Schizophrenia is a chronic brain disorder that affects around 24 million people worldwide. Psychosis is one of the main diagnostic symptoms. Individuals with schizophrenia, as well as those at clinical high-risk for psychosis (CHR-P), are disproportionately exposed to adverse social determinants of health (SDOH). These exposures are key drivers of health inequity in schizophrenia, being consistently linked to earlier illness onset and poorer long-term outcomes. Yet, the brain-based mechanisms through which structural disadvantage becomes biologically embedded are unknown.
We first investigated the relationship between life events and global structural brain metrics in CHR-P and healthy control (HC) individuals recruited from the 9-site North American Prodrome Longitudinal Study 3 (NAPLS3). We found that CHR-P individuals experience greater adverse SDOH exposure than HC.
Part two of the project examines how SDOH correlate with the amygdala, hippocampus, and total cortical volume, along with brain age. We found significant correlations between SDOH domains and brain metrics, providing novel evidence for linking greater risk for violent behavior, poorer premorbid adjustment, and greater life event stress with brain abnormalities in CHR-P, consistent with the relationship we’ve observed in schizophrenia patients.
These findings highlight the importance of studying the CHR-P phase as these detrimental associations predate psychosis onset, so this can help clinicians identify at-risk individuals and prevent or delay the onset of severe psychotic disorders like schizophrenia and improve long-term mental health outcomes. Further research is also important to find biomarkers in SDOHs or brain structure that can act as predictors of conversion to psychosis.