Are diverse factors proxies for architectural influences? A case for architecture in the aetiology of schizophrenia

Introduction The last half-century of epidemiological enquiry into schizophrenia can be characterized by the search for neurological imbalances and lesions for genetic factors. The growing consensus is that these directions have failed, and there is now a growing interest in psychosocial and developmental models. Another area of recent interest is in epigenetics – the multiplication of genetic influences by environmental factors. Methods This integrative review comparatively maps current psychosocial, developmental and epigenetic models for schizophrenia epidemiology to identify crossover and theoretical gaps. Results In the flood of data that is being produced around the schizophrenia epidemiology, one of the most consistent findings is that schizophrenia is an urban syndrome. Once demographic factors have been discounted, between one-quarter and one-third of all incidence is repeatedly traced back to urbanicity – potentially threatening more established models, such as the psychosocial, genetic and developmental hypotheses. Conclusions Close analysis demonstrates how current models for schizophrenia epidemiology appear to miss the mark. Furthermore, the built environment appears to be an inextricable factor in all current models and indeed may be a valid epidemiological factor on its own. The reason the built environment hasn’t already become a de rigueur area of epidemiological research is possibly trivial – it just doesn’t attract enough science, and lacks a hero to promote it alongside other hypotheses.