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- Title
Multidimensional Approach to Exploring Neighborhood Determinants and Symptom Severity Among Individuals With Psychosis.
- Authors
Oluwoye, Oladunni; Puzia, Megan; Lissau, Ari; Amram, Ofer; Weeks, Douglas L.
- Abstract
Importance: The impact of cumulative exposure to neighborhood factors on psychosis, depression, and anxiety symptom severity prior to specialized services for psychosis is unknown. Objective: 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. Exposures: 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. Main Outcomes and Measures: Outcomes were Community Assessment of Psychic Experiences 15-item, Patient Health Questionnaire 9-item, and Generalized Anxiety Disorder 7-item scale. Results: 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. Conclusions and Relevance: 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. Key Points: Question: Is the cumulative exposure to neighborhood-level socioeconomic and environmental factors among individuals with first-episode psychosis associated with psychosis, depression, and anxiety symptom severity at intake? Findings: In this cohort study with a sample of 225 participants with first-episode psychosis, with approximately half of individuals residing in urban high-risk neighborhoods, residents of urban high-risk neighborhoods had more severe symptom severity at intake than individuals residing in rural neighborhoods. Meaning: These results suggest that the combination of various intersecting neighborhood factors are associated with symptom severity prior to the initiation of coordinated specialty care. This cohort study of US adolescents and adults who experienced first-episode psychosis examines associations of neighborhood-level socioeconomic and environmental factors with symptom severity.
- Subjects
UNITED States; RISK assessment; STATISTICAL correlation; ECOLOGY; RESEARCH funding; SOCIAL determinants of health; HEALTH status indicators; RECREATION; INCOME; SOCIAL factors; QUESTIONNAIRES; MEDICAL care; SEX distribution; SEVERITY of illness index; ANXIETY; DESCRIPTIVE statistics; POPULATION geography; AGE distribution; LONGITUDINAL method; TRANSPORTATION; WALKING; RACE; ECONOMIC impact; ENVIRONMENTAL exposure; RESEARCH; PSYCHOSES; HOUSING stability; GROCERY industry; SOCIODEMOGRAPHIC factors; PSYCHOLOGICAL tests; COMPARATIVE studies; DATA analysis software; NEIGHBORHOOD characteristics; MENTAL depression; URBANIZATION; EDUCATIONAL attainment; EVALUATION
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2410269
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.10269