Neighborhood Characteristics and Social Functioning: Exploring Shared and Distinct Psychosocial Pathways Among Individuals at Clinical High-Risk for Psychosis

Qingyue E Yuan; Cope Feurer; Qing D Zhou; Ricardo Carrion; Jean Addington; Carrie E Bearden; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Matcheri Keshavan; Daniel H Mathalon; Diana O Perkins; William S Stone; Scott W Woods; Elaine F Walker; Benson S Ku

doi:10.1093/schbul/sbaf192

Neighborhood Characteristics and Social Functioning: Exploring Shared and Distinct Psychosocial Pathways Among Individuals at Clinical High-Risk for Psychosis

Schizophr Bull. 2025 Nov 10:sbaf192. doi: 10.1093/schbul/sbaf192. Online ahead of print.

Authors

Qingyue E Yuan^{1

2}, Cope Feurer³, Qing D Zhou⁴, Ricardo Carrion⁵, Jean Addington⁶, Carrie E Bearden⁷, Kristin S Cadenhead⁸, Tyrone D Cannon^{9

10}, Barbara A Cornblatt^{5

11}, Matcheri Keshavan¹², Daniel H Mathalon^{13

14}, Diana O Perkins³, William S Stone¹², Scott W Woods⁹, Elaine F Walker⁴, Benson S Ku¹

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States.
² Department of Psychology, University of Wisconsin-Madison, Madison, WI 53705, United States.
³ Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27514, United States.
⁴ Department of Psychology, Emory University, Atlanta, GA 30322, United States.
⁵ Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States.
⁶ Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N4N1, Canada.
⁷ Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States.
⁸ Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, United States.
⁹ Department of Psychiatry, Yale University, New Haven, CT 06511, United States.
¹⁰ Department of Psychology, Yale University, New Haven, CT 06511, United States.
¹¹ Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States.
¹² Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.
¹³ Department of Psychiatry, University of California, San Francisco, CA 94143, United States.
¹⁴ San Francisco Veterans Affairs Health Care System, San Francisco, California, 94121, United States.

PMID: 41212179
DOI: 10.1093/schbul/sbaf192

Abstract

Background and hypothesis: Recent research suggests that environmental factors may contribute to psychosis through at least partially distinct pathways. This study examined how neighborhood socioeconomic deprivation and social fragmentation relate to impaired social functioning in individuals at clinical high risk for psychosis (CHR-P) via social and contextual risk factors.

Study design: Data were collected from the North American Prodrome Longitudinal Study Phase 3. Neighborhood characteristics were geocoded using participant addresses at baseline. Social and contextual risk factors were derived from the Structural Assessment of Violence Risk in Youth. Social functioning was measured using the Global Assessment of Functioning: Social Scale.

Study results: Neighborhood social fragmentation was associated with greater peer rejection (β = 0.11; 95% CI, 0.01-0.22, P = .034), which, in turn, was negatively associated with social functioning (β = -0.18; 95% CI, -0.23 to -0.12, P < .001). Both neighborhood social fragmentation (β = 0.18; 95% CI, 0.03-0.33, P = .022) and neighborhood socioeconomic deprivation (β = 0.34; 95% CI, 0.21-0.48, P < .001) were associated with greater community disorganization, which was negatively associated with social functioning (β = -0.08; 95% CI, -0.17 to -0.01, P = .046). Neighborhood socioeconomic deprivation had a direct negative association with social functioning (β = -0.15; 95% CI, -0.29 to -0.02, P = .03).

Conclusions: This study identified shared and distinct pathways relating neighborhood characteristics to impaired social functioning among CHR-P individuals. Understanding how environmental factors impact social functioning may help develop effective interventions for youth at high risk.

Keywords: clinical high risk; neighborhood disadvantage; psychosis; psychosocial factors; social fragmentation; socioeconomic deprivation.

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Abstract

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