Cities, Children, and Psychosis

June 3, 2016

Are children who grow up in cities more vulnerable to developing mental illness later in life?   A new research study by a team of British and American researchers suggests a strong link between urban living and risk of developing schizophrenia.

The study, which has recently published in the journal Schizophrenia Bulletin provides evidence that children growing up in urban settings are twice as likely to develop schizophrenia as adults than children raised in rural settings.

According to the neurodevelopmental model of schizophrenia, problems in early development, including during pregnancy, can lead to psychotic symptoms occurring during adolescence or young adulthood.

Positive psychotic symptoms, including hallucinations and delusions, are also surprisingly common in children. Even though these symptoms are usually temporary, they can suggest later problems such as substance abuse, depression, PTSD, and suicide.

In recent years, more studies than ever have found disturbing links between city-dwelling and psychosis though researchers remain divided about the cause.   While most of these studies focus on psychosis in adults, new research looking at children growing up in cities suggests that the roots of psychosis can begin much earlier in life.  Children and adolescents showing positive psychotic symptoms are also at increased risk of developing later schizophrenia.

This is why a team of researchers at Duke University in North Carolina and University College in London focused on these symptoms to explore the link between psychosis and city-dwelling.  Led by Joanne Newbury and Louise Arseneault of the Institute of Psychiatry, Psychology, and Neuroscience at King’s College in London, the researchers examined data from more than 2000 U.K.-born children to determine how urban living affected the development of psychiatric symptoms over time.

The children examined were part of the Environmental Risk (E-Risk) Longitudinal Twin Study looking at 2232 British twin children who were born in England and Wales between 1994 and 1995.  All of the twins in the study were same-sex (49 percent male) and belonged to families who received home visits conducted until he children were twelve years of age.

Along with collecting information on family income, family medical history, and overall health, participants were also asked about whether they lived in cities, suburbs, smaller towns, or rural settings.  Questionnaires were also sent to every household in the same postal code as the participating E-Risk families to verify where they were living and the quality of their neighbourhood.

All of the participating twelve-year-old children were privately interviewed about seven different psychotic symptoms.   Specific questions included, ““have other people ever read your thoughts?,” “have you ever thought you were being followed or spied on?,” and “have you ever heard voices that other people cannot hear?”

The responses to these questions were reviewed by mental health professionals to determine how many children were providing clear evidence of psychotic symptoms as well as additional mental health issues such as anxiety and depression.  Mothers of all participants were also questioned about mental health symptoms to identify whether maternal psychosis could be affecting how their children were responding.

Study results showed that 7.4 percent of children living in urban settings reported experiencing at least one psychotic symptom by the age of twelve.  For rural-dwelling children, it was only 4.4 percent.  This link between city living and psychosis held up even when other factors such as family history of mental illness, family income, and neighbourhood quality were taken into account.

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