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Open Access 01-12-2021 | Schizophrenia | Research article

Impact of urban birth and upbringing on expression of psychosis in a Chinese undergraduate population

Authors: Jeremy W. Coid, Yamin Zhang, Huan Sun, Hua Yu, Wei Wei, Xiaojing Li, Qiuyue Lv, Wanjie Tang, Qiang Wang, Wei Deng, Wanjun Guo, Liansheng Zhao, Xiaohong Ma, Yajing Meng, Mingli Li, Huiyao Wang, Ting Chen, Tao Li

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Urban birth and upbringing show consistent associations with psychotic illness but the key urban exposures remain unknown. Associations with psychotic-like experiences (PEs) are inconsistent. These could be confounded by common mental disorders associated with PEs. Furthermore, associations between PEs and urban exposures may not extrapolate to psychotic disorders such as schizophrenia.

Methods

Annual cross-sectional surveys among first year Chinese undergraduates 2014–2019 (n = 47,004). Self-reported, hierarchical categorisation of psychosis: from psychoticism, paranoid ideation, schizotypal symptoms, nuclear syndrome using SCL-90-R, to clinical diagnosis of schizophrenia. Depressive symptoms using PHQ 9. Dissociative symptoms and posttraumatic stress disorder (PTSD) measured using PCL-C. Etiological factors of family history and childhood disadvantage. We studied effects of urban birth, urban living and critical times of exposure in childhood on psychosis phenotypes.

Results

Associations with urbanicity were found only after adjustments for depression. Urban birth was associated with paranoia (AOR 1.34, 1.18–1.53), schizotypal symptoms (AOR 1.59, 1.29–1.96), and schizophrenia (AOR 2.07, 1.10–3.87). The same phenotypes showed associations with urban residence > 10 years. Only schizophrenia showed an association with urban exposure birth-3 years (AOR 7.01, 1.90–25.86). Child maltreatment was associated with both psychosis and depression. Urbanicity measured across the total sample did not show any associations with demography, family history of psychosis, or child maltreatment. Sensitivity analysis additionally adjusting for dissociative symptoms and PTSD showed the same pattern of findings.

Conclusions

Urban birth and urban living showed a hierarchical pattern of increasing associations from paranoid ideation to schizotypal disorder to schizophrenia, confirming that associations for psychotic experiences could be extrapolated to schizophrenia, but only after adjusting for confounding from depression, dissociative symptoms and PTSD. Several etiological factors were the same for psychosis and depression. Future studies of PEs should adjust for confounding from common mental disorders and dissociative symptoms. Effects of urbanicity on psychosis were not explained by demography, family history of mental disorder, or child maltreatment.

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Title: Impact of urban birth and upbringing on expression of psychosis in a Chinese undergraduate population
Authors: Jeremy W. Coid
Yamin Zhang
Huan Sun
Hua Yu
Wei Wei
Xiaojing Li
Qiuyue Lv
Wanjie Tang
Qiang Wang
Wei Deng
Wanjun Guo
Liansheng Zhao
Xiaohong Ma
Yajing Meng
Mingli Li
Huiyao Wang
Ting Chen
Tao Li
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Schizophrenia
Mood Disorders
Affective Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03475-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of urban birth and upbringing on expression of psychosis in a Chinese undergraduate population

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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