Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study

Giuseppe D'Andrea; Diego Quattrone; Giada Tripoli; Edoardo Spinazzola; Charlotte Gayer-Anderson; Hannah E Jongsma; Lucia Sideli; Simona A Stilo; Caterina La Cascia; Laura Ferraro; Daniele La Barbera; Andrea Tortelli; Eva Velthorst; Lieuwe de Haan; Pierre-Michel Llorca; Jose Luis Santos; Manuel Arrojo; Julio Bobes; Julio Sanjuán; Miguel Bernardo; Celso Arango; James B Kirkbride; Peter B Jones; Bart P Rutten; Franck Schürhoff; Andrei Szöke; Jim van Os; Evangelos Vassos; Jean-Paul Selten; Craig Morgan; Marta Di Forti; Ilaria Tarricone; Robin M Murray

doi:10.1111/acps.13767

Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study

Acta Psychiatr Scand. 2024 Nov 1. doi: 10.1111/acps.13767. Online ahead of print.

Authors

Giuseppe D'Andrea^{1

2}, Diego Quattrone³, Giada Tripoli^{4

5

6}, Edoardo Spinazzola⁴, Charlotte Gayer-Anderson⁷, Hannah E Jongsma^{8

9}, Lucia Sideli¹⁰, Simona A Stilo^{4

11}, Caterina La Cascia⁵, Laura Ferraro⁵, Daniele La Barbera⁵, Andrea Tortelli¹², Eva Velthorst¹³, Lieuwe de Haan¹⁴, Pierre-Michel Llorca¹⁵, Jose Luis Santos¹⁶, Manuel Arrojo¹⁷, Julio Bobes¹⁸, Julio Sanjuán¹⁹, Miguel Bernardo²⁰, Celso Arango²¹, James B Kirkbride²², Peter B Jones²³, Bart P Rutten²⁴, Franck Schürhoff²⁵, Andrei Szöke²⁵, Jim van Os^{4

26}, Evangelos Vassos⁴, Jean-Paul Selten²⁶, Craig Morgan⁷, Marta Di Forti³, Ilaria Tarricone^{27

28}, Robin M Murray⁴

Affiliations

¹ University of Montréal Hospital Reseach Centre (CRCHUM), Montréal, Québec, Canada.
² Prevention and Early Intervention Program for Psychosis (PEPP)-Montréal, Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.
³ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁵ Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy.
⁶ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
⁷ ESRC Center for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
⁸ Centre for Transcultural Psychiatry 'Veldzicht', Balkbrug, Netherlands.
⁹ University Centre for Psychiatry, University Medical Centre Groningen, Groningen, Netherlands.
¹⁰ Department of Human Science, LUMSA University, Rome, Italy.
¹¹ Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy.
¹² Etablissement Public de Santé Maison Blanche, Paris, France.
¹³ Department of Research, Community Mental Health Service, GGZ Noord-Holland-Noord, Netherlands.
¹⁴ Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.
¹⁵ Université Clermont Auvergne, Clermont-Ferrand, France.
¹⁶ Department of Psychiatry, Servicio de Psiquiatría Hospital "Virgen de la Luz", Cuenca, Spain.
¹⁷ Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain.
¹⁸ Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, Ineuropa, CIBERSAM, Oviedo, Spain.
¹⁹ Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain.
²⁰ Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain.
²¹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
²² PsyLife Group, Division of Psychiatry, UCL, London, England, UK.
²³ Department of Psychiatry, University of Cambridge, Cambridge, England, UK.
²⁴ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands.
²⁵ Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, France.
²⁶ School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands.
²⁷ Department of Medical and Surgical Sciences (DIMEC), Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy.
²⁸ Department of Mental Health and Pathological Addiction, Bologna, Italy.

PMID: 39483050
DOI: 10.1111/acps.13767

Abstract

Background: Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.

Methods: We recruited 1080 individuals representative of the populations aged 18-64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.

Results: Population density was associated with schizotypy (β = 0.248,95%CI = 0.122-0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ² = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362-0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083-0.297;p = 0.001).

Conclusions: The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.

Keywords: population density; psychosis spectrum; schizotypy; urban design; urbanicity.

Grants and funding

Seventh Framework Programme