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Title: Place, race, and psychosis

Citation Type: Dissertation/Thesis

Publication Year: 2011

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Abstract: Once vibrant in a previous era of social psychiatric and sociologic research, interest in the role of social context in the etiology of psychosis has been revived. This line of research is defined by analyses of urban life and schizophrenia on the one hand, and migration, race/ethnicity, and neighborhood-level factors on the other. This dissertation integrates two strands of research regarding social context—urbanicity and neighborhood—to illuminate the interrelationships among place, race, and psychosis in the United States, where patterns of urbanization and suburbanization are deeply connected to race. A tripartite approach is employed in the treatment of this critical issue in the epidemiology of schizophrenia. A systematic review of studies regarding the spatial variation in the incidence of schizophrenia in developed countries since 1950, along the axes of urbanicity and neighborhood, is provided. Therein, an approach to the investigation of the role of social context in the etiology of schizophrenia is presented. Key to this approach is the characterization of social pathways, or the causal cascade by which place-based exposures are maintained and created; and consideration of the complexities of social context at an arguably critical point in the lifecourse, enriched by consideration of the role of history. This approach is applied to two epidemiologic analyses of key characteristics of neighborhoods at birth of a cohort born in the East Bay Area of California, 1959-67. Results are presented here. The first of these analyses, which addresses neighborhood population density, shows that birth in the most densely populated neighborhoods was significantly related to schizophrenia in adulthood, irrespective of race and family socioeconomic status at birth. The second set of analyses, which concerns neighborhood ethnic density in a sample restricted to blacks, demonstrates that neighborhood ethnic density was significantly protective against schizophrenia in adulthood. Both the specification of causal models and the interpretation of results are anchored in the history of the social context into which the cohort was born. An in-depth and integrative discussion of the empirical findings links them to the framework established in the systematic review and firmly anchors them in historical context. Taken together, the elements of this dissertation constitute a cohesive, historically grounded examination of the role of social context in the etiology of schizophrenia, in which place and race intersect to produce complex patterns, and shed light on potential opportunities for intervention and/or promotion beyond the individual level.

Url: https://search.proquest.com/docview/862744222/abstract/2EB9D0CA31E4E13PQ/1?accountid=14586

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Authors: March, Dana

Institution: Columbia University

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Degree: Doctor of Philosophy

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Pages: 229

Data Collections: IPUMS USA

Topics: Health, Race and Ethnicity

Countries: United States