The Association Between Neighborhood Poverty and Hippocampal Volume Among Individuals at Clinical High-Risk for Psychosis: The Moderating Role of Social Engagement

Neighborhood ethnoracial diversity and positive psychotic symptoms among youth at high-risk and healthy comparisons

Neighborhood ethnoracial composition has been associated with schizophrenia, but mechanisms are unclear. This study investigates the moderators and mediators of the association between neighborhood ethnoracial diversity and positive symptoms among youth at clinical high-risk for psychosis (CHR-P) and healthy comparisons (HC). Data were collected as part of The North American Prodrome Longitudinal Study and included 492 youth at CHR-P and 136 HCs. Neighborhood ethnoracial diversity measures the probability that two people chosen at random will be from different ethnoracial groups. Attenuated positive symptoms were derived from the Scale of Prodromal Symptoms. Peer victimization and discriminatory experiences were constructed as latent variables. Using structural equation modeling, this study tested the relationship of these variables and included the following covariates: age, sex, neighborhood poverty, and depressive symptoms. Greater neighborhood ethnoracial diversity was associated with reduced positive symptoms among ethnoracial minorities at CHR-P (β=-3.78; 95 % CI [-6.61, -0.84]). Fewer life events of peer victimization (β=-0.13; 95 % CI [-0.24, -0.03]) leading to perceived ethnoracial discrimination (β=0.56; 95 % CI [0.45, 0.67]) mediated 15.06 % of this association. These findings deepen our understanding of the social determinants of psychosis and may help develop effective interventions to prevent psychosis, especially among ethnoracial minority youth at high risk.

How does the macroenvironment influence brain and behaviour-a review of current status and future perspectives

The environment influences brain and mental health, both detrimentally and beneficially. Existing research has emphasised the individual psychosocial 'microenvironment'. Less attention has been paid to 'macroenvironmental' challenges, including climate change, pollution, urbanicity, and socioeconomic disparity. Notably, the implications of climate and pollution on brain and mental health have only recently gained prominence. With the advent of large-scale big-data cohorts and an increasingly dense mapping of macroenvironmental parameters, we are now in a position to characterise the relation between macroenvironment, brain, and behaviour across different geographic and cultural locations globally. This review synthesises findings from recent epidemiological and neuroimaging studies, aiming to provide a comprehensive overview of the existing evidence between the macroenvironment and the structure and functions of the brain, with a particular emphasis on its implications for mental illness. We discuss putative underlying mechanisms and address the most common exposures of the macroenvironment. Finally, we identify critical areas for future research to enhance our understanding of the aetiology of mental illness and to inform effective interventions for healthier environments and mental health promotion.

Improvements in Transitional Care Among Medicaid-Insured Patients With Serious Mental Illness

BACKGROUND

The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients.

PURPOSE

To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI.

METHODS

We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis.

RESULTS

Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care.

CONCLUSIONS

Participants with and without SMI benefit equitably from Thrive.

Relations of Lifetime Perceived Stress and Basal Cortisol With Hippocampal Volume Among Healthy Adolescents and Those at Clinical High Risk for Psychosis: A Structural Equation Modeling Approach

BACKGROUND

Hippocampal volume (HV) is sensitive to environmental influences. Under normative conditions in humans, HV increases linearly into childhood and asymptotes in early adulthood. Studies of humans and nonhuman animals have provided evidence of inverse relationships between several measures of stress and HV.

METHODS

Using structural equation modeling, this study aimed to characterize the relationships of age, basal cortisol, biological sex, and lifetime perceived stress with bilateral HV in a sample of healthy adolescents and adolescents at clinical high risk for psychosis (CHR-P) (N = 571, 43% female; age range = 12-19.9 years). This sample included 469 individuals at CHR-P and 102 healthy comparison participants from the combined baseline cohorts of the second and third NAPLS (North American Prodrome Longitudinal Study).

