# Impact of Neighborhood Characteristics on Conversion to Psychosis among Youth at Clinical High Risk for Psychosis

> **NIH NIH K23** · EMORY UNIVERSITY · 2023 · $194,076

## Abstract

Project Summary/Abstract
The proposed research and training plan are designed to promote my development as an independent
investigator in the field of neighborhood characteristics as they relate to conversion to psychosis through
neurobiological and psychosocial mediators among youth at clinical high risk for psychosis (CHR-P). Urban
upbringing (growing up in cities as compared to rural areas) is one of the strongest environmental risk factors
for schizophrenia. More recent studies have suggested that social stress might explain this association. In
particular, neighborhood residential instability (NRI) has been used to measure social fragmentation and has
also been associated with increased schizophrenia rates and prevalence. In addition, my published work found
that NRI predicts an earlier age at onset of psychosis among individuals with first-episode psychosis even after
controlling for known risk factors. Furthermore, my preliminary data indicate that county-level residential
instability (a rough proxy for NRI) during childhood 1) predicts conversion to psychosis and 2) predicts smaller
corticolimbic gray matter volume (GMV) among a subset of youth at CHR-P who never moved. Dr. Walker (one
of my mentors) has shown that psychosocial deprivation as measured by reduced childhood peer
relationships, parental absence, and emotional neglect is associated with smaller corticolimbic GMV, whereas
threat (defined as exposures that involve harm; e.g., childhood sexual and physical abuse) is not. Based on
these findings, I hypothesize that NRI leads to psychosocial deprivation, which in turn contributes to smaller
corticolimbic GMV, which ultimately increases risk for psychosis. To test this hypothesis, I propose the
following Specific Aims: (1) Test the association between NRI and conversion to psychosis and corticolimbic
GMV, including the cortical, perigenual anterior cingulate cortex, and hippocampal GMV and control regions
including insula and thalamus. (2) Test the association between NRI and psychosocial deprivation and threat.
(3) Explore the experiences and circumstances of youth at CHR-P living in residential areas that differ in NRI,
from very unstable to highly stable. The proposed studies will provide a novel integration of multiple levels of
investigation including public health, developmental studies in humans, and the impact of environmental
factors on the brain and behavior to discover novel targets for intervention both at the individual and
neighborhood levels to prevent or mitigate psychosis conversion in high-risk individuals. Future research will
further elucidate the relationship of neighborhood characteristics with the psychosocial and neurobiological
factors associated with risk for psychosis, such as investigating whether NRI exposure at specific
developmental periods and regional brain changes would have a differential impact on psychosis. If NRI leads
to psychosocial deprivation and neurobiological changes, for example, target...

## Key facts

- **NIH application ID:** 10650851
- **Project number:** 5K23MH129684-02
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Benson Ku
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $194,076
- **Award type:** 5
- **Project period:** 2022-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10650851

## Citation

> US National Institutes of Health, RePORTER application 10650851, Impact of Neighborhood Characteristics on Conversion to Psychosis among Youth at Clinical High Risk for Psychosis (5K23MH129684-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10650851. Licensed CC0.

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