MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC.
Schizophr Bull. 2018 Feb 15;44(2):348-358. doi: 10.1093/schbul/sbx060.
Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences.
Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins who were interviewed about adolescent psychotic experiences at age 18. Urbanicity, neighborhood characteristics, and personal victimization by violent crime were measured during childhood and adolescence via geocoded census data, surveys of over 5000 immediate neighbors of the E-Risk participants, and interviews with participants themselves.
Adolescents raised in urban vs rural neighborhoods were significantly more likely to have psychotic experiences (OR = 1.67, 95% CI = 1.21-2.30, P = .002). This association remained significant after considering potential confounders including family socioeconomic status, family psychiatric history, and adolescent substance problems (OR = 1.43, 95% CI = 1.01-2.03, P = .042), but became nonsignificant after considering adverse social conditions in urban neighborhoods such as low social cohesion and high neighborhood disorder (OR = 1.35, 95% CI = 0.94-1.92, P = .102). The combined association of adverse neighborhood social conditions and personal crime victimization with adolescent psychotic experiences (adjusted OR = 4.86, 95% CI = 3.28-7.20, P < .001) was substantially greater than for either exposure alone, highlighting a potential interaction between neighborhood conditions and crime victimization (interaction contrast ratio = 1.81, 95% CI = -0.03 to 3.65) that was significant at the P = .054 level.
Cumulative effects of adverse neighborhood social conditions and personal victimization by violent crime during upbringing partly explain why adolescents in urban settings are more likely to report psychotic experiences. Early intervention efforts for psychosis could be targeted towards victimized youth living in urban and socially adverse neighborhoods.
对于城市化、不良邻里环境和暴力犯罪受害对青少年出现精神病体验的影响，人们知之甚少。
参与者来自环境风险（E-Risk）纵向双胞胎研究，这是一项具有全国代表性的 2232 名英国双胞胎队列研究，他们在 18 岁时接受了关于青少年精神病体验的访谈。城市化程度、邻里特征以及个人遭受暴力犯罪的受害情况，通过经地理编码的人口普查数据、对 E-Risk 参与者的 5000 多名近邻的调查以及对参与者本人的访谈进行测量。
在城市和农村社区长大的青少年出现精神病体验的可能性显著更高（OR = 1.67，95%CI = 1.21-2.30，P =.002）。在考虑了包括家庭社会经济地位、家庭精神病史和青少年物质问题在内的潜在混杂因素后，这种关联仍然显著（OR = 1.43，95%CI = 1.01-2.03，P =.042），但在考虑了城市社区中不良的社会条件（如低社会凝聚力和高邻里混乱）后，这种关联变得不显著（OR = 1.35，95%CI = 0.94-1.92，P =.102）。不良邻里社会条件和个人犯罪受害与青少年精神病体验的综合关联（调整后的 OR = 4.86，95%CI = 3.28-7.20，P <.001）明显大于任何单一因素的关联，突出了邻里条件和犯罪受害之间的潜在相互作用（交互对比比 = 1.81，95%CI = -0.03 至 3.65），在 P =.054 水平上具有统计学意义。
成长过程中不良邻里社会条件和个人遭受暴力犯罪受害的累积效应，部分解释了为什么城市环境中的青少年更有可能报告精神病体验。针对受暴力犯罪受害的青少年开展精神病早期干预工作，可以将目标人群定位在居住在城市和社会环境不利的邻里中的青少年。
