To the Editor The study findings of DeVylder et al1 on associations between urban settings and psychosis in low- and middle-income countries show heterogeneity. For some countries, risk is increased; for some, it is not. No attempt is made to investigate this heterogeneity.
In China, where urbanization underpins rapid economic development, investigating effects of social factors on brain pathology and development is crucial. Future studies should exclude bias and avoid confounding before it can be concluded that social factors have no bearing on psychosis.2 The study by DeVylder et al1 includes only individuals currently living in an urban environment with no adjustment for exposure time, whether participants were temporary work migrants, or, most importantly, if they were born in and/or exposed to urban environments during infancy.
Coid JW, Zhang Y, Li T. Urbanicity and Psychosis. JAMA Psychiatry. 2018;75(12):1301. doi:10.1001/jamapsychiatry.2018.2347
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