Urbanicity and psychosis- are cities bad for mental health? Novel insights from UK data linkage and participant perspectives; mixed methods study

在英国，生活在城市的精神病患者比生活在农村地区的患者多，而且有大量证据表明，城市生活可能与精神病的风险较高有关。然而，其背后的原因仍然知之甚少。虽然有人认为城市生活可能与社会孤立的风险增加有关，与当地社区的其他居民“联系较少”，和/或生活在已知与精神健康状况不佳有关的贫困地区，但与此相关的证据仍然很少，特别是来自英国。英格兰公共卫生部和其他地方政府机构越来越有兴趣支持旨在使城市更有利于心理健康的政策，但支持此类政策的数据仍然很少。在这个项目中，我们将使用欧洲最大的二级心理健康提供者之一的电子健康记录，覆盖伦敦萨瑟克、兰贝斯、刘易舍姆和克罗伊登等行政区明确界定的集水区的130万居民，并与2011年英国人口普查的个人信息相关联（关于个人社会背景的丰富信息来源），以评估城市生活与精神病相关的风险。该关联数据集包括大约20，000名精神病患者，每个人与五名没有精神健康问题的人相匹配，他们将作为“对照”或比较组。该数据集将能够定量评估城市建筑环境中的预测因素（包括家庭贫困，社会隔离，家庭支持，种族/移民状况）与精神病发作，在英国以前不可能的方式。攻读博士学位的学生还将采访多达20名精神病患者，以了解他们对城市生活和心理健康问题的体验。这些访谈的信息将与健康记录的定量结果相结合，以进一步提供见解。该项目的CASE合作伙伴心理健康中心是一家主要致力于解决心理健康不平等问题的慈善机构。将与心理健康中心一道，在考虑到相关利益攸关方（例如公共卫生和慈善机构）的意见的情况下，绘制该项目与城市政策有关的领域，这将确保将调查结果转化为可采取行动的政策建议。

In the UK, more people who have psychosis live in cities than rural areas, and there is a large body of evidence suggesting that city living may be associated with a higher risk of psychosis. However, the reasons underlying this remain poorly understood. Although it has been suggested that city living may be associated with a heightened risk of social isolation, being 'less connected' to others resident in local communities, and/ or living in more deprived areas which are known to be associated with poor mental health, evidence relating to this remains scarce, particularly from the UK. Public Health England and other local government bodies are increasingly interested in supporting policies targeted at making cities more mental-health friendly, yet data to support such policy remains scarce. In this project we will use electronic health records from one of the largest secondary mental health providers in Europe, covering a catchment of 1.3 million people resident in a well-defined catchment area across the London boroughs of Southwark, Lambeth, Lewisham and Croydon, linked to individual-level information from UK census 2011 (a rich source of information on individual social contexts), to assess the risk of city living being associated with psychosis. The linked dataset comprises around 20,000 people with psychosis each matched to five people without mental health problems, who will act as a 'control' or comparison group. This dataset will enable a quantitative assessment of predictors in the urban built environment (including household poverty, social isolation, family support, ethnicity/ migration status) with the onset of psychosis, in a way that has not been previously possible in the UK. The student undertaking this PhD will also interview up to 20 people with psychosis, to understand their experiences of city living and mental health problems. The information from these interviews will be combined with the quantitative findings from the health records, to further inform insights. The CASE partners for this project, The Centre for Mental Health, is a charity with a major focus on tackling mental health inequalities. Together with the Centre for Mental Health, areas of this project relevant to urban policy will be mapped, taking into account the views of relevant stakeholders (for example public health and charities), which will ensure that findings are translated into actionable policy recommendations.