It's almost the end of another long day. Outside the confines of my four-walled, windowless, room-for-one-and-a-small-cat office, I'm informed (via my computer's dashboard) that the UK has been afforded a rare glimpse of summer: it's a balmy 28°C outside. Unfortunately, confined as I am to my 8 m concrete-enclosed capsule, it's just as hot – and twice as humid – inside the hospital where I work. The ailing fan is doing its best to force the saturated air around my room, and the bright, strip neon lighting is defying the odds by keeping a browning vine alive. Seeking a change from the statistical models I've been struggling with all day, I turn to The Impact of the Environment on Psychiatric Disorder.
The book itself is divided into 11 approachable chapters, providing a comprehensive overview of the central themes – both historically and currently – in research investigating the role of the environment in psychiatric disorder. One of the most notable features of the book is its ability to cover the breadth of environmental issues concerning contemporary psychiatric research, while remaining concise, accessible and informative. The major psychiatric outcomes of anxiety, depression, suicide and schizophrenia receive roughly equal weighting. Other disorders, including post-traumatic stress disorder, bipolar disorder and personality disorders, are also addressed.
The introduction to the book is timely and bold, questioning current methodological approaches in environmental research and the erroneous pursuit of the single risk factor for psychiatric disorders. The book is not limited to critiquing its own field, and the first chapter proper, an excellent review of gene–environment interactions by Ming Tsuang and colleagues, highlights the need for genetic and environmental perspectives to align more closely if we are to progress in our search for the causes of psychiatric disorders.
Three further chapters provide reviews of geographical variation in psychiatric disorders, urban–rural differences and socioeconomic status, and the relationship between migration and mental health, respectively. There are also important contributions on the role of psychosocial factors and social support, and how these may mediate the relationship between the environment and mental health. Two chapters address the role of the physical environment, which often receives less attention than social or biological factors. The book does not directly address toxicological causes of psychiatric disorder, such as pollutants or infections, save for their possible role in the season-of-birth effect, reviewed here in the penultimate chapter. The only other notable omission is the exclusion of a chapter on the family environment and psychiatric disorder. The book concludes by considering psychiatric morbidity following disasters, providing an important overview of this methodologically challenging research.
Freeman and Stansfeld have produced an excellent, comprehensive and concise introduction to environmental research in psychiatry. Equally, the book's clarity of thinking will serve as a useful reference within the field. Finally, it provides a timely reminder that a new generation of studies will be required; directly capable of elucidating the complex, life course associations between genes, individuals and their environments, if we are to further our understanding of psychiatric disorders.
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