Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 44
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Heslin, M. Desai, R. Lappin, J. M. Donoghue, K. Lomas, B. Reininghaus, U. Onyejiaka, A. Croudace, T. Jones, P. B. Murray, R. M. Fearon, P. Doody, G. A. Dazzan, P. Fisher, H. L. Demjaha, A. Craig, T. and Morgan, C. 2016. Biological and psychosocial risk factors for psychotic major depression. Social Psychiatry and Psychiatric Epidemiology, Vol. 51, Issue. 2, p. 233.

    Linszen, Mascha M.J. Brouwer, Rachel M. Heringa, Sophie M. and Sommer, Iris E. 2016. Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses. Neuroscience & Biobehavioral Reviews, Vol. 62, p. 1.

    Reininghaus, Ulrich Kempton, Matthew J. Valmaggia, Lucia Craig, Tom K. J. Garety, Philippa Onyejiaka, Adanna Gayer-Anderson, Charlotte So, Suzanne H. Hubbard, Kathryn Beards, Stephanie Dazzan, Paola Pariante, Carmine Mondelli, Valeria Fisher, Helen L. Mills, John G. Viechtbauer, Wolfgang McGuire, Philip van Os, Jim Murray, Robin M. Wykes, Til Myin-Germeys, Inez and Morgan, Craig 2016. Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study. Schizophrenia Bulletin, Vol. 42, Issue. 3, p. 712.

    de Sousa, Paulo Spray, Amy Sellwood, William and Bentall, Richard P. 2015. ‘No man is an island’. Testing the specific role of social isolation in formal thought disorder. Psychiatry Research, Vol. 230, Issue. 2, p. 304.

    Di Forti, Marta Marconi, Arianna Carra, Elena Fraietta, Sara Trotta, Antonella Bonomo, Matteo Bianconi, Francesca Gardner-Sood, Poonam O'Connor, Jennifer Russo, Manuela Stilo, Simona A Marques, Tiago Reis Mondelli, Valeria Dazzan, Paola Pariante, Carmine David, Anthony S Gaughran, Fiona Atakan, Zerrin Iyegbe, Conrad Powell, John Morgan, Craig Lynskey, Michael and Murray, Robin M 2015. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. The Lancet Psychiatry, Vol. 2, Issue. 3, p. 233.

    Hodgekins, J. Birchwood, M. Christopher, R. Marshall, M. Coker, S. Everard, L. Lester, H. Jones, P. Amos, T. Singh, S. Sharma, V. Freemantle, N. and Fowler, D. 2015. Investigating trajectories of social recovery in individuals with first-episode psychosis: a latent class growth analysis. The British Journal of Psychiatry, Vol. 207, Issue. 6, p. 536.

    O'Donoghue, Brian Nelson, Barnaby Yuen, Hok Pan Lane, Abbie Wood, Stephen Thompson, Andrew Lin, Ashleigh McGorry, Patrick and Yung, Alison R. 2015. Social environmental risk factors for transition to psychosis in an Ultra-High Risk population. Schizophrenia Research, Vol. 161, Issue. 2-3, p. 150.

    Revier, Camice J. Reininghaus, Ulrich Dutta, Rina Fearon, Paul Murray, Robin M. Doody, Gillian A. Croudace, Tim Dazzan, Paola Heslin, Margaret Onyejiaka, Adanna Kravariti, Eugenia Lappin, Julia Lomas, Ben Kirkbride, James B. Donoghue, Kim Morgan, Craig and Jones, Peter B. 2015. Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study. The Journal of Nervous and Mental Disease, Vol. 203, Issue. 5, p. 379.

    Smyth, Natasha Siriwardhana, Chesmal Hotopf, Matthew and Hatch, Stephani L. 2015. Social networks, social support and psychiatric symptoms: social determinants and associations within a multicultural community population. Social Psychiatry and Psychiatric Epidemiology, Vol. 50, Issue. 7, p. 1111.

    Tortelli, A. Errazuriz, A. Croudace, T. Morgan, C. Murray, R. M. Jones, P. B. Szoke, A. and Kirkbride, J. B. 2015. Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950–2013. Social Psychiatry and Psychiatric Epidemiology, Vol. 50, Issue. 7, p. 1039.

    Akdeniz, Ceren Tost, Heike and Meyer-Lindenberg, Andreas 2014. The neurobiology of social environmental risk for schizophrenia: an evolving research field. Social Psychiatry and Psychiatric Epidemiology, Vol. 49, Issue. 4, p. 507.

