Social Fragmentation and Schizophrenia: A Systematic Review

Area of Science:

• Epidemiology
• Psychiatry
• Sociology

Background:

• Social context is increasingly recognized as a factor in psychosis development.
• Social fragmentation, a measure of neighborhood social cohesion, is a key area-level characteristic.
• Epidemiological research suggests a potential causal role for social context in psychosis etiology.

Purpose of the Study:

• To systematically review the relationship between area-level social fragmentation and psychosis outcomes.
• To synthesize existing evidence on how neighborhood social fragmentation impacts psychosis rates and related factors.

Main Methods:

• A systematic review was conducted using MEDLINE, PsycINFO, and Web of Science databases.
• Inclusion criteria focused on area-level social environment measures and psychosis outcomes (incidence, prevalence, onset, severity, duration).
• 19 eligible articles were identified from 579 initially screened, with data extracted and coded by two independent reviewers.

Main Results:

• 14 out of 19 studies found an association between social fragmentation and higher psychosis rates.
• This association persisted after controlling for area-level factors (deprivation, social capital, race/ethnicity, urbanicity) and individual factors (age, sex, migrant status, socioeconomic status).
• Area-level social fragmentation was linked to various psychosis outcomes, including incidence, prevalence, and symptom severity.

Conclusions:

• Measures of area-level social fragmentation are associated with increased psychosis rates.
• Further research is necessary to elucidate the underlying mechanisms driving this association.
• Social context, specifically neighborhood fragmentation, represents a significant environmental factor in psychosis research.