When the Structural, Social, and Biological Domains Converge: The Case of Neighborhood Ethnic Density and Psychosis.

Abstract: Biological mechanisms associated with psychosis risk are often formed by generations of social-environmental experiences within families, communities, and neighborhoods, and further shaped by structural policies. This column first describes conceptual work that integrates macrolevel structural, individual-level social, and biological domains to better understand psychosis risk. It then highlights the interconnection of low neighborhood ethnic density and racial exclusion as an example of how social determinants connect to social and biological consequences associated with psychosis outcomes. Neighborhood ethnoracial diversity may be protective against social and biological mechanisms connected to psychosis outcomes among minoritized groups at risk for psychosis. This is particularly salient during childhood because such diversity attenuates stress processes associated with social exclusion and discrimination. Moreover, ethnoracially diverse communities foster close relationships and social connection. We provide supportive literature to illustrate the importance of multilevel/multifactorial approaches for identifying psychosis risk and protective factors. Investing further in integrative approaches for understanding psychosis risk and prognosis may translate into more substantial improvements for individuals with these lived experiences.