TY - JOUR
T1 - Association of urbanicity with psychosis in low- and middle-income countries
AU - DeVylder, Jordan E.
AU - Kelleher, Ian
AU - Lalane, Monique
AU - Oh, Hans
AU - Link, Bruce G.
AU - Koyanagi, Ai
N1 - Funding Information:
Funding/Support: This study is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the NationalR+D+Iand funded by the Instituto de Salud Carlos III–General Branch Evaluation and Promotion of Health Research and the European Regional Development Fund (Dr Koyanagi).
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/7
Y1 - 2018/7
N2 - IMPORTANCE: Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. OBJECTIVE To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS: This international population-based study used cross-sectional survey data collected as part of theWorld Health Organization (WHO)World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. EXPOSURES: Urban vs nonurban residence, determined by the WHO based on national data. MAIN OUTCOMES AND MEASURES: Psychotic experiences, assessed using theWHOComposite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. RESULTS: Among the 215 682 participants (50.8%women and 49.2%men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95%CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95%CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95%CI, 0.87-1.07), OR for low-income countries of 0.98 (95%CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95%CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95%CI, 0.73-1.16), OR for low-income countries of 0.92 (95%CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95%CI, 0.67-1.27) for psychotic disorder. CONCLUSIONS AND RELEVANCE: Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This findingmay provide better understanding of the mechanisms by which urban livingmay contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparitiesmay vary between developing and developed nations.
AB - IMPORTANCE: Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. OBJECTIVE To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS: This international population-based study used cross-sectional survey data collected as part of theWorld Health Organization (WHO)World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. EXPOSURES: Urban vs nonurban residence, determined by the WHO based on national data. MAIN OUTCOMES AND MEASURES: Psychotic experiences, assessed using theWHOComposite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. RESULTS: Among the 215 682 participants (50.8%women and 49.2%men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95%CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95%CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95%CI, 0.87-1.07), OR for low-income countries of 0.98 (95%CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95%CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95%CI, 0.73-1.16), OR for low-income countries of 0.92 (95%CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95%CI, 0.67-1.27) for psychotic disorder. CONCLUSIONS AND RELEVANCE: Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This findingmay provide better understanding of the mechanisms by which urban livingmay contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparitiesmay vary between developing and developed nations.
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U2 - 10.1001/jamapsychiatry.2018.0577
DO - 10.1001/jamapsychiatry.2018.0577
M3 - Article
C2 - 29799917
AN - SCOPUS:85049573587
SN - 2168-622X
VL - 75
SP - 678
EP - 686
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 7
ER -