab and The Mental Elf.