Environmental and social factors in psychosis: the role of green space, social functioning and loneliness

Abstract

There is a growing evidence base recognising the risk reducing effects and potential therapeutic benefits of exposure to green spaces for common mental health problems. Chapter 1 details a systematic review investigating the incidence of schizophrenia spectrum disorders (SSDs) in relation to green space exposure, and the potential benefits of exposure for people with SSDs in terms of health service use and mental health symptoms. Seven databases were searched and twelve studies were eligible for inclusion. Findings suggest that exposure to green spaces reduces the risk of SSDs and these benefits are present from childhood through to adulthood. In addition, there is emerging evidence that exposure to green space can improve mental health symptoms and reduce health service use for people with SSDs. However, quality analysis was mixed for these benefits and studies exploring incidence were conducted mostly in Denmark, therefore these findings may not generalise cross-culturally. Future research is needed to identify the therapeutic “dose” of green space and examine any cross-cultural differences.

Social functioning and loneliness are also implicated within SSDs, with changes to these factors preceding onset of psychosis. However, little research is available which explores the relationships between social functioning, loneliness and prodromal psychosis symptoms within the general population. Chapter 2 presents a longitudinal study examining the relationships between social functioning, loneliness, prodromal symptoms and symptom related distress within a nonclinical sample. Social functioning was negatively associated with prodromal symptoms and distress, and loneliness was positively associated with prodromal symptoms and distress. Loneliness also mediated the effect of social functioning on prodromal symptoms and distress. However, the sample comprised of mostly White, female-identifying, undergraduate students, therefore these results may not generalise to other populations. The findings suggest a need to target social functioning and loneliness as preventative strategies for psychosis within student populations. Future research should determine whether these results can be applied cross-culturally or within at-risk populations.

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Identifiers

ORCID for Louise Helen Marcham: orcid.org/0000-0002-2222-0456

ORCID for Lyn Ellett: orcid.org/0000-0002-6051-3604

ORCID for Thomas Richardson: orcid.org/0000-0002-5357-4281

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