Association between urban living and mental illness?

[JabsterL]

Mescape Psychiatry's top story today relates to the question of whether urban living causes mental illness, based on a recently published longitudinal study of 2.4 million people across multiple generations examining the potential role of social causation -- not just association and very evident social drift -- regarding the link between urbanization and schizophrenia. Which leads to the larger question of the potential impact of "nurture" in predisposing and/or precipitating a first-break. As someone who lives and works in the urban environment of Brooklyn and see schizophrenia all over the place in NYC (not just at work), I wonder if anyone has any thoughts on this idea -- or is it simply an odds game (more people, more schizophrenia)?

http://schizophreniabulletin.oxfordjournals.org/content/early/2014/07/22/schbul.sbu105.abstract

Medscape Psychiatry Q&A with lead author of study:
http://www.medscape.com/viewarticle/830404?nlid=64193_421&src=wnl_edit_medp_psyc&uac=%%uac%%&spon=12

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[birchswing]

Mescape Psychiatry's top story today relates to the question of whether urban living causes mental illness, based on a recently published longitudinal study of 2.4 million people across multiple generations examining the potential role of social causation -- not just association and very evident social drift -- regarding the link between urbanization and schizophrenia. Which leads to the larger question of the potential impact of "nurture" in predisposing and/or precipitating a first-break. As someone who lives and works in the urban environment of Brooklyn and see schizophrenia all over the place in NYC (not just at work), I wonder if anyone has any thoughts on this idea -- or is it simply an odds game (more people, more schizophrenia)?

http://schizophreniabulletin.oxfordjournals.org/content/early/2014/07/22/schbul.sbu105.abstract

Medscape Psychiatry Q&A with lead author of study:
http://www.medscape.com/viewarticle/830404?nlid=64193_421&src=wnl_edit_medp_psyc&uac=%%uac%%&spon=12

I didn't read the article because I probably wouldn't understand it, but are they saying it's being in an urban area itself (like population density, noise, pollution), the other things that correlate with living in an urban area, or they don't know?

As a correlation, I could see a possible link between urbanization and the amount of time that your parents work, for example. Or even if you live on a farm and both your parents work, you're still with them. I think we have a huge disconnect in society when it comes to children. There is this belief that adults should do what makes them happy. I don't believe in that. The needs of children do not change because the aspirations of adults do. We have a generation of kids who have grown up in what I call day-orphanages, many starting at 6 weeks old. Human beings have existed for millions of years. Infants don't change in a matter of decades or centuries in their needs.

I'm not sure it's a blessing but if you do live in an urban area, you probably also have better access to good mental healthcare.

Edited to add: It's not just about aspirations. It's also about culture. Pretty much everyone I went to high school with is having babies now, so I see this a lot. I see mothers complaining about how expensive daycare is and asking for recommendations about where to find the cheapest place per week, while complaining about their terrible jobs, while bemoaning that they just break even between the costs of daycare and what they make at their crappy jobs. And I feel like tapping them on the head to point out that they've laid out all the dots to a very illogical situation with a very obvious solution. But of course, I don't. There's some new inherent cultural value that this is what we are supposed to do. And BTW, I consider myself very progressive. I don't care who raises a child. It just makes me sad when I see these situations where no one wants to raise a child. I think children need a primary caregiver to attach to, and many have one or two in name only.

 

[barzan]

I don't think its novel I have read such association previously, such as immigrants especially the second generation.
Schizophrenia is a neurodevelopmental disease, I would question how does urbanization provoke it?

 

[erg923]

Associated with or causes? Big diff...

 

[notdeadyet]

I don't think its novel I have read such association previously, such as immigrants especially the second generation.

What's interesting is that the second generation immigrant thing is true regardless of whether they immigrated from a rural village to NYC or a huge city to a more rural area. It's also not a phenomenon limited to schizophrenia or mental illness; the primary care folks also notice similar numbers with things like heart disease, diabetes, etc.

Schizophrenia is a neurodevelopmental disease, I would question how does urbanization provoke it?

SCZ may be neurodevelopmental, but stressors contribute to the disease demonstrating observable symptoms. Folks can reach 25yo without symptoms until they smoke crack/methamphetamines or go through basic training. Cumulative stressors in an urban environment could accelerate that.

As could cumulative stressors in a rural environment. I'm curious if the data gets sliced and they compare prevelance amongst like and like for protective factors like money, which tends to reduce (but not eliminate) stressors.

 

[birchswing]

Just came across this and it reminded me of this thread:

http://www.uofmhealth.org/news/arch...sion-and-beating-stress-outdoors-nature-group

I often daydream about places in nature I was in as a child. I can go on walks around my neighborhood, but it's not the same as walking on a trail in a forest or wandering around an island. Nature is so perfect. Revitalizing.

 

[nitemagi]

This is so so so not a new idea. This idea pre-dates modern psychiatry by hundreds of years, where the belief was that mental illness (esp psychosis) was an internalization of the chaotic environment of cities. They went on to try "asylums" that focused on beautifully landscaped areas and more outdoor living. Some of that continues in areas of new england, with a focus on putting patients to work doing things like farming/gardening. If it had cured all of mental illness they would have had it figured out before modern psych even emerged.

 

[birchswing]

This is so so so not a new idea. This idea pre-dates modern psychiatry by hundreds of years, where the belief was that mental illness (esp psychosis) was an internalization of the chaotic environment of cities. They went on to try "asylums" that focused on beautifully landscaped areas and more outdoor living. Some of that continues in areas of new england, with a focus on putting patients to work doing things like farming/gardening. If it had cured all of mental illness they would have had it figured out before modern psych even emerged.

