THE CITY EFFECT: HOW URBAN LIVING SHAPES PSYCHOTIC RELAPSE RISK
DOI:
https://doi.org/10.22551/Abstract
Urbanization is a rapidly intensifying global trend and a significant determinant of population mental health. Growing evidence demonstrates that individuals exposed to urban environments experience a markedly higher risk of developing psychotic disorders, particularly schizophrenia, with effects that show clear dose-response patterns based on timing and duration of exposure. This study aimed to examine relapse burden in a hospital-based cohort of patients with psychotic disorders, with particular focus on urban residence and environmental correlates. Materials and methods: We conducted a six-month observational cross-sectional study including 60 hospitalized patients with schizophrenia-spectrum or acute psychotic disorders. Relapse vulnerability was operationalized using prior psychiatric hospitalizations. A subgroup of 31 patients underwent depressive symptom assessment and biomarker analysis, alongside 19 healthy controls. Sociodemographic, lifestyle, and environmental exposures were recorded. Descriptive statistics and correlation analyses were performed. We complemented the observational findings by a targeted literature synthesis. Results: Half of our cohort had 3 or more hospitalizations, indicating substantial relapse burden. Within the acute psychotic subgroup, 65% were of urban origin. Smoking (41.7%) and occupational chemical exposure (16.7%) were notable environmental factors. The predominance of urban residence among relapse-prone patients aligns with epidemiological evidence supporting an exposure-gradient relationship between urbanicity and psychosis. Conclusions: Urbanicity appears to function as a cumulative environmental correlate of psychotic relapse. Integrating epidemiological, psychosocial, and neurobiological perspectives may inform targeted prevention strategies and urban mental health policies aimed at reducing relapse risk.
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