Slum living predicts psychosis severity in first-episode patients

Abstract

The impact of social exclusion on psychosis is poorly understood. This study explores how slum living affects some clinical markers of patients in the first episode of psychosis. We hypothesized that living in a slum would lead to a longer duration of untreated psychosis and greater initial psychosis severity, as measured by the positive and negative syndrome scale. To test this hypothesis, we studied—in São Paulo, Brazil—a sample of 190 antipsychotic-naive patients in the first episode of psychosis. Living in a slum area was positively correlated with a higher initial positive and negative syndrome scale total score (p = 0.029, B = 9.882) and severity of negative (p = 0.044, B = 1.906) and disorganization (p = 0.032, B = 2.474) symptoms. We also found statistically significant associations between lower income and educational levels and higher positive and negative syndrome scale and between longer duration of untreated psychosis and brown or Black races. Our main findings reinforce the broader idea that social exclusion impacts core psychotic disorders’ clinical features. Psychosis severity was analyzed during the first episode of psychosis in São Paulo by place of residence (in slums), age, sex and race. A positive correlation was found between people with high positive and negative syndrome scale scores (a measure of psychosis severity) and high negative and disorganization symptoms.