Social Activities May Offset Psychosis Risk in Poor Communities

Social engagement such as participation in community or school-based activities may mitigate psychosis risk in susceptible youth living in disadvantaged communities, new research suggests.

A study of more than 170 young participants showed reduced hippocampal volume in those living in poor neighborhoods who had low social engagement vs their peers with greater community engagement.

Dr Benson Ku

“These findings demonstrate the importance of considering broader environmental influences and indices of social engagement when conceptualizing adversity and potential interventions for individuals at clinical high risk for psychosis,” co-investigator Benson Ku, MD, a postdoctoral fellow and psychiatry resident at Emory University School of Medicine, Atlanta, Georgia, told Medscape Medical News.

The results were presented at the American Society of Clinical Psychopharmacology (ASCP) 2022 Annual Meeting.

A Personal Connection

It’s well known that growing up in low-income housing is associated with lower hippocampal volume and an increased risk for schizophrenia, said Ku.

“The inverse relationship between poverty and hippocampal gray matter volume has [also] been shown to be mediated by social stress, which can include things like lack of parental caregiving, and stressful life events,” he added

Ku himself grew up in a socioeconomically disadvantaged family in Queens, New York, and said he had initially performed poorly in school. His early experiences have helped inform his clinical and research interests in the social determinants of mental health.

“I found community support in the Boys’ Club of New York and a local Magic Shop near where I lived, which helped me thrive and become the successful man I am today. I have also heard from my patients how their living conditions and neighborhood have significantly impacted their mental health,” Ku said.

“A more in-depth understanding of the social determinants of mental health has helped build rapport and empathy with my patients,” he added.

To explore the association between neighborhood poverty, social engagement, and hippocampal volume in youth at high risk for psychosis, the researchers analyzed data from the North American Prodrome Longitudinal Study Phase 2, a multisite consortium.

The researchers recruited and followed up with help-seeking adolescents and young adults from diverse neighborhoods. The analysis included 174 youth, ages 12-33 years, at high clinical risk for psychosis.

Hippocampal volume was assessed using structural MRI. Neighborhood poverty was defined as the percentage of residents with an annual below the poverty level in the past year.

Social engagement was derived from the desirable events subscale items of the Life Events Scale. These activities included involvement in a church or synagogue; participation in a club, neighborhood, or other organization; taking a vacation; engaging in a hobby, sport, craft, or recreational activity; acquiring a pet; or making new friends.

Lower Hippocampal Volume

Results showed neighborhood poverty was associated with reduced hippocampal volume, even after controlling for several confounders, including race/ethnicity, family history of mental illnesses, household poverty, educational level, and stressful life events.

Among the 77 participants with lower social engagement, which was defined as three or fewer social activities, neighborhood poverty was associated with reduced hippocampal volume.

However, in the 97 participants who reported greater social engagement, which was defined as four or more social activities, neighborhood poverty was not significantly associated with hippocampal volume.

“It is possible that social engagement may mitigate the deleterious effects of neighborhood poverty on brain morphology, which may inform interventions offered to individuals from disadvantaged neighborhoods,” Ku said.

“If replication of the relationships between neighborhood poverty, hippocampal volume, and social engagement is established in other populations in longitudinal studies, then targeted interventions at the community level and increased social engagement may potentially play a major role in disease prevention among at-risk youth,” he said.

Ku noted social engagement might look different in urban vs rural settings.

“In urban areas, it might mean friends, clubs, neighborhood organizations, etc. In rural areas, it might mean family, pets, crafts, etc. The level of social engagement may also depend on neighborhood characteristics, and more research would be needed to better understand how geographic area characteristics — remote, rural, urban — affects social engagement,” he said.

Interesting, Innovative

Dr Nagy Youssef

Commenting for Medscape Medical News, Nagy Youssef, MD, PhD, director of clinical research and professor of psychiatry, Ohio State University College of Medicine, Columbus, said the study suggests “social engagement may reduce the negative effect of poverty in this population, and if replicated in a larger study, could assist and be a part of the early intervention and prevention in psychosis.”

Overall, “this is an interesting and innovative study that has important medical and social implications and is a good step toward helping us understand these relationships and mitigate and prevent negative consequences, as best as possible, in this population,” said Youssef, who was not part of the research.

The analysis was supported by a grant from the National Institute of Mental Health to the North American Prodrome Longitudinal Study. Ku and Youssef report no relevant financial relationships.

American Society of Clinical Psychopharmacology (ASCP) 2022: Abstract 3003484. Presented June 2, 2022.

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