Why Is Schizophrenia More Common In Urban Areas

Looking After Your Physical Health

Schizophrenia takes a toll on your physical health as well as your mental health. It can sap your energy, confidence and motivation you might feel less capable of keeping up your physical health or lose the desire to try.

Another major influence on your physical health is the side-effects of antipsychotic medication. Newer antipsychotic medications have fewer side-effects, but weight gain is still a common one.

People being treated for schizophrenia are much more likely than the general population to be overweight, have high blood pressure and develop diabetes.

Theyre also more likely to smoke, drink too much and use recreational drugs, which can have a negative effect on your mental and physical health.

If youre struggling with these problems, you may hear your doctor use the term metabolic syndrome. It means you have some combination of:

• weight gain around the abdomen
• high blood pressure
• low levels of the good cholesterol
• high blood glucose levels.

Metabolic syndrome is common in people with a sedentary lifestyle and unhealthy diet, but its especially common in people with schizophrenia.

There is support to help you get healthy and stay healthy.

Urban Neighbourhoods With High Deprivation Population Density And Inequality Found To Have Higher Rates Of Schizophrenia

Our data seems to suggest that both absolute and relative levels of deprivation predict the incidence of schizophrenia.

James Kirkbride

Higher rates of schizophrenia in urban areas can be attributed to increased deprivation, increased population density and an increase in inequality within a neighbourhood, new research reveals. The research, led by the University of Cambridge in collaboration with Queen Mary University of London, was published today in the journal Schizophrenia Bulletin.

Dr James Kirkbride, lead author of the study from the University of Cambridge, said: Although we already know that schizophrenia tends to be elevated in more urban communities, it was unclear why. Our research suggests that more densely populated, more deprived and less equal communities experience higher rates of schizophrenia and other similar disorders. This is important because other research has shown that many health and social outcomes also tend to be optimal when societies are more equal.

The scientists used data from a large population-based incidence study conducted in three neighbouring inner city, ethnically diverse boroughs in East London: City & Hackney, Newham, and Tower Hamlets.

The incidence of schizophrenia still showed variation between neighbourhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia increased deprivation increased population density, and an increase in inequality .

Help For Family & Friends

The family and friends of someone with schizophrenia need care and support too its okay to set boundaries for the care you can give, and to prioritise your own physical and mental health.

There are many other people out there who share your experience, and many services designed to help carers of people with mental health issues. Here are a few places to find support:

SANE factsheets provide brief, introductory information about mental health. For more in-depth information, read SANEs Schizophrenia guide.

This SANE factsheet is currently being reviewed by industry professionals and people with lived experience

Schizophrenia impacts a person’s thoughts, perceptions, emotions, and behaviour. It can cause periods where people lose touch with reality. Other changes such as reduced motivation, flattened emotional expression, and problems processing information can also occur.

With treatment and support people can and do live fulfilling lives.

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The Mystery Of Urban Psychosis

Why are paranoia and schizophrenia more common in cities?

Southwyck House in South London is a block of flats so intimidating that it is often mistaken for a prison. Locally known as the Brixton barrier block, it has a stark exterior of brick and concrete that literally looms over you, giving the impression that unseen people are staring down through the sparse rectangular windows.

It was built as a social housing project, designed to shield its residents from the noise of a phantom motorway that was intended to run from Blackheath to Battersea. The road was never built due to petty political squabbles, but the building now stands as a seven-story barricade against its illusory traffic.

If youre not used to the built-up environment of the inner city, the block can certainly feel unsettling. But here, urban alienation may run deeper than mere architecture. The area was found to have the highest rate of diagnosed schizophrenia in a large study of South London, even when compared with directly adjacent neighborhoods.

The research that found this striking variation was led by epidemiologist James Kirkbride, now at University College London. Kirkbrides work is but one in more than a century of studies that have found higher rates of psychosis in cities and which have sparked an intense debate over whetherto put it in its original terms cities cause madness or whether those affected by madness just tend to end up in cities.

Interpreting The Facts And Figures

Challenges in making associations between urban living and mental healthConfounding factors

• Pre-existing risk factors: People move to the city, in search of better services, economic and social opportunities, and distance from past negative experiences. This may be driven by poverty, unemployment, physical and mental health problems, previous trauma, personal crises, family break up, addiction, and immigration. These are all individual risk factors for experiencing mental health problems.
• Socioeconomic factors: People with pre-existing risk factors, particularly low socioeconomic status, may encounter negative disparities in the city. For example, this can involve physical and psychological segregation into neighbourhoods characterised by poverty and social challenges, engendering feelings of injustice and hopelessness, and experiences of prejudice and discrimination that may affect mental health.
• Reporting bias: Urban areas may be more likely to collect more detailed data on mental health compared to rural areas, for example because they are home to more universities or provide more services.