RESULTS

A structural model that constrained the individual effects of basal cortisol and perceived stress to single path coefficients, and freely estimated the effects of age and biological sex in group models, optimized model fit and parsimony relative to other candidate models. Significant inverse relationships between basal cortisol and bilateral HV were observed in adolescents at CHR-P and healthy comparison participants. Significant sex differences in bilateral HV were also observed, with females demonstrating smaller HV than males in both groups.

CONCLUSIONS

Multigroup structural equation modeling revealed heterogeneity in the relationships of age and biological sex with basal cortisol, lifetime perceived stress, and bilateral HV in individuals at CHR-P and healthy comparison participants. Moreover, the findings support previous literature indicating that elevated basal cortisol is a nonspecific risk factor for reduced HV.

The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends

BACKGROUND

Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents.

METHODS

Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends.

RESULTS

Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted β = 0.05; 95% CI: 0.01-0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted β = -0.02; 95% CI: -0.04 to <-0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted β = 0.07; 95% CI: 0.03-0.11). However, among those with more close friends, the association was non-significant (adjusted β = 0.03; 95% CI: -0.01 to 0.07).

CONCLUSIONS

Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels.

Aspects of Area Deprivation Index in Relation to Hippocampal Volume Among Children

Importance

Area deprivation index (ADI) has been shown to be associated with reduced hippocampal volume (HV) among youths. The social environment may interact with the association between ADI and HV.

Objective

To investigate which aspects of ADI are uniquely associated with bilateral HV and whether school and family environments have moderating interactions in associations between ADI and HV.

Design, Setting, and Participants

This cross-sectional study used data from the Adolescent Brain and Cognitive Development (ABCD) study. Participants aged 9 and 10 years were recruited from 21 sites in the US between September 2016 and August 2018. Data analysis was performed between March 2023 and April 2024.

Exposures

ADI aspects were derived from participant primary home addresses provided by parents or guardians.

Main Outcomes and Measures

HV was automatically segmented from structural brain images ascertained from magnetic resonance imaging. Multiple generalized linear mixed modeling tested associations between 9 indices of ADI and bilateral HV, with family groups and recruitment sites as random effects. After stepwise backward selection, models were adjusted for individual-level covariates, including age, sex, race and ethnicity, parental education, household income, and estimated intracranial volume.

Results

This study included 10 114 participants aged 9 and 10 years (median [IQR] age, 9.92 [9.33-10.48] years; 5294 male [52.3%]; 200 Asian [2.0%], 1411 Black [14.0%], and 6655 White [65.8%]; 1959 Hispanic [19.4%]). After stepwise backward selection and adjusting for covariates, only the percentage of neighborhood-level single-parent households was associated with right HV (adjusted β per 1-SD increase in single-parent households, -0.03; 95% CI, -0.06 to -0.01; P = .01). School environment interacted with neighborhood-level single-parent households in its association with right HV (adjusted β per 1-SD increase in score, 0.02; 95% CI, 0.01 to 0.03; P = .003), such that there was an inverse association only among those at a school with the mean environment score (adjusted β per 1% increase in single-parent households, -0.03; 95% CI, -0.05 to -0.01; P = .02) and worse (-1 SD score) school environment score (adjusted β per 1% increase in single-parent households, -0.05; 95% CI, -0.09 to -0.01; P < .001) but not among those at better (+1 SD score) school environments.

Conclusions and Relevance

In this study, an increased percentage of neighborhood-level single-parent households was associated with reduced right HV among children in schools with the mean or worse but not better environment score. These findings suggest that longitudinal research concerning the association of neighborhood-level characteristics and school environments with hippocampal development may be warranted to better understand complex interactions between various social factors and child neurodevelopment and mental health outcomes.

