Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study

Giuseppe D'Andrea; Diego Quattrone; Giada Tripoli; Edoardo Spinazzola; Charlotte Gayer-Anderson; Hannah E. Jongsma; Lucia Sideli; Simona A. Stilo; Caterina La Cascia; Laura Ferraro; Daniele La Barbera; Andrea Tortelli; Eva Velthorst; Lieuwe de Haan; Pierre Michel Llorca; Jose Luis Santos; Manuel Arrojo; Julio Bobes; Julio Sanjuán; Miguel Bernardo; Celso Arango; James B. Kirkbride; Peter B. Jones; Bart P. Rutten; Franck Schürhoff; Andrei Szöke; Jim van Os; Evangelos Vassos; Jean Paul Selten; Craig Morgan; Marta Di Forti; Ilaria Tarricone; Robin M. Murray

doi:10.1111/acps.13767

Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study

Giuseppe D'Andrea^*, Diego Quattrone, Giada Tripoli, Edoardo Spinazzola, Charlotte Gayer-Anderson, Hannah E. Jongsma, Lucia Sideli, Simona A. Stilo, Caterina La Cascia, Laura Ferraro, Daniele La Barbera, Andrea Tortelli, Eva Velthorst, Lieuwe de Haan, Pierre Michel Llorca, Jose Luis Santos, Manuel Arrojo, Julio Bobes, Julio Sanjuán, Miguel BernardoCelso Arango, James B. Kirkbride, Peter B. Jones, Bart P. Rutten, Franck Schürhoff, Andrei Szöke, Jim van Os, Evangelos Vassos, Jean Paul Selten, Craig Morgan, Marta Di Forti, Ilaria Tarricone, Robin M. Murray

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.

Methods: We recruited 1080 individuals representative of the populations aged 18–64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.

Results: Population density was associated with schizotypy (β = 0.248,95%CI = 0.122–0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ² = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362–0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083–0.297;p = 0.001).

Conclusions: The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.

Original language	English
Pages (from-to)	506-520
Number of pages	15
Journal	Acta Psychiatrica Scandinavica
Volume	151
Issue number	4
Early online date	1-Nov-2024
DOIs	https://doi.org/10.1111/acps.13767
Publication status	Published - 2025

Keywords

population density
psychosis spectrum
schizotypy
urban design
urbanicity

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Acta Psychiatr Scand - 2024 - D'Andrea - Variation of subclinical psychosis as a function of population density acrossFinal publisher's version, 1.34 MBLicence: CC BY-NC

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D'Andrea, G., Quattrone, D., Tripoli, G., Spinazzola, E., Gayer-Anderson, C., Jongsma, H. E., Sideli, L., Stilo, S. A., La Cascia, C., Ferraro, L., La Barbera, D., Tortelli, A., Velthorst, E., de Haan, L., Llorca, P. M., Santos, J. L., Arrojo, M., Bobes, J., Sanjuán, J., ... Murray, R. M. (2025). Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study. Acta Psychiatrica Scandinavica, 151(4), 506-520. https://doi.org/10.1111/acps.13767

@article{8e857675c8ed4f10b1554ef9463a04a4,

title = "Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study",

abstract = "Background: Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.Methods: We recruited 1080 individuals representative of the populations aged 18–64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.Results: Population density was associated with schizotypy (β = 0.248,95%CI = 0.122–0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ2 = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362–0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083–0.297;p = 0.001).Conclusions: The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.",

keywords = "population density, psychosis spectrum, schizotypy, urban design, urbanicity",

