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

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.