Genetic, Environmental and psychosocial Risk Factors for Psychotic Disorders: A Case–Control Study in Damascus, Syria

Introduction: Schizophrenia is a chronic neurodevelopmental disorder characterized by positive, negative, and cognitive symptoms, leading to substantial disability and premature mortality. Affecting approximately 1% of the global population, it typically manifests in late adolescence or early adulthood. Its etiology involves complex interactions between genetic susceptibility and environmental exposures, including obstetric complications, prenatal stress, urbanicity, migration, and substance use. Despite extensive international research, data from Syria remain limited. This study aimed to investigate genetic, environmental and psychosocial risk factors associated with psychotic disorders in a Syrian population. Methodology: A case–control study was conducted at Al-Mouwasat University Hospital, Damascus, Syria, between October 2022 and October 2023. The study included 100 patients with psychotic disorders and 100 first- or second-degree relatives without psychotic disorders, aged 18–65 years. Data were collected through structured interviews covering sociodemographic characteristics, psychiatric and medical history, obstetric complications (Lewis–Murray Scale), socioeconomic status, and medication adherence (MARS). Categorical and continuous variables were analyzed using chi-square and Mann–Whitney/Kruskal–Wallis tests, respectively. Spearman correlation and binary logistic regression were performed, with statistical significance set at p < 0.05. Results Maternal prenatal stress was significantly more prevalent among cases than controls (32% vs 14%) and was associated with increased odds of psychotic disorder (OR = 2.89, 95% CI: 1.43–5.85). Cases also demonstrated significantly higher rates of obstetric complications. Rural-to-urban transition was more common among cases, whereas general migration and parental age at childbirth were not significantly associated. In multivariable analysis, employment status was independently protective, while rural-to-urban transition remained a significant risk factor. Conclusion Psychotic disorders among Syrian adults are influenced by prenatal and social factors, particularly maternal stress during pregnancy and rural-to-urban transition, while employment appears protective. These findings underscore the importance of early identification, maternal mental health support, and social interventions to reduce risk and improve outcomes.