Psychosis

Abstract Evidence for a causal role for social conditions in psychosis is slowly accumulating. Three overlapping associations stand out. Firstly, a dose–response relationship with growing up in urban environments and evidence that changing this urban exposure, for example by moving to a more rural location decreases risk. Secondly, belonging to a minority group (e.g. black ethnicity), especially when resident in neighbourhoods where minorities form a small proportion of the population. Thirdly, exposure to sexual and other abuse in childhood and adolescence and to intrusive experiences in adulthood. These causal pathways overlap and interact, affecting perceptions of risk and the trustworthiness of other people, with clear implications for the delivery of psychiatric services.