I think that article I linked to blurs the lines between mental illness and depression/stress in the vernacular. I think they're saying that nature walks help with the latter. I think you can make a distinction between stress/depression as the absence of good mental health and clinical depression and other mental illnesses as the presence of disordered mental health.

The type of stress/depression people talk about in the vernacular is related to mental illness, though. I am personally very affected by the buildings I am in. Some buildings are just inherently stress-inducing. Most people have an aversion to hospitals, for example, and not just because of the reason people visit hospitals (I've seen hospitals change in recent years to reflect more of nature, including wishing ponds, etc.).

I doubt there is anyone today who thinks nature cures mental illness, just as most people don't think massage does either, but there's a reason people go the country or the mountains when they have time off.

Asylums and gardening were certainly a step up from being tied down wrapped in wet sheets or the other now-bizarre techniques that were used. Even today, I imagine an extended country excursion might be nicer than three days of doping someone up and streeting them.

 

[PhinyGage]

Ummm....am I the only one not considering an obvious confounder?

1.) People with mental illness are more likely to survive in urban areas. The average case of schizophrenia may be too disorganized to fend for self out in the country. At least you can beg for change or pick a trashcan if you need a quick snack. And depressed people with serious neurovegetative symptoms aren't likely to whither away before anyone notices. I smell a mendelian like phenomenon. People with pronounced mental illness are likely to be more "fit" in urban areas. Rural living is likely to confer poor outcomes, especially for those who are totally isolated.

 

[Ibid]

What gets called mental illness is for the most part the result of social conflict..... you can get away from people in the country..... not so much in the urban environment where if you behave oddly by the standards of the community you are going to bother someone and hence come to the attention of services...

 

[Ibid]

This is so so so not a new idea. This idea pre-dates modern psychiatry by hundreds of years, where the belief was that mental illness (esp psychosis) was an internalization of the chaotic environment of cities. They went on to try "asylums" that focused on beautifully landscaped areas and more outdoor living. Some of that continues in areas of new england, with a focus on putting patients to work doing things like farming/gardening. If it had cured all of mental illness they would have had it figured out before modern psych even emerged.

Just out of interest when do you spot the start of modern psychiatry..... I mean it only started 150 yrs ago tops..... so when did modern kick in..... just interested in what you are saying....

 

[whopper]

I've known several people with mental illness who intentionally moved to an urban area to get better services. Many counties have no community mental health centers or piss-poor ones (not so much due to poor management though that can happen but lack of resources).

I did residency in NJ. Then then governor announced a mental health initiative where the state would significantly raise funding to treat the mentally ill. The next year in the hospital we had people come in from deep south telling me they moved because they couldn't get any free services in their own state so now they were going to become NJ residents to get services there.

Same thing happens in urban areas many of which have better community mental health resources.

 

[barzan]

I've known several people with mental illness who intentionally moved to an urban area to get better services. Many counties have no community mental health centers or piss-poor ones (not so much due to poor management though that can happen but lack of resources).

I did residency in NJ. Then then governor announced a mental health initiative where the state would significantly raise funding to treat the mentally ill. The next year in the hospital we had people come in from deep south telling me they moved because they couldn't get any free services in their own state so now they were going to become NJ residents to get services there.

Same thing happens in urban areas many of which have better community mental health resources.

Thats really sad considering all the hardships they went through to receive the proper free treatment.

 

[xsw]

It appears that no one has actually read the paper.

The paper argues against the commonly held view that urbanicity is a risk factor for schizophrenia. By using extended family incidence rates they found that urbanicity was not associated with schizophrenia once genetic loading was accounted for.

 

[smalltownpsych]

It appears that no one has actually read the paper.

The paper argues against the commonly held view that urbanicity is a risk factor for schizophrenia. By using extended family incidence rates they found that urbanicity was not associated with schizophrenia once genetic loading was accounted for.

We don't have time to read every article posted on here. We are busy reading relevant articles and by that I mean research that directly connects with our current work. Therefore, we rely on our colleagues to make key points like that for us. Then if we have interest or need, we read further and more critically.

 

[whopper]

I don't know if urbanicity truly contributes. I do know in an urban setting you will see more schizophrenics simply because there are more people densely packed in, and voter attitudes tend to go Democrat, and that party is more sensitive to social funding of medical care. I also know that in rural settings, the culture tends to be more extended families, hence more people willing to care for their family's mentally ill thus not pushing these people into the public's view while this phenomenon tends to happen less in the urban settings.

All of these could be a factors.

Thats really sad considering all the hardships they went through to receive the proper free treatment.

Agree. A lot of it has to do with the local cultures. Some states put barely anything, some states put a lot. I knew police officers in states where there was very little to offer the mentally ill intentionally drive mentally ill people across the state line and dump them across the border so that person could get better treatment.

When one lives in a cramped setting such as a city, if a person is schizophrenic you're more likely to see them in your face because there's less distance between you and the other person. Instead of acres, it could be just a few dozen feet. When 1% of the population has schizophrenia and you literally see hundreds of people a day vs just a few, guess where you're going to see more of it? NYC vs the bayou or the Pine Barrens? This in turn will make that person more likely to want social services to treat schizophrenics.

And now I'll just whine. I've made comments like this for years on the forum, and occasionally I'd get some ivory tower attending mouth-off how I'm making this stuff up and nothing like this ever happens. (Yeah right). Especially when I mentioned how one town was dumping their patients on us. Oh yeah such a thing could never happen.

http://archpsyc.jamanetwork.com/article.aspx?articleID=1743011