Challenges in measurementDefining the urban environmentMeasuring mental healthHappiness and its confoundersThis information was developed by Layla McCay, Centre for Urban Design and Mental Health, and Todd Litman, Victoria Transport Policy Institute. For further information on these facts and figures, please refer to the Victoria Transport Policy Institute Report, Urban Sanity.

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What Resources Are Available For Suicide Prevention Efforts

The U.S. Department of Health and Human Services considers suicide a significant public health problem and is involved in prevention activities. Several federal agencies collaborate and direct necessary prevention resources, services, and programs that are both public and private. Federal resources on suicide prevention include:

• Suicide Prevention, Centers for Disease Control and Prevention

• Contact by email for information and resources 800.273.8255

Economic Valuations Of Mental Costs

Mental disorder costs go far beyond the direct costs their economic costs assessment for the society as a whole should monetarily translate also the following indirect factors: increased chance of leaving school early, lower likelihood of achieving good and full-time employment, reduced quality of life for the individual and her loved ones. The monetary quantification of indirect costs on health usually follows the human capital method which measures the personal direct costs plus the amount of discounted earnings from lost productivity due to several reasons such as those listed above .

Early commencement mental disorders result to be statistically significantly associated with the interruption of secondary education , which in turn means less likelihood to be employed in higher skilled professions .

As expected, psychiatric disorders between the ages of 18 and 25, after controlling for confounding variables, was statistically significantly negatively linked with workforce participation, income and economic living standards at age 30, and, more generally, cumulative episodes of psychiatric disorders negatively affect life outcomes .

The 2018 OECD report estimates as more than 4% of GDP the costs due to mental illness across Europe , while Gustavsson et al. estimated it to be around 800 billion for the 2010, including Norway, Iceland and Switzerland to the 28 European countries.

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Study Population And Information Sources

Our follow-up study investigated the entire Swedish population, in total 4.4 million women and men aged 2564 years on 31 December 1996. The individuals were followed from 1 January 1997 to 31 December 1999, until first admission to hospital for treatment of psychosis or depression, death from any cause, emigration from Sweden, or until the end of the study. A total of 35 727 individuals with previous hospital admissions for psychosis or depression during 19921996 were excluded. Information on demographic and socioeconomic characteristics was obtained from a national database holding annual individual data for the whole Swedish adult population. Personal identification numbers were used to link these data to the Swedish Hospital Discharge Register at the National Board of Health and Welfare. All individuals had been previously geocoded to their area of residence or small-area market statistics level, which allowed us to include the level of urbanisation in the study. The whole of Sweden is divided into 9667 SAMS areas. The average population in each SAMS area is approximately 2000 persons for Stockholm and 1000 persons for the rest of Sweden. A total of 135 719 individuals were excluded from the study because of missing SAMS codes and/or other explanatory variables, or because they lived in SAMS areas with fewer than 50 individuals such areas were excluded from the study because of unstable statistical estimates. The analysis eventually included 8135 SAMS areas.

Does City Life Pose A Risk To Mental Health

Recent studies shed light on the link between urban living and psychosis

Life in the city can be taxing. City dwellers often face higher rates of crime, pollution, social isolation and other environmental stressors than those living in rural areas. For years studies have consistently linked the risk of developing schizophrenia to urban environmentsbut researchers are only beginning to understand why this association exists. Addressing the link is increasingly urgent: According to a recent U.N. report, the proportion of people living in cities will rise from 54 percent of the worlds population in 2014 to 66 percent by 2050.

Researchers first suggested in the 1930s that urban living might increase schizophrenia risk. Since then many large epidemiological studies have reported an association between the two, primarily in European countries such as Sweden and Denmark. Converging evidence has revealed that growing up in the city doubles the risk of developing psychosis later in life. Studies have also begun to find that urban environments may heighten the risk of other mental health issues such as depression and anxiety.

A number of factors, including elements of the social environment and physical stressors could explain how the city erodes well-being. Conversely, people predisposed to mental illness may simply be more likely to move into urban environments. Two studies published this month shed new light on these effects and suggest both scenarios could be involved.

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How This Fits In

Earlier studies have reported an increased incidence of schizophrenia in African-Caribbeans living in the UK, but methodological difficulties have influenced the interpretation of these findings. In the most robust UK study to date, the incidence of schizophrenia was found to be ninefold higher in black Caribbeans than in the white British population. The contributory risk factors appear to be a combination of social and psychological factors, which result in particular vulnerability to the development of schizophrenia. Increased awareness of these factors in the black Caribbean community may contribute to early diagnosis and rapid access to appropriate treatment, which in turn are likely to translate into improved long-term outcomes

The computerised search strategy was restricted to publications in the English language from 1987 to 2007. A total of 604 unique references were identified. Titles and abstracts were screened to discard irrelevant papers, and reference lists from non-discarded papers were checked for additional sources. A total of 231 relevant references were collated. Selected references are cited here the full list of references is available from the authors.

