Psychosis and urbanicity – a review of the recent literature from epidemiology to neurourbanism

Purpose of review: Epidemiological studies associate city living with an elevated psychosis risk. Urban (social/economic) stress and exposure to environmental toxins, pollution or disease agents have been proposed to underlie this association. This review provides an update on the recent evidence (May 2017 - November 2018). Recent findings: Of 645-screened studies, 17 on: (1) urbanicity-psychosis associations in worldwide high, middle and low-income countries, (2) explanatory mechanisms, including nature exposure, social and economic stressors and genetic risk; (3) urbanicity effects on the brain and coping; and (4) urbanicity and resources, were included. The reviewed evidence revealed complex patterns of urbanicity-psychosis associations with considerable international variation within Europe and between low, middle and high-income countries worldwide. Social and economic stressors (e.g. migration, ethnic density, economic deprivation), nature exposure and access to resources could only explain part of the urbanicity effects. Risk factors differed between countries and between affective and non-affective psychosis. Summary: Urbanicity-psychosis associations are heterogeneous and driven by multiple risk and protective factors that seem to act differently in different ethnic groups and countries. Interdisciplinary research combining approaches, e.g. from experimental neuroscience and epidemiology, is needed to unravel specific urban mechanisms that in- or decrease psychosis risk