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. Author manuscript; available in PMC: 2026 Oct 7.
Published in final edited form as: Schizophr Res. 2026 Sep 22;297:669–676. doi: 10.1016/j.schres.2026.09.021

Hippocampal volume and persistent distressing psychotic-like experiences across early adolescence: the moderating role of physical activity

Benson S Ku a,*, Ella J Arrant a, Katherine SF Damme b, Elaine F Walker c
PMCID: PMC13641160  NIHMSID: NIHMS2211478  PMID: 42832871

Abstract

Background.

Persistent distressing psychotic-like experiences (PLEs) in youth are associated with cognitive, functional, and psychiatric impairments. Reduced hippocampal volume (HV) is a nonspecific neurodevelopmental risk marker across psychiatric disorders. While physical activity is associated with better mental health, the characteristics of physical activity most relevant to these outcomes remain unclear. This study examined whether HV is associated with persistent distressing PLEs in early adolescence and whether physical activity, particularly team sports, moderates this relationship.

Methods.

Using data from 9,476 Adolescent Brain Cognitive Development Study youth, this longitudinal study examined associations between HV (age 10) and persistent distressing PLEs (ages 10–13), and whether physical activity (age 10) moderated these associations. HV was derived from structural MRI. Physical activity type and frequency were parent-reported. PLEs were assessed using the Prodromal Questionnaire-Brief Child Version. Multilevel logistic regression models adjusted for intracranial volume, demographics, study site, and family.

Results.

Reduced right HV was associated with greater odds of persistent distressing PLEs (adjusted odds ratio [aOR] per 1-SD increase = 0.91, 95% CI: 0.85 to 0.98). Team sports participation moderated this association (interaction aOR=1.07, 95% CI: 1.01 to 1.14), such that it was no longer statistically significant at higher participation levels (+1 SD; β=0.001, 95% CI: −0.01 to 0.01).

Conclusions.

Reduced right HV was associated with persistent distressing PLEs, with a weaker association observed among youth with greater team sports participation, suggesting a potential role of physical activity and social context. Findings warrant further investigation of features of team-based activities as potential modifiable factors in future prevention research.

1. Introduction

Persistent and distressing psychotic-like experiences (PLEs) are strongly associated with the development of psychosis (Karcher et al., 2022; Oh et al., 2024; Trotta et al., 2020; Kline et al., 2014). Symptom persistence and distress are linked to greater functional impairment, mental health service utilization, cognitive deficits, and future psychopathology (Karcher et al., 2022; Dominguez et al., 2011; Downs et al., 2013; Kline et al., 2014). Despite evidence of their potential importance, the mechanisms and modifiable environmental factors that shape the emergence and persistence of distressing PLEs remain poorly understood.

Hippocampal volume (HV) has been identified as a nonspecific marker of vulnerability across a wide range of psychiatric conditions, including psychotic disorders (Brosch et al., 2022; Smith, 2005; Videbech and Ravnkilde, 2004; Mondelli et al., 2011; Van Erp et al., 2016; Besteher et al., 2020; Heckers and Konradi, 2015; Chopra et al., 2023). The presence of hippocampal asymmetries in schizophrenia further suggests that left and right HV may not be interchangeable when considering their associations with psychosis-related outcomes (Gutman et al., 2022). Hippocampal atrophy is thought to disrupt inhibitory neuron function, resulting in glutamatergic dysregulation and downstream striatal dopamine hyperactivity, a core feature of psychosis pathophysiology (Lodge and Grace, 2011; Mathew et al., 2014; Lieberman et al., 2018; Pines et al., 2025). Moreover, the hippocampus is highly sensitive to stress; chronic stress and sustained hypothalamic-pituitary-adrenal axis activation can exacerbate hippocampal atrophy, creating a feed-forward loop that increases psychosis vulnerability (Damme et al., 2024a; Walker et al., 2008).

Given these converging pathways linking hippocampal integrity to psychosis risk, identifying behavioral and environmental factors associated with hippocampal structure may provide important insight into potentially modifiable influences on neurodevelopment. Physical activity, for example, has been associated with hippocampal neurogenesis (Hopkins et al., 2011; Ma et al., 2017; Yau et al., 2011), improved stress regulation (Zhang et al., 2024; Dastamooz et al., 2025), and enhanced antioxidant function that may mitigate oxidative stress-related neural damage (Avloniti et al., 2017; Fisher et al., 2020). Beyond neurobiological mechanisms, physical activity in youth is consistently linked to better psychosocial functioning and lower psychopathology and has increasingly been incorporated into prevention and early intervention efforts (Damme et al., 2024b; Damme et al., 2022; Firth et al., 2020; Andersen et al., 2024). Emerging evidence further suggests that physical activity may be associated with PLEs (Cooper et al., 2025; Ye and Tang, 2023).

