Does Built Environment Impact Baseline Clinical Presentations for People in Early Psychosis Treatment?
Iqra Imam (1), Kelsey A. Johnson (1), Raquelle I. Mesholam-Gately (1,2), Margaret E. Guyer (3), Matcheri Keshavan (1,2)
1. Beth Israel Deaconess Medical Center, Boston, MA
2. Harvard Medical School Department of Psychiatry, Boston, MA
3. Massachusetts Department of Mental Health, Boston, MA
Background: In public health research, “built environment” refers to the physical spaces in which people live, work, and recreate. The inequitable distribution of resources across communities creates inequities in environments that support health. For individuals with schizophrenia, environmental factors such as urbanization and socioeconomic status (SES) are known to impact symptom severity and quality of life. In this study, we assess the impact of built environment on psychosis through the CDC Social Vulnerability Index (SVI), which highlights factors such as housing, neighborhood racial density, and SES.
Methods: The SVI dataset includes geographical data for four main themes: socioeconomic status, household characteristics, racial and ethnic minority status, and housing type & transportation. We mapped these themes for Massachusetts using the ArcGIS software and overlaid this information with zip code data from the MAPNET Assessment Battery. Analyses compared SVI themes with clinical outcome variables in the MAPNET Assessment Battery including baseline symptom severity, substance use, and quality of life.
Results: In total, 299 zip codes were available from MAPNET assessments collected between 2017-2024, with 202 having follow-up data. Total social vulnerability did not differ significantly between those with and without follow-up data (t=-0.42, p=0.67). We report on analyses which explore the associations between social vulnerability and baseline symptom presentations, including symptom severity, substance use, and quality of life.
Conclusions: This project used geographical analyses to examine the impact of built environment on individuals being treated for first-episode psychosis. These methods can be beneficial in showing which environmental factors impact care the most, and which have a primary role in patients’ quality of life. Ultimately, we hope that geomapping methods may guide the implementation of innovative public health supports for serious mental illness across Massachusetts.