Planning For The Future

Relapse prevention plan

A relapse is when, after you recover from an episode of psychosis, your symptoms return and you experience another episode.

A relapse prevention plan is a powerful tool for staying well and avoiding a worsening of your mental health issue. Making a plan involves:

• identifying your triggers: what events or situations could set your symptoms off?
• identifying your warning signs: what changes in your thinking, emotions and behaviour signal the early signs of psychosis?
• planning responses: what will you do to cope or seek help when you experience triggers & warning signs?
• listing support people: who will you call when you experience triggers & warning signs?

Having a relapse prevention can make you and the people who care for you feel more secure, even if you never have to use it.

You can read more about relapse prevention plans at Orygen and Here to Help.

Advance care directives

Because of the way schizophrenia affects thinking, feeling and behaviour, if your symptoms worsen at some time in the future, you may not be able to make good decisions about your care. It can also be hard for the people around you to know whats best for you when the situation is intense and confusing.

An advance care directive is your instructions for what you want to happen if you cant make your own choices, and who you authorise to make decisions for you.

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Study Finds More Psychotic Symptoms Among Children Living In Cities

Lower social cohesion among neighbors and higher crime rates contribute to higher rates of psychotic symptoms among urban children, a new study from researchers at Duke University and Kings College London finds.

Previous research has also identified higher rates of psychotic symptoms among children in cities. The new study, available online this week in Schizophrenia Bulletin, is the first to examine why.

Psychotic symptoms include paranoid thoughts, hearing or seeing things that others do not, and believing others can read ones mind. Psychotic experiences in childhood are associated with schizophrenia and other psychiatric disorders in adulthood.

We wanted to understand how the communities children live in are affecting them, said Candice Odgers, an associate professor of psychology and public policy at Duke and senior associate director at the universitys Center for Child and Family Policy. This study helps us identify specific features of neighborhoods that may be especially toxic for childrens mental health.

While a small minority of children overall experience persistent psychotic symptoms and eventual clinical diagnosis, those numbers are higher in cities. In fact, many studies have found a two-fold increase for psychosis in adults and children raised in urban areas, which is concerning given that more than two-thirds of the worlds population is expected to live in cities by 2050, according to United Nations reports.

Urbanicity And Psychosis Risk

Urbanicity, symptoms and hospitalization

Across different European sites, urban living was associated with higher general, negative, disorganized, and manic symptoms in FEP. Interestingly, urbanicity was associated with higher positive and negative symptoms in the United Kingdom and lower positive and negative symptoms in Spain. No such associations were present in the Netherlands, France or Italy . On the Italian island of Sardinia, lower hospitalization rates for schizophrenia and other psychiatric disorders have been found for individuals from towns with more than 10,000 residents than for individuals from smaller municipalities .

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How Common Is Schizophrenia

Schizophrenia affects roughly 20 million people worldwide.

Schizophrenia is diagnosed about twice as often in men than women. Its also more common in urban than rural areas.

Symptoms of schizophrenia usually emerge between the late teens and mid-30s, most often becoming evident in the early-to-mid 20s for men and late 20s for women. It is much less common for schizophrenia to be diagnosed in childhood. Adults diagnosed with schizophrenia have often experienced other emotional or behavioural disturbances during childhood.

Other Medication You Might Need To Take

If you experience psychosis, you may experience other mental health issues, like depression, mania, anxiety, and the negative symptoms of schizophrenia.

So you may be prescribed anti-anxiety medications, anti-depressants or mood stabilisers along with your antipsychotics. This is relatively common the medications are often used together.

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How Can Our School Take Action To Prevent Suicides

According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death among youth in America. Rural schools can play an important role in preventing suicide among rural youth by:

• Becoming involved with your state or community’s suicide prevention coalition to learn how to coordinate your school’s efforts with state or community efforts.
• Visiting SPRC’s Customized Information pages for Teachers andSchool Mental Health Providers to learn more about how to respond to students and staff at risk for suicide.
• Implementing a school-based suicide prevention program, which includes a comprehensive set of interventions, such as:
• Gatekeeper training

To review guidelines for school-based suicide prevention programs, please refer to the University of South Florida’s Youth Suicide Prevention School-Based Guide. The guide also includes tips on responding following a suicide or suicide attempt in the school community. For more information on any of the items listed above, please visit the SPRC Online Library or contact one of the SPRC Prevention Specialists.

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