City Kids More Likely to Have Psychotic Experiences Than Rural Youth, Study shows

Kids raised in the city have significantly higher risk for psychosis, a new study shows, due in part to increase levels of victimization from crime. Jonathan Alcorn / REUTERS

Kids growing up in the city are significantly more likely than those raised in the country to have psychotic experiences, such as hearing voices and experiencing intense paranoia. A study published May 22 in the journal Schizophrenia Bulletin shows that these youths are more than 40 percent more likely to have a psychotic experience by the age of 18 than their rural counterparts. This lines up with previous research showing that urban kids are more likely to develop schizophrenia, mental disorders and are at a higher risk for suicide.

What is it about the city that increases the risk for psychosis and mental health problems? Candice Odgers, a researcher at Duke University and one of the study's two senior authors, says much of the risk can be explained by the extent of disorder and lack of cohesion in urban environments, and whether a person has been the victim of a violent crime. The group's work shows that 62 percent of kids who grow up in more dangerous areas and who had been victimized said they'd had a psychotic experience; only one-third as many in safer areas who hadn't experienced crime reported the same. These sorts of experiences may lead to an extreme wariness toward potential harm known as hypervigilance, and paranoia.

Perhaps surprisingly, one in three adolescents reports ever having some psychotic experience, though these become less common in adulthood, says Helen Fisher, a researcher at King's College London and the other study senior author. "For most adolescents these experiences are fairly transitory and can be reasonably benign but nonetheless they're often extremely distressing for the young person at the time particularly if they don't feel able to talk to anyone about them," Fisher says. These young people are however at a seven-fold increased risk for developing schizophrenia by mid-adulthood and at a threefold increased risk of attempting suicide, she adds.

Odgers notes that neighborhood disorder and cohesion are hugely important, and these are things that can be addressed by communities. Specific signs of disorder include things like broken windows, drug activity, levels of crime and prevalence of trash. Some of these are easier to address than others. Level of societal cohesion—how well people know and trust their neighbors—also appears to play a major role in preventing individuals from developing mental illness.

Traditionally, treatments for psychosis have focused on the individual, Odgers says. But measures to improve communities also are vitally important in preventing this and other mental illnesses, she adds. Providing psychological services to at-risk youth in urban areas could also help reduce their risk of subsequent psychosis and mental problems, the study concludes.