Team-based activity may be particularly relevant to psychosis risk, as prior work has shown that participation in team sports moderates the association between polygenic risk for schizophrenia and PLEs (Ku et al., 2024c). Compared with individual sports, team sports have also been associated with fewer psychopathological symptoms and better health outcomes (Gorham et al., 2019; Kunitoki et al., 2023; Janković et al., 2025; Eime et al., 2013). These findings suggest that characteristics distinguishing team- and individual-based physical activity may be particularly relevant to mental health, although the specific factors underlying these associations remain unclear. For example, social engagement within team settings may contribute to these differences by providing opportunities for peer support and cooperation (Eime et al., 2013; Ditzen and Heinrichs, 2014; Ku et al., 2022). However, whether team-based activity confers benefits beyond those associated with physical activity itself, particularly in relation to neurobiological vulnerability and PLEs, remains unclear.

The present study examines 1) whether left and right HV are associated with persistent distressing PLEs and 2) whether the level (i.e., frequency and duration) and type (i.e., team-based, individual, and overall) of physical activity moderate this relationship. We hypothesized that reduced HV would be associated with greater odds of persistent distressing PLEs and that greater physical activity, particularly participation in team sports, would weaken this association. Clarifying these pathways may reveal actionable targets to identify or offset neurobiological vulnerability.

2. Materials and methods

2.1. Design

This longitudinal cohort study used data from the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®; release 6.0), a dataset of de-identified participant information collected from youth recruited between September 2016 and October 2018 from 21 U.S. study sites. The ABCD Study was designed to examine how childhood experiences, including sports participation, affect neurodevelopment and subsequent outcomes in nearly 12,000 youth. All study procedures were approved both centrally by the University of California, San Diego Institutional Review Board (IRB) and locally by the IRBs at each site. Parents and guardians provided informed written consent, and children provided verbal assent. This report follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines (Von Elm et al., 2007).

2.2. Participants

Participants aged 9–10 years (hereafter age 10) were recruited between September 2016 and October 2018 and subsequently assessed at approximately annual intervals. PLE data were collected at each assessment. Participants were excluded if baseline neuroimaging data were missing or did not meet quality-control criteria, or if PLE reporting was incomplete (Figure S1). Distributions of sociodemographic and behavioral characteristics among included and excluded participants are presented in Table S1. Sociodemographic characteristics, including age, biological sex, and race/ethnicity were collected through self-report and interviewer-administered measures at baseline.

2.3. Measures

2.3.1. Prodromal-Questionnaire-Brief Child version (PQ-BC)

The Prodromal-Questionnaire-Brief Child (PQ-BC) version was administered annually by ABCD Study research assistants to assess participants’ PLEs over the past month. The PQ-BC is a 21-item, self-report instrument adapted from the Prodromal-Questionnaire-Brief (Loewy et al., 2011) to increase comprehension for children aged 9–10 years (Karcher et al., 2018). Each item assesses the presence or absence of a PLE. For endorsed items, children were asked whether the experience was bothersome (“Did it bother you?”) and, if so, to rate the associated level of distress on a five-point visual response scale, with higher scores indicating greater distress (Figure S2). Consistent with prior work, endorsed items rated ≥3 on the distress scale were considered distressing (Karcher et al., 2018). Participants with complete PQ-BC data through the three-year follow-up were classified as having persistent distressing PLEs if they endorsed at least one distressing PLE at two or more of the four assessments (baseline, one-, two-, and three-year follow-up). Thus, persistent distressing PLEs in this study reflected distressing experiences occurring across multiple assessments, whether continuously or intermittently, rather than an isolated, potentially transient endorsement, as defined in prior studies (Chen et al., 2026; Ku et al., 2025; Wade et al., 2025).

PQ-BC data from the four-year follow-up assessment were also available for a subset of participants and were incorporated into prospective sensitivity analyses. For these analyses, persistent distressing PLEs were defined using the same two-of-four criterion, requiring endorsement of at least one distressing PLE at two or more of the four follow-up assessments (one-, two-, three-, and four-year follow-up).

2.3.2. Physical activity measures

Physical activity data were derived from the caregiver-reported Sports and Activities Involvement Questionnaire at baseline (Huppertz et al., 2016). We applied the following formula to convert session duration and frequency of participation into average weekly hours of participation for each of 23 sports at age 10 (Palmer et al., 2021; Ku et al., 2024c):

SessionDurationmin×DaysperWeek×4.333WeeksperMonth×MonthsperYear60MinutesperHour×52WeeksperYear.

We then classified sports as individual or team-based according to criteria informed by prior literature (Table S2) (Ku et al., 2024c; Conley et al., 2020). Team sports were defined as activities that involve coordinated play among multiple players (e.g., softball/baseball, basketball, field hockey, football). Individual sports were defined as those that can be performed independently (e.g., dance/ballet, climbing, gymnastics). The resulting sport-specific weekly averages were then summed across all sports to derive total physical activity and separately summed within team and individual sports to derive team- and individual-based physical activity, respectively.

2.3.3. Imaging data acquisition and processing

All participating sites conducted structural magnetic resonance imaging using similar sequences on 3T Siemens, Philips, or General Electric scanners with a 32-channel head coil (https://github.com/nih-fmrif/abcd_protocols). While participants watched a child-appropriate movie of their choice, a 3-dimensional, T1-weighted image with a 1-mm isotropic voxel resolution was acquired (Casey et al., 2018). To maintain data quality and minimize motion artifacts, real-time motion-detection and correction software were used at Siemens and General Electric sites and, when available