Structural brain abnormalities in schizophrenia in adverse environments: examining the effect of poverty and violence in six Latin American cities
Journal
The British Journal of Psychiatry
ISSN
0007-1250
1472-1465
Date Issued
2020
Author(s)
Nicolas A. Crossley
Andre Zugman
Francisco Reyes-Madrigal
Leticia S. Czepielewski
Mariana N. Castro
Ana M. Diaz-Zuluaga
Julian A. Pineda-Zapata
Ramiro Reckziegel
Ary Gadelha
Andrea Jackowski
Cristiano Noto
Luz M. Alliende
Barbara Iruretagoyena
Tomas Ossandon
Juan P. Ramirez-Mahaluf
Carmen P. Castañeda
Alfonso Gonzalez-Valderrama
Ruben Nachar
Pablo León-Ortiz
Carlos López-Jaramillo
Salvador M. Guinjoan
Clarissa S. Gama
Camilo de la Fuente-Sandoval
Rodrigo A. Bressan
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Summary</jats:title><jats:sec id="S0007125020001439_sec_a1"><jats:title>Background</jats:title><jats:p>Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.</jats:p></jats:sec><jats:sec id="S0007125020001439_sec_a2"><jats:title>Aims</jats:title><jats:p>We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.</jats:p></jats:sec><jats:sec id="S0007125020001439_sec_a3" sec-type="methods"><jats:title>Method</jats:title><jats:p>This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.</jats:p></jats:sec><jats:sec id="S0007125020001439_sec_a4" sec-type="results"><jats:title>Results</jats:title><jats:p>A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (<jats:italic>P</jats:italic> = 0.006). Controls showed a positive correlation between total grey matter volume and income (<jats:italic>R</jats:italic> = 0.14, <jats:italic>P</jats:italic> = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (<jats:italic>R</jats:italic> = −0.076, <jats:italic>P</jats:italic> = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.</jats:p></jats:sec><jats:sec id="S0007125020001439_sec_a5" sec-type="conclusions"><jats:title>Conclusions</jats:title><jats:p>Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.</jats:p></jats:sec>
Subjects
schizophrenia
;
magnetic resonance imaging
;
grey matter
;
violence
;
poverty
;
brain
;
cities
;
gray matter
;
humans
;
latin america
;
magnetic resonance imaging
;
poverty
;
schizophrenia
;
violence
;
adult
;
article
;
brain function
;
brain region
;
clinical feature
;
cohort analysis
;
controlled study
;
data analysis software
;
demography
;
environmental exposure
;
female
;
gray matter volume
;
hippocampus
;
homicide
;
household income
;
human
;
image processing
;
image segmentation
;
low income country
;
major clinical study
;
male
;
middle income country
;
multicenter study
;
neighborhood
;
neuroimaging
;
neuropathology
;
nuclear magnetic resonance imaging
;
occipital cortex
;
poverty
;
prefrontal cortex
;
right hippocampus
;
schizophrenia
;
schizophreniform disorder
;
south and central america
;
violence
;
brain
;
city
;
clinical trial
;
diagnostic imaging
;
gray matter
;
poverty
;
schizophrenia
;
violence