author = "Giuseppe D'Andrea and Diego Quattrone and Giada Tripoli and Edoardo Spinazzola and Charlotte Gayer-Anderson and Jongsma, {Hannah E.} and Lucia Sideli and Stilo, {Simona A.} and {La Cascia}, Caterina and Laura Ferraro and {La Barbera}, Daniele and Andrea Tortelli and Eva Velthorst and {de Haan}, Lieuwe and Llorca, {Pierre Michel} and Santos, {Jose Luis} and Manuel Arrojo and Julio Bobes and Julio Sanju{\'a}n and Miguel Bernardo and Celso Arango and Kirkbride, {James B.} and Jones, {Peter B.} and Rutten, {Bart P.} and Franck Sch{\"u}rhoff and Andrei Sz{\"o}ke and {van Os}, Jim and Evangelos Vassos and Selten, {Jean Paul} and Craig Morgan and {Di Forti}, Marta and Ilaria Tarricone and Murray, {Robin M.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.",

year = "2025",

doi = "10.1111/acps.13767",

language = "English",

volume = "151",

pages = "506--520",

journal = "Acta Psychiatrica Scandinavica",

issn = "0001-690X",

publisher = "Wiley",

number = "4",

}

D'Andrea, G, Quattrone, D, Tripoli, G, Spinazzola, E, Gayer-Anderson, C, Jongsma, HE, Sideli, L, Stilo, SA, La Cascia, C, Ferraro, L, La Barbera, D, Tortelli, A, Velthorst, E, de Haan, L, Llorca, PM, Santos, JL, Arrojo, M, Bobes, J, Sanjuán, J, Bernardo, M, Arango, C, Kirkbride, JB, Jones, PB, Rutten, BP, Schürhoff, F, Szöke, A, van Os, J, Vassos, E, Selten, JP, Morgan, C, Di Forti, M, Tarricone, I & Murray, RM 2025, 'Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study', Acta Psychiatrica Scandinavica, vol. 151, no. 4, pp. 506-520. https://doi.org/10.1111/acps.13767

TY - JOUR

T1 - Variation of subclinical psychosis as a function of population density across different European settings

T2 - Findings from the multi-national EU-GEI study

AU - D'Andrea, Giuseppe

AU - Quattrone, Diego

AU - Tripoli, Giada

AU - Spinazzola, Edoardo

AU - Gayer-Anderson, Charlotte

AU - Jongsma, Hannah E.

AU - Sideli, Lucia

AU - Stilo, Simona A.

AU - La Cascia, Caterina

AU - Ferraro, Laura

AU - La Barbera, Daniele

AU - Tortelli, Andrea

AU - Velthorst, Eva

AU - de Haan, Lieuwe

AU - Llorca, Pierre Michel

AU - Santos, Jose Luis

AU - Arrojo, Manuel

AU - Bobes, Julio

AU - Sanjuán, Julio

AU - Bernardo, Miguel

AU - Arango, Celso

AU - Kirkbride, James B.

AU - Jones, Peter B.

AU - Rutten, Bart P.

AU - Schürhoff, Franck

AU - Szöke, Andrei

AU - van Os, Jim

AU - Vassos, Evangelos

AU - Selten, Jean Paul

AU - Morgan, Craig

AU - Di Forti, Marta

AU - Tarricone, Ilaria

AU - Murray, Robin M.

PY - 2025

Y1 - 2025

N2 - Background: Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.Methods: We recruited 1080 individuals representative of the populations aged 18–64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.Results: Population density was associated with schizotypy (β = 0.248,95%CI = 0.122–0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ2 = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362–0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083–0.297;p = 0.001).Conclusions: The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.

AB - Background: Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.Methods: We recruited 1080 individuals representative of the populations aged 18–64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.Results: Population density was associated with schizotypy (β = 0.248,95%CI = 0.122–0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ2 = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362–0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083–0.297;p = 0.001).Conclusions: The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.

KW - population density

KW - psychosis spectrum

KW - schizotypy

KW - urban design

KW - urbanicity

UR - http://www.scopus.com/inward/record.url?scp=85208069748&partnerID=8YFLogxK

U2 - 10.1111/acps.13767

DO - 10.1111/acps.13767

M3 - Article

AN - SCOPUS:85208069748

SN - 0001-690X

VL - 151

SP - 506

EP - 520

JO - Acta Psychiatrica Scandinavica

JF - Acta Psychiatrica Scandinavica

IS - 4

ER -

Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study

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