PsyLife - Understanding the social determinants of psychosis & other mental health problems over the life course
Setting: Various, including Swedish national register data, ALSPAC birth cohort (UK), and the National Longitudinal Study of Children & Youth (NLSCY, Canada)
Funders: Wellcome Trust & Royal Society, MHRUK
Conducted at: Division of Psychiatry, UCL
PI: Prof James B. Kirkbride
Partners: Prof Ian Colman (University of Ottawa); Prof Christina Dalman (Karolinska Institutet)
Aim: To delineate the burden and social and environmental determinants of psychosis & other mental health problems
Method: Various methodologies, including causal inference methods applied to longitudinal datasets of mental health problems. Methods include causal mediation analysis, genetically-informed modelling, multilevel survival analysis, and other multilevel models.
Main findings: In ALSPAC, we demonstrated that the association between greater neighbourhood deprivation at birth and psychotic symptoms in adolescence was not explained by polygenic risk for schizophrenia . We have also shown that children who live in neighbourhoods with higher levels of perceived neighbourhood stress and discord were more likely to report psychotic experiences during adolescence .
In nationwide Swedish data, we used causal mediation analysis to show that up to a quarter of the association between urban birth and later risk of psychotic disorder could be attributed to effects on cognition, if causal .
In other Swedish register studies, we have shown increased risk of mental health problems amongst migrants and their children appear specific to psychotic rather than affective domains of neuropsychopathology , and are influenced by family  and neighbourhood  social support during and after migration. Moving house more often and over longer distances in childhood and adolescence (but not adulthood) also predicts increased future risk of psychotic disorder .
We were the first group to conclusively demonstrate that refugees were more likely to experience psychosis than Swedish-born individuals and non-refugee migrants from the same regions . We have shown elevated risks in refugee and other migrant groups do not exist for suicide  or substance use disorders , but rates of these mental health problems converge to Swedish rates over time. Migrants also experience more adverse pathways to psychiatric care [5,14].
Using Canadian data, we have also shown that children growing up in more adverse neighbourhoods are more likely to report mental health difficulties in adolescence . However, we have also shown that growing up in positive environments, with high levels of social capital, can protect children against mental health problems in adolescence following exposure to stressful life events .
Impact: Results have furthered our understanding of the social aetiology of psychotic disorders, and could aid population-level prevention strategies for improving mental health in different communities.