Epidemiology of Psychotic Disorders and Environmental Influences

Psychotic disorders, encompassing conditions such as schizophrenia and related non-affective and affective psychoses, impose a substantial global burden of disease. Incidence varies markedly by geography, age, sex and sociodemographic group, with rates often peaking in young adulthood and showing higher risk among marginalised populations. Environmental influences operate at multiple levels: neighbourhood social fragmentation and deprivation can elevate risk, while cohesive communities and high ethnic density may confer protection. Urban living is associated with roughly double the risk of psychotic disorder compared with rural settings, potentially through exposure to social adversity, isolation, pollution and reduced access to natural environments. Early-life residential instability and childhood adversities further compound vulnerability, interacting with genetic liability to shape onset. Emerging evidence highlights air pollution and limited access to green space as modifiable risk factors, and gene–environment interplay as critical to individual trajectories. Understanding these complex interdependencies offers pathways for targeted prevention, from urban planning that increases green space to community interventions that strengthen social capital. Programme design for early intervention services must account for local variations in incidence, guided by robust epidemiological surveillance and translational research.

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Epidemiology of Psychotic Disorders and Environmental Influences publication trend

The graph below shows the total number of articles in epidemiology of psychotic disorders and environmental influences across all publications each year (not limited to Nature Index journals).

Technical terms

Incidence: The number of new cases of a disorder arising in a specified population over a defined period.

Urbanicity: The characteristic of residing in densely populated urban areas, often linked to unique social and environmental exposures.

Social fragmentation: The breakdown of social cohesion within a community, marked by loneliness, distrust and weakened neighbourhood ties.

Polygenic risk score: A quantitative measure of an individual’s inherited susceptibility to a disorder, based on the cumulative effect of multiple genetic variants.

Subclinical psychotic experience: Non-clinical manifestations of psychotic symptoms, such as unusual perceptual experiences or transient paranoid thoughts, not meeting full diagnostic criteria.

References

1. Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South. JAMA Psychiatry (2023).
2. Urbanicity and psychotic experiences: Social adversities, isolation and exposure to natural environments predict psychosis. Journal of Environmental Psychology (2024).
3. Urbanicity and psychotic disorders: Facts and hypotheses. Dialogues in Clinical Neuroscience (2023).
4. International incidence of psychotic disorders, 2002–17: a systematic review and meta-analysis. The Lancet Public Health (2019).
5. Association of Air Pollution Exposure With Psychotic Experiences During Adolescence. JAMA Psychiatry (2019).
6. Childhood Residential Mobility, Schizophrenia, and Bipolar Disorder: A Population-based Study in Denmark. Schizophrenia Bulletin (2014).
7. Ethnic density, urbanicity and psychosis risk for migrant groups – A population cohort study. Schizophrenia Research (2017).
8. The EUropean Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI): Incidence and First-Episode Case–Control Programme. Social Psychiatry and Psychiatric Epidemiology (2020).