Urbanicity and psychotic experiences: Social adversities, isolation and exposure to natural environments predict psychosis

Background: Research has shown that incidence rates of psychotic experiences are higher in urban areas, defined by their population density, and that an increasing number of people move to cities. Thus, it is critical to understand which characteristics of cities drive this association. To date, efforts to explore urban risk have predominantly focused on a few or single preselected candidate factors and clinical populations. Methods: We aimed to identify the best predictors of psychotic experiences (PE) in a subclinical population, considering 26 factors describing the physical and social environment. Two feature selection models were employed, i.e., a Boruta algorithm, a random forests approach, and an elastic net penalised logistic regression model. Results: Individual-specific social environment features emerged as the most robust predictors of PE, including childhood adversity, stressful life events, social isolation and low household income. Exposure to natural environments was found to be negatively associated with PE. Conclusions: Spending more time in residential natural environments could be an actionable target for preventing and treating psychosis.