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Multilevel investigation of the role of urbanicity in psychotic phenomena during childhood and adolescence

Student thesis: Doctoral ThesisDoctor of Philosophy

City-living is one of the most consistently identified factors associated with psychosis. Individuals who are born and raised in urban (versus rural) settings have around a two-fold adulthood risk for psychotic disorder. However, very little is currently known about the potential role of the urban environment in subclinical psychotic phenomena among children and adolescents. These symptoms, such as auditory hallucinations and delusions, are thought to lie on a phenotypic and aetiological continuum with psychotic disorders, and therefore constitute a prime target for early-intervention as well as a useful paradigm to investigate the pathogenesis of psychosis. This thesis comprises three studies investigating the potential neighbourhood- and individual-level pathways linking urban upbringing to early psychotic phenomena during childhood and adolescence. Analyses use data from the Environmental-Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 twin children born in 1994 and 1995. The first study explores the association between urban upbringing and childhood psychotic symptoms, and tests the extent that adverse neighbourhood social conditions such as low levels of social cohesion and high levels of crime and disorder mediate the association between urban upbringing and childhood psychotic symptoms. The second study investigates the cumulative association of neighbourhood social adversity and personal crime victimisation with adolescent psychotic experiences. The third study uses longitudinal and genetically informed methods to explore the association between personal perceptions of neighbourhood adversity and adolescent psychotic experiences. In each study, psychotic phenomena are shown to be significantly more common among children and adolescents raised in urban settings. Analyses highlight several potential pathways linking the urban environment to the emergence of early psychotic phenomena, including adverse neighbourhood social conditions, direct victimisation by violent crime during adolescence, and adolescents’ personal perceptions of threatening neighbourhood conditions. The findings in this thesis suggest that wider environmental factors should be explored as targets in future preventative intervention efforts for early psychotic phenomena.
Original languageEnglish
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Award date2018

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