The Intersection of Community Violence and First Episode Psychosis: An Exploratory Analysis in the Metro Boston Area
Anne Thompson, (1,2) Brittany Gouse, (1,2) Danielle Walker, (1,2) Cindy Xu, Samantha LaMartine, (1,2) Ellie Reagan, (1,2) Amelia Blanton, (1,2)Hannah E. Brown (1,2)
1: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
2: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA
Background: Witnessed and experienced trauma increase the risk of the development of a schizophrenia spectrum disorder (SSD) and increase the severity of psychotic symptoms. Post traumatic stress disorder (PTSD) is commonly underrecognized in SSDs and when untreated carries adverse prognostic outcomes. Here, we explore potential exposure to community violence among individuals with first episode psychosis (FEP) on a neighborhood level at an urban safety net hospital.
Methods: We performed a cross sectional analysis of clinic census data for individuals who enrolled in Boston Medical Center’s FEP program between 2019-2022. Only patients living in the metro boston area policed by Boston Police Department were included. Patient addresses were used to crosswalk patient-level data to Boston Police Department Bureau of Intelligence and Analysis data on fatal and non-fatal shootings in 2022. We used descriptive statistics as well as independent t-tests and chi squared tests to explore the relationship between sociodemographic factors and shooting rates on both a neighborhood and individual level. We also performed a mixed effects model to control for neighborhood-level clustering.
Results: There was complete geocoding data for 136 FEP patients. The number of yearly shootings in Boston varied widely on a neighborhood level, from 2 in West Roxbury to 47 in Mattapan in 2022. The majority of our clinic (72.8%) lived in the top quartile for gun violence in Boston. We did not find statistically significant associations between age, race, gender, or primary language, insurance, and neighborhood-level gun violence in bivariate or multivariate analyses.
Conclusions: At our safety-net hospital, the vast majority of of patients in our FEP program live in communities with relatively high rates of gun violence. Our next step is to examine the impact of neighborhood-level gun violence on outcomes such as the duration of untreated psychosis and comorbid PTSD.