Alvin M. Keeling 
Social engagement such as participation in community or school activities may mitigate the risk of psychosis in susceptible young people living in disadvantaged communities, new research suggests.
A study of more than 170 young participants showed reduced hippocampal volume in those living in poor neighborhoods who had low social engagement compared to their peers with greater community engagement.
Dr. Benson Ku
“These results demonstrate the importance of considering broader environmental influences and social engagement cues when conceptualizing adversity and potential interventions for people at high clinical risk for psychosis,” said the co. -researcher Benson Ku, MD, postdoctoral fellow and psychiatry resident at Emory University School. of Medicine, Atlanta, Georgia, said Medscape Medical News.
The findings were presented at the 2022 Annual Meeting of the American Society of Clinical Psychopharmacology (ASCP).
A personal connection
It is well known that growing up in low income housing is associated with lower hippocampal volume and increased risk of schizophreniasaid Ku.
“The inverse relationship between poverty and hippocampal gray matter volume has [also] It has been shown to be influenced by social stress, which can include things like lack of parental care and stressful life events,” he added.
Ku himself grew up in a socioeconomically disadvantaged family in Queens, New York, and said he initially did poorly in school. Her early experiences helped inform her clinical and research interests in the social determinants of mental health.
“I found community support at the Boys’ Club of New York and at a local Magic Shop near my home, which helped me grow into the successful man I am today. My patients have also shared with me how their living conditions and neighborhoods have had a significant impact on their mental health,” Ku said.
“A deeper understanding of the social determinants of mental health has helped build rapport and empathy with my patients,” he added.
To explore the association between neighborhood poverty, social engagement, and hippocampal volume in youth at high risk for psychosis, researchers analyzed data from the North American Prodrome Longitudinal Study Phase 2, a multisite consortium .
Researchers recruited and followed help-seeking adolescents and young adults from various neighborhoods. The analysis focused on 174 young people, aged 12 to 33, presenting a high clinical risk of psychosis.
Hippocampal volume was assessed by structural MRI. Neighborhood poverty was defined as the percentage of residents whose annual income was below the poverty line during the past year.
Social engagement was derived from items in the Desirable Events subscale of the Life Events Scale. These activities included involvement in a church or synagogue; participation in a club, neighborhood or other organization; take a break; engaging in a hobby, sport, craft or recreational activity; acquiring a pet; or make new friends.
Lower hippocampal volume
The results showed that neighborhood poverty was associated with reduced hippocampal volume, even after controlling for several confounding factors, including ethnicity, family history of mental illness, household poverty, education and stressful life events.
Among the 77 participants with lower social engagement, defined as three or fewer social activities, neighborhood poverty was associated with reduced hippocampal volume.
However, among the 97 participants who reported greater social engagement, defined as four or more social activities, neighborhood poverty was not significantly associated with hippocampal volume.
“It is possible that social engagement may mediate the deleterious effects of neighborhood poverty on brain morphology, which may inform interventions offered to people from disadvantaged neighborhoods,” Ku said.
“If replication of the relationships between neighborhood poverty, hippocampal volume, and social engagement is established in other populations in longitudinal studies, then targeted community-level interventions and increased social engagement can potentially play a major role in preventing disease in at-risk youth,” he said.
Ku noted that social engagement might look different in urban and rural settings.
“In urban areas, this may mean friends, clubs, neighborhood organizations, etc. In rural areas, this may mean family, pets, crafts, etc. The level of social engagement may also depend on neighborhood characteristics, and further research would be needed to better understand how characteristics of geographic areas – remote, rural, urban – affect social engagement,” he said.
Interesting, Innovative
Doctor Nagy Youssef
Commenting for Medscape Medical News, Nagy Youssef, MD, PhD, director of clinical research and professor of psychiatry, Ohio State University College of Medicine, Columbus, said the study suggests that “social engagement can reduce the negative effect of poverty in this population, and if replicated in a larger study, could help and be part of early intervention and prevention of psychosis.”
Overall, “this is an interesting and innovative study that has important medical and social implications and is a good step in helping us understand these relationships and how best to mitigate and prevent negative consequences in this population,” said Youssef, who was not part of the research.
The analysis was supported by a grant from the National Institute of Mental Health to the North American Prodrome Longitudinal Study. Ku and Youssef do not report any relevant financial relationship.
American Society of Clinical Psychopharmacology (ASCP) 2022: Abstract 3003484. Presented June 2, 2022.
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