    Bowers, L. 2014. Safewards: a new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing, Vol. 21, Issue. 6, p. 499.

    Lim, Michelle H. and Gleeson, John F. 2014. Social Connectedness Across the Psychosis Spectrum: Current Issues and Future Directions for Interventions in Loneliness. Frontiers in Psychiatry, Vol. 5,

    Murray, Robin M. Sideli, Lucia Mulè, Alice and La Barbera, Daniele 2014. Searching for the truth about schizophrenia requires the application of similarly high standards of proof to biological and social risk factors∗. Psychosis, Vol. 6, Issue. 1, p. 85.

    Sideli, L. D’Agostino, R. Tripoli, G. La Cascia, C. Seminerio, F. Marinaro, A.M. Sartorio, C. Mulè, A. and La Barbera, D. 2014. EPA-0874 – Social disadvantage and psychosis: a case control study on italian first-episodes of psychosis. European Psychiatry, Vol. 29, p. 1.

    Sündermann, Oliver Onwumere, Juliana Kane, Fergus Morgan, Craig and Kuipers, Elizabeth 2014. Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety. Social Psychiatry and Psychiatric Epidemiology, Vol. 49, Issue. 3, p. 359.

    Suvisaari, Jaana Opler, Mark Lindbohm, Marja-Liisa and Sallmén, Markku 2014. Risk of schizophrenia and minority status: A comparison of the Swedish-speaking minority and the Finnish-speaking majority in Finland. Schizophrenia Research, Vol. 159, Issue. 2-3, p. 303.

    Webber, Martin 2014. From Ethnography to Randomized Controlled Trial: An Innovative Approach to Developing Complex Social Interventions. Journal of Evidence-Based Social Work, Vol. 11, Issue. 1-2, p. 173.

    DeVylder, Jordan E. Oh, Hans Y. Yang, Lawrence H. Cabassa, Leopoldo J. Chen, Fang-pei and Lukens, Ellen P. 2013. Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States. Schizophrenia Research, Vol. 150, Issue. 1, p. 223.

    Gayer-Anderson, C. and Morgan, C. 2013. Social networks, support and early psychosis: a systematic review. Epidemiology and Psychiatric Sciences, Vol. 22, Issue. 02, p. 131.


Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study

  • C. Morgan (a1), J. Kirkbride (a2), G. Hutchinson (a3), T. Craig (a1) (a4), K. Morgan (a5), P. Dazzan (a4), J. Boydell (a4), G. A. Doody (a6), P. B. Jones (a2), R. M. Murray (a4), J. Leff (a4) and P. Fearon (a4)
  • DOI:
  • Published online: 10 November 2008

Numerous studies have reported high rates of psychosis in the Black Caribbean population in the UK. Recent speculation about the reasons for these high rates has focused on social factors. However, there have been few empirical studies. We sought to compare the prevalence of specific indicators of social disadvantage and isolation, and variations by ethnicity, in subjects with a first episode of psychosis and a series of healthy controls.


All cases with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were recruited over a 3-year period. Data relating to clinical and social variables were collected from cases and controls.


On all indicators, cases were more socially disadvantaged and isolated than controls, after controlling for potential confounders. These associations held when the sample was restricted to those with an affective diagnosis and to those with a short prodrome and short duration of untreated psychosis. There was a clear linear relationship between concentrated disadvantage and odds of psychosis. Similar patterns were evident in the two main ethnic groups, White British and Black Caribbean. However, indicators of social disadvantage and isolation were more common in Black Caribbean subjects than White British subjects.


We found strong associations between indicators of disadvantage and psychosis. If these variables index exposure to factors that increase risk of psychosis, their greater prevalence in the Black Caribbean population may contribute to the reported high rates of psychosis in this population.

Corresponding author
*Address for correspondence: C. Morgan, Ph.D., Centre for Public Mental Health, Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

E Agerbo , M Byrne , WW Eaton , PB Mortensen (2004). Marital and labour market status in the long run in schizophrenia. Archives of General Psychiatry 61, 2833.

J Allardyce , H Gilmour , J Atkinson , T Rapson , J Bishop , RG McCreadie (2005). Social fragmentation, deprivation and urbanicity. British Journal of Psychiatry 187, 401406.

J Boydell , J van Os , K McKenzie , J Allardyce , R Goel , RG McCreadie , R Murray (2001). Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. British Medical Journal 323, 13361338.

B Cooper (2005). Immigration and schizophrenia: the social causation hypothesis revisited. British Journal of Psychiatry 186, 361363.

H Hafner , W Loffler , K Maurer , M Hambrecht , W der Heiden (1999). Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatrica Scandinavica 100, 105118.

J Harrison , S Barrow , F Creed (1995). Social deprivation and psychiatric admission rates among different diagnostic groups. British Journal of Psychiatry 167, 450462.

CA Harvey , C Pantellis , J Taylor , PJ McCabe , K Lefevre , PG Campbell , SR Hirsch (1996). The Camden schizophrenia surveys. II. High prevalence of schizophrenia in an inner London borough and its relationship to socio-demographic factors. British Journal of Psychiatry 168, 418426.

A Hollingshead , RC Redlich (1958). Social Class and Mental Illness. Wiley: London.

G Hutchinson , R Mallett , H Fletcher (1999). Are the increased rates of psychosis reported for the population of Caribbean origin in Britain an urban effect? International Review of Psychiatry 11, 122128.

A Jablensky , N Sartorius , G Ernberg , M Anker , A Korten , JA Cooper , R Day , A Bertlesen (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine (Monograph Supplement) 20, 197.

R Jenkins , H Meltzer (1995). The National Psychiatric Morbidity Survey in Great Britain. Social Psychiatry and Psychiatric Epidemiology 30, 14.

PB Jones , P Bebbington , A Foerster , SW Lewis , R Murray , A Russell , P Sham , BK Toone , S Wilkins (1993). Premorbid social underachievement in schizophrenia: results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry 162, 6571.

S Karlsen , J Nazroo (2002). Relation between racial discrimination, social class, and health among ethnic minority groups. American Journal of Public Health 92, 624631.

J Kirkbride , P Fearon , C Morgan , P Dazzan , K Morgan , J Tarrant , T Lloyd , J Holloway , G Hutchinson , J Leff , R Mallett , G Harrison , R Murray , P Jones (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry 63, 250258.

R Mallett , J Leff , D Bhugra , D Pang , JH Zhao (2002). Social environment, ethnicity and schizophrenia. Social Psychiatry and Psychiatric Epidemiology 37, 329335.

S Marwaha , S Johnson (2004). Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.

C Morgan , R Abdul-Al , J Lappin , P Jones , P Fearon , M Leese , T Croudace , K Morgan , P Dazzan , T Craig , J Leff , R Murray (2006). Clinical and social determinants of duration of untreated psychosis in the AESOP first-episode psychosis study. British Journal of Psychiatry 189, 446452.

C Morgan , T Burns , R Fitzpatrick , V Pinfold , S Priebe (2007 a). Social exclusion and mental health: a conceptual and methodological review. British Journal of Psychiatry 191, 477483.

C Morgan , H Fisher (2007). Environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.

C Morgan , J Kirkbride , J Leff , T Craig , G Hutchinson , K McKenzie , K Morgan , P Dazzan , G Doody , P Jones , R Murray , P Fearon (2007 b). Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychological Medicine 37, 495505.

I Myin-Germeys , J van Os (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.

C Pedersen , P Mortensen (2001). Evidence of a dose–response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 10391046.

JP Selten , E Cantor-Graae (2005). Social defeat: risk factor for psychosis. British Journal of Psychiatry 187, 101102.

M Sharpley , G Hutchinson , K McKenzie , R Murray (2001). Understanding the excess of psychosis among the African-Caribbean population in England. British Journal of Psychiatry 178 (Suppl. 40), s60s68.

G Thornicroft , G Strathdee , M Phelan , F Holloway , T Wykes , G Dunn , P McCrone , M Leese , S Johnson , G Szmukler (1998). Rationale and design. PRiSM Psychosis Study I. British Journal of Psychiatry 173, 363370.

E Walsh , M Leese , PJ Taylor , I Johnson , T Burns , F Creed , A Higgit , R Murray (2002). Psychosis in high security and general psychiatric services: report from the UK700 and Special Hospitals' Treatment Resistant Schizophrenia groups. British Journal of Psychiatry 180, 351357.

M Webber , P Huxley (2004). Social exclusion and risk of emergency compulsory admission. A case-control study. Social Psychiatry and Psychiatric Epidemiology 39, 10001009.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *