Impact of Neighborhood Characteristics on Conversion to Psychosis among Youth at Clinical High Risk for Psychosis

社区特征对临床精神病高危青少年转化为精神病的影响

• 批准号: 10650851
• 负责人: Benson Ku
• 金额: $ 19.41万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650851
• 关键词: Age; Air Pollution; American; Anterior; Area; Behavior; Brain; Brain region; Censuses; Characteristics; Child Abuse; Child Sexual Abuse; Childhood; Cities; Computer software; Consensus; County; Data; Development; Early Intervention; Elements; Environmental Exposure; Environmental Impact; Environmental Risk Factor; Equation; Ethnic Origin; Family history of; Geography; Goals; Health Resources; Hippocampus; Human; Individual; Insula of Reil; Intervention; Interview; Investigation; Longitudinal Studies; Magnetic Resonance Imaging; Measures; Mediating; Mediator; Mental Health; Mental disorders; Mentors; Methodology; Modeling; Neighborhoods; Neurobiology; Neurodevelopmental Disorder; Outcome; Patients; Persons; Population Density; Populations at Risk; Poverty; Prevalence; Proxy; Psychoses; Psychosocial Deprivation; Psychotic Disorders; Public Health; Publishing; Qualitative Methods; Race; Research; Research Design; Research Personnel; Risk; Risk Factors; Schizophrenia; Sexual abuse; Site; Social isolation; Subgroup; Testing; Thalamic structure; Training; Urbanicity; Work; Youth; cingulate cortex; clinical high risk for psychosis; design; emotional neglect; experience; first episode psychosis; follow-up; gray matter; high risk population; low socioeconomic status; novel; peer; physical abuse; predictive test; prevent; psychosis risk; psychosocial; rural area; sex; social; social relationships; social stress

Project Summary/Abstract The proposed research and training plan are designed to promote my development as an independent investigator in the field of neighborhood characteristics as they relate to conversion to psychosis through neurobiological and psychosocial mediators among youth at clinical high risk for psychosis (CHR-P). Urban upbringing (growing up in cities as compared to rural areas) is one of the strongest environmental risk factors for schizophrenia. More recent studies have suggested that social stress might explain this association. In particular, neighborhood residential instability (NRI) has been used to measure social fragmentation and has also been associated with increased schizophrenia rates and prevalence. In addition, my published work found that NRI predicts an earlier age at onset of psychosis among individuals with first-episode psychosis even after controlling for known risk factors. Furthermore, my preliminary data indicate that county-level residential instability (a rough proxy for NRI) during childhood 1) predicts conversion to psychosis and 2) predicts smaller corticolimbic gray matter volume (GMV) among a subset of youth at CHR-P who never moved. Dr. Walker (one of my mentors) has shown that psychosocial deprivation as measured by reduced childhood peer relationships, parental absence, and emotional neglect is associated with smaller corticolimbic GMV, whereas threat (defined as exposures that involve harm; e.g., childhood sexual and physical abuse) is not. Based on these findings, I hypothesize that NRI leads to psychosocial deprivation, which in turn contributes to smaller corticolimbic GMV, which ultimately increases risk for psychosis. To test this hypothesis, I propose the following Specific Aims: (1) Test the association between NRI and conversion to psychosis and corticolimbic GMV, including the cortical, perigenual anterior cingulate cortex, and hippocampal GMV and control regions including insula and thalamus. (2) Test the association between NRI and psychosocial deprivation and threat. (3) Explore the experiences and circumstances of youth at CHR-P living in residential areas that differ in NRI, from very unstable to highly stable. The proposed studies will provide a novel integration of multiple levels of investigation including public health, developmental studies in humans, and the impact of environmental factors on the brain and behavior to discover novel targets for intervention both at the individual and neighborhood levels to prevent or mitigate psychosis conversion in high-risk individuals. Future research will further elucidate the relationship of neighborhood characteristics with the psychosocial and neurobiological factors associated with risk for psychosis, such as investigating whether NRI exposure at specific developmental periods and regional brain changes would have a differential impact on psychosis. If NRI leads to psychosocial deprivation and neurobiological changes, for example, targeted psychosocial interventions could then be designed for youth at risk. In addition, geographic identification of at-risk groups could guide allocation of mental health resources to areas with greater psychosis risk for early intervention.

项目概要/摘要 拟议的研究和培训计划旨在促进我作为独立的人的发展 邻里特征领域的调查员，因为它们与通过以下方式转变为精神病有关 临床精神病高危青少年中的神经生物学和心理社会中介因素（CHR-P）。城市的 成长环境（与农村地区相比，在城市长大）是最严重的环境风险因素之一 对于精神分裂症。最近的研究表明，社会压力可能解释这种关联。在 特别是，邻里居住不稳定（NRI）已被用来衡量社会分裂，并已 也与精神分裂症发病率和患病率增加有关。另外，我发表的作品发现 NRI 预测首发精神病患者的精神病发病年龄较早，即使在 控制已知的风险因素。此外，我的初步数据表明，县级住宅 童年时期的不稳定（NRI 的粗略代表）1) 预测转化为精神病，2) 预测更小 CHR-P 中从未移动过的青少年子集的皮质边缘灰质体积 (GMV)。沃克博士（一 我的导师）表明，通过减少童年同龄人来衡量心理社会剥夺 人际关系、父母缺席和情感忽视与较小的皮质边缘 GMV 相关，而 威胁（定义为涉及伤害的暴露；例如童年性虐待和身体虐待）则不然。基于 根据这些发现，我假设 NRI 会导致社会心理剥夺，进而导致较小的 皮质边缘 GMV，最终会增加精神病的风险。为了检验这个假设，我提出 具体目标如下： (1) 测试 NRI 与转变为精神病和皮质边缘症之间的关联 GMV，包括皮质、膝周前扣带皮层和海马 GMV 和控制区域 包括岛叶和丘脑。 (2) 检验 NRI 与心理社会剥夺和威胁之间的关联。 (3) 探索居住在 NRI 不同的住宅区的 CHR-P 青年的经历和情况， 从非常不稳定到高度稳定。拟议的研究将提供多层次的新颖整合 调查包括公共卫生、人类发育研究以及环境影响 影响大脑和行为的因素，以发现个人和行为的新干预目标 社区层面以预防或减轻高危人群的精神病转化。未来的研究将 进一步阐明邻里特征与心理社会和神经生物学的关系 与精神病风险相关的因素，例如调查 NRI 暴露是否在特定 发育时期和大脑区域的变化会对精神病产生不同的影响。如果 NRI 领先 社会心理剥夺和神经生物学变化，例如有针对性的社会心理干预 然后可以为处于危险中的青少年设计。此外，对高危人群的地理识别可以指导 将精神卫生资源分配给精神病风险较高的地区进行早期干预。

项目成果

The association between county-level mental health provider shortage areas and suicide rates in the United States during the COVID-19 pandemic.

COVID-19 大流行期间美国县级精神卫生服务提供者短缺地区与自杀率之间的关联。

• DOI: 10.1016/j.genhosppsych.2024.02.012
• 发表时间: 2024
• 期刊: General hospital psychiatry
• 影响因子: 7
• 作者: Ku,BensonS;BarreraFlores,FranciscoJ;Congdon,Peter;Yuan,Qingyue;Druss,BenjaminG
• 通讯作者: Druss,BenjaminG