Ku Benson S, Compton Michael T, Walker Elaine F, Druss Benjamin G
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
Corresponding author: Benson S. Ku, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE #300, Atlanta, GA 30329 (
J Clin Psychiatry. 2021 Dec 7;83(1):21r13941. doi: 10.4088/JCP.21r13941.
Accumulating evidence implicates social context in the etiology of psychosis. One important line of epidemiologic research pointing to a potentially causal role of social context pertains to what is termed . The authors conducted a systematic review of the relationship between area-level social fragmentation and psychosis. Three databases (MEDLINE, PsycINFO, and Web of Science) were searched from inception to May 2, 2021. There were no language restrictions. Search terms were those that identify the area-level orientation, social fragmentation, sample, and outcome. Inclusion criteria were the following: (1) social environment measured at the area level with (2) psychosis outcomes (incidence rates, prevalence of psychosis or schizophrenia, age at onset of psychosis, psychotic symptom severity, and duration of untreated psychosis). In total, 579 research articles were identified, and 19 were eligible to be included in this systematic review. Two reviewers independently screened, extracted data from, and coded all articles. Evidence from 14 of 19 articles indicates that area-level characteristics reflecting social fragmentation are associated with higher psychosis rates and other outcomes of psychosis even after controlling for other area-level characteristics including deprivation, social capital, race/ethnicity, and urbanicity and individual-level characteristics including age, sex, migrant status, and socioeconomic status. In conclusion, this review finds evidence that measures of area-level social fragmentation are associated with higher psychosis rates. Further research into mechanisms is needed to better characterize this association.
越来越多的证据表明社会环境与精神病的病因有关。流行病学研究的一个重要方向指出社会环境可能具有因果作用，这与所谓的……有关。作者对地区层面的社会碎片化与精神病之间的关系进行了系统综述。检索了三个数据库（MEDLINE、PsycINFO和Web of Science），时间跨度从建库至2021年5月2日。没有语言限制。检索词包括用于识别地区层面导向、社会碎片化、样本和结果的词汇。纳入标准如下：（1）在地区层面测量的社会环境，以及（2）精神病结果（发病率、精神病或精神分裂症的患病率、精神病发病年龄、精神病症状严重程度以及未治疗精神病的持续时间）。总共识别出579篇研究文章，其中19篇符合纳入本系统综述的条件。两名评审员独立对所有文章进行筛选、数据提取和编码。19篇文章中有14篇的证据表明，即使在控制了其他地区层面特征（包括贫困、社会资本、种族/民族和城市化程度）以及个体层面特征（包括年龄、性别、移民身份和社会经济地位）之后，反映社会碎片化的地区层面特征仍与较高的精神病发病率及其他精神病结果相关。总之，本综述发现有证据表明地区层面社会碎片化的测量指标与较高的精神病发病率相关。需要进一步研究其机制，以更好地描述这种关联。