Developmental perspectives on the origins of psychotic disorders: The need for a transdiagnostic approach

Research on serious mental disorders, particularly psychosis, has revealed highly variable symptom profiles and developmental trajectories prior to illness-onset. As Dante Cicchetti pointed out decades before the term "transdiagnostic" was widely used, the pathways to psychopathology emerge in a system involving equifinality and multifinality. Like most other psychological disorders, psychosis is associated with multiple domains of risk factors, both genetic and environmental, and there are many transdiagnostic developmental pathways that can lead to psychotic syndromes. In this article, we discuss our current understanding of heterogeneity in the etiology of psychosis and its implications for approaches to conceptualizing etiology and research. We highlight the need for examining risk factors at multiple levels and to increase the emphasis on transdiagnostic developmental trajectories as a key variable associated with etiologic subtypes. This will be increasingly feasible now that large, longitudinal datasets are becoming available and researchers have access to more sophisticated analytic tools, such as machine learning, which can identify more homogenous subtypes with the ultimate goal of enhancing options for treatment and preventive intervention.

Associations between childhood ethnoracial minority density, cortical thickness, and social engagement among minority youth at clinical high-risk for psychosis

An ethnoracial minority density (EMD) effect in studies of psychotic spectrum disorders has been observed, whereby the risk of psychosis in ethnoracial minority group individuals is inversely related to the proportion of minorities in their area of residence. The authors investigated the relationships among area-level EMD during childhood, cortical thickness (CT), and social engagement (SE) in clinical high risk for psychosis (CHR-P) youth. Data were collected as part of the North American Prodrome Longitudinal Study. Participants included 244 ethnoracial minoritized (predominantly Hispanic, Asian and Black) CHR-P youth and ethnoracial minoritized healthy controls. Among youth at CHR-P (n = 164), lower levels of EMD during childhood were associated with reduced CT in the right fusiform gyrus (adjusted β = 0.54; 95% CI 0.17 to 0.91) and right insula (adjusted β = 0.40; 95% CI 0.05 to 0.74). The associations between EMD and CT were significantly moderated by SE: among youth with lower SE (SE at or below the median, n = 122), lower levels of EMD were significantly associated with reduced right fusiform gyrus CT (adjusted β = 0.72; 95% CI 0.29 to 1.14) and reduced right insula CT (adjusted β = 0.57; 95% CI 0.18 to 0.97). However, among those with greater SE (n = 42), the associations between EMD and right insula and fusiform gyrus CT were not significant. We found evidence that lower levels of ethnic density during childhood were associated with reduced cortical thickness in regional brain regions, but this association may be buffered by greater levels of social engagement.

How does the macroenvironment influence brain and behaviour - a review of current status and future perspectives

The environment influences mental health, both detrimentally and beneficially. Current research has emphasized the individual psychosocial 'microenvironment'. Less attention has been paid to 'macro-environmental' challenges including climate change, pollution, urbanicity and socioeconomic disparity. With the advent of large-scale big-data cohorts and an increasingly dense mapping of macroenvironmental parameters, we are now in a position to characterise the relation between macroenvironment, brain, and behaviour across different geographic and cultural locations globally. This review synthesises findings from recent epidemiological and neuroimaging studies, aiming to provide a comprehensive overview of the existing evidence between the macroenvironment and the structure and functions of the brain, with a particular emphasis on its implications for mental illness. We discuss putative underlying mechanisms and address the most common exposures of the macroenvironment. Finally, we identify critical areas for future research to enhance our understanding of the aetiology of mental illness and to inform effective interventions for healthier environments and mental health promotion.

Hippocampal Connectivity with the Default Mode Network is Linked to Hippocampal Volume in the Clinical High Risk for Psychosis Syndrome and Healthy Individuals

Reduced hippocampal volume (HV) is an established brain morphological feature of psychiatric conditions. HV is associated with brain connectivity in humans and non-human animals and altered connectivity is associated with risk for psychiatric illness. Associations between HV and connectivity remain poorly characterized in humans, and especially in phases of psychiatric illness that precede disease onset. This study examined associations between HV and hippocampal functional connectivity (FC) during rest in 141 healthy controls and 248 individuals at-risk for psychosis. Significant inverse associations between HV and hippocampal FC with the inferior parietal lobe (IPL) and thalamus were observed. Select associations between hippocampal FC and HV were moderated by diagnostic group. Significant moderation results shifted from implicating the IPL to the temporal pole after excluding participants on antipsychotic medication. Considered together, this work implicates hippocampal FC with the temporoparietal junction, within a specialized subsystem of the default mode network, as sensitive to HV.

Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: III. Biology

BACKGROUND

Social determinants of health (SDoHs) are nonmedical factors that significantly impact health and longevity. We found no published reviews on the biology of SDoHs in schizophrenia-spectrum psychotic disorders (SSPD).

STUDY DESIGN

We present an overview of pathophysiological mechanisms and neurobiological processes plausibly involved in the effects of major SDoHs on clinical outcomes in SSPD.

STUDY RESULTS

This review of the biology of SDoHs focuses on early-life adversities, poverty, social disconnection, discrimination including racism, migration, disadvantaged neighborhoods, and food insecurity. These factors interact with psychological and biological factors to increase the risk and worsen the course and prognosis of schizophrenia. Published studies on the topic are limited by cross-sectional design, variable clinical and biomarker assessments, heterogeneous methods, and a lack of control for confounding variables. Drawing on preclinical and clinical studies, we propose a biological framework to consider the likely pathogenesis. Putative systemic pathophysiological processes include epigenetics, allostatic load, accelerated aging with inflammation (inflammaging), and the microbiome. These processes affect neural structures, brain function, neurochemistry, and neuroplasticity, impacting the development of psychosis, quality of life, cognitive impairment, physical comorbidities, and premature mortality. Our model provides a framework for research that could lead to developing specific strategies for prevention and treatment of the risk factors and biological processes, thereby improving the quality of life and increasing the longevity of people with SSPD.

CONCLUSIONS

Biology of SDoHs in SSPD is an exciting area of research that points to innovative multidisciplinary team science for improving the course and prognosis of these serious psychiatric disorders.

Restoring the missing person to personalized medicine and precision psychiatry

Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological "omics" data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is inadequate to guide clinical care because people differ in ways that are not captured by broad diagnostic categories. One of the first steps in developing this personalized approach to treatment was the use of genetic markers to guide pharmacotherapeutics based on predictions of pharmacological response or non-response, and the potential risk of adverse drug reactions. Advances in technology have made a greater degree of specificity or precision potentially more attainable. To date, however, the search for precision has largely focused on biological parameters. Psychiatric disorders involve multi-level dynamics that require measures of phenomenological, psychological, behavioral, social structural, and cultural dimensions. This points to the need to develop more fine-grained analyses of experience, self-construal, illness narratives, interpersonal interactional dynamics, and social contexts and determinants of health. In this paper, we review the limitations of precision psychiatry arguing that it cannot reach its goal if it does not include core elements of the processes that give rise to psychopathological states, which include the agency and experience of the person. Drawing from contemporary systems biology, social epidemiology, developmental psychology, and cognitive science, we propose a cultural-ecosocial approach to integrating precision psychiatry with person-centered care.

No robust evidence for an interaction between early-life adversity and protective factors on global and regional brain volumes

Childhood adversity is associated with brain morphology and poor psychological outcomes, and evidence of protective factors counteracting childhood adversity effects on neurobiology is scarce. We examined the interplay of childhood adversity with protective factors in relation to brain morphology in two independent longitudinal cohorts, the Generation R Study (N = 3008) and the Mannheim Study of Children at Risk (MARS) (N = 179). Cumulative exposure to 12 adverse events was assessed across childhood until age 9 years in Generation R and 11 years in MARS. Protective factors (temperament, cognition, self-esteem, maternal sensitivity, friendship quality) were assessed at various time-points during childhood. Global brain volumes and volumes of amygdala, hippocampus, and the anterior cingulate, medial orbitofrontal and rostral middle frontal cortices were assessed with anatomical scans at 10 years in Generation R and at 25 years in MARS. Childhood adversity was related to smaller cortical grey matter, cerebral white matter, and cerebellar volumes in children. Also, no buffering effects of protective factors on the association between adversity and the brain outcomes survived multiple testing correction. We found no robust evidence for an interaction between protective factors and childhood adversity on broad brain structural measures. Small interaction effects observed in one cohort only warrant further investigation.