Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane.
Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane.
JAMA Netw Open. 2024 May 1;7(5):e2410269. doi: 10.1001/jamanetworkopen.2024.10269.
The impact of cumulative exposure to neighborhood factors on psychosis, depression, and anxiety symptom severity prior to specialized services for psychosis is unknown.
To identify latent neighborhood profiles based on unique combinations of social, economic, and environmental factors, and validate profiles by examining differences in symptom severity among individuals with first episode psychosis (FEP).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used neighborhood demographic data and health outcome data for US individuals with FEP receiving services between January 2017 and August 2022. Eligible participants were between ages 14 and 40 years and enrolled in a state-level coordinated specialty care network. A 2-step approach was used to characterize neighborhood profiles using census-tract data and link profiles to mental health outcomes. Data were analyzed March 2023 through October 2023.
Economic and social determinants of health; housing conditions; land use; urbanization; walkability; access to transportation, outdoor space, groceries, and health care; health outcomes; and environmental exposure.
Outcomes were Community Assessment of Psychic Experiences 15-item, Patient Health Questionnaire 9-item, and Generalized Anxiety Disorder 7-item scale.
The total sample included 225 individuals aged 14 to 36 years (mean [SD] age, 20.7 [4.0] years; 152 men [69.1%]; 9 American Indian or Alaska Native [4.2%], 13 Asian or Pacific Islander [6.0%], 19 Black [8.9%], 118 White [55.1%]; 55 Hispanic ethnicity [26.2%]). Of the 3 distinct profiles identified, nearly half of participants (112 residents [49.8%]) lived in urban high-risk neighborhoods, 56 (24.9%) in urban low-risk neighborhoods, and 57 (25.3%) in rural neighborhoods. After controlling for individual characteristics, compared with individuals residing in rural neighborhoods, individuals residing in urban high-risk (mean estimate [SE], 0.17 [0.07]; P = .01) and urban low-risk neighborhoods (mean estimate [SE], 0.25 [0.12]; P = .04) presented with more severe psychotic symptoms. Individuals in urban high-risk neighborhoods reported more severe depression (mean estimate [SE], 1.97 [0.79]; P = .01) and anxiety (mean estimate [SE], 1.12 [0.53]; P = .04) than those in rural neighborhoods.
This study found that in a cohort of individuals with FEP, baseline psychosis, depression, and anxiety symptom severity differed by distinct multidimensional neighborhood profiles that were associated with where individuals reside. Exploring the cumulative effect of neighborhood factors improves our understanding of social, economic, and environmental impacts on symptoms and psychosis risk which could potentially impact treatment outcomes.
在接受专门的精神病服务之前，累积接触邻里因素对精神病、抑郁和焦虑症状严重程度的影响尚不清楚。
根据社会、经济和环境因素的独特组合，确定潜在的邻里特征，并通过检查首发精神病（FEP）个体之间的症状严重程度差异来验证特征。
设计、地点和参与者：本队列研究使用了美国 FEP 个体的邻里人口统计数据和健康结果数据，这些个体在 2017 年 1 月至 2022 年 8 月期间接受服务。合格的参与者年龄在 14 至 40 岁之间，并参加了州级协调的专科护理网络。使用人口普查区数据采用两步法对邻里特征进行描述，并将特征与心理健康结果联系起来。数据于 2023 年 3 月至 2023 年 10 月进行分析。
健康的社会决定因素和经济决定因素；住房条件；土地利用；城市化；步行能力；交通、户外空间、食品杂货和医疗保健的获取；健康结果；以及环境暴露。
结果是 15 项社区心理体验评估、9 项患者健康问卷和 7 项广泛性焦虑症量表。
总样本包括 225 名年龄在 14 至 36 岁的个体（平均[SD]年龄，20.7[4.0]岁；152 名男性[69.1%]；9 名美国印第安人或阿拉斯加原住民[4.2%]，13 名亚洲或太平洋岛民[6.0%]，19 名黑人[8.9%]，118 名白人[55.1%]；55 名西班牙裔[26.2%]）。在确定的 3 个不同特征中，近一半的参与者（112 名居民[49.8%]）居住在城市高风险社区，56 名（24.9%）居住在城市低风险社区，57 名（25.3%）居住在农村社区。在控制个体特征后，与居住在农村社区的个体相比，居住在城市高风险（平均估计值[SE]，0.17[0.07]；P=0.01）和城市低风险（平均估计值[SE]，0.25[0.12]；P=0.04）社区的个体表现出更严重的精神病症状。居住在城市高风险社区的个体报告了更严重的抑郁（平均估计值[SE]，1.97[0.79]；P=0.01）和焦虑（平均估计值[SE]，1.12[0.53]；P=0.04）症状，比居住在农村社区的个体更严重。
本研究发现，在首发精神病队列中，基线精神病、抑郁和焦虑症状严重程度因不同的多维邻里特征而有所不同，这些特征与个体居住的位置有关。探索邻里因素的累积效应可以提高我们对社会、经济和环境对症状和精神病风险的影响的理解，这可能会影响治疗结果。
