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September 2018

Weaving Causal Explanations of Schizophrenia in Urban Areas: The Role of Gene-Environment Selection

Author Affiliations
  • 1Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
JAMA Psychiatry. 2018;75(9):878-880. doi:10.1001/jamapsychiatry.2018.1795

Schizophrenia has long been reported to be more common in urban areas,1,2 although recent research suggests this association may not occur in low- and middle-income countries.3 Explanations of this urbanicity association, entwined with links between the disorder and socioeconomic deprivation, have led people to question the possibilities of a reverse causal association: do people with early illness or strong liability drift into cities and down the social scale, or do those environments exert a toxic effect? Few studies dissect city life from a socioenvironmental context,4 but urbanicity certainly is associated with cognition and the brain.5 Evidence is also emerging that part of the liability to living in deprived neighborhoods is associated with genetics; it is heritable, and, moreover, genes conferring liability to schizophrenia may be particularly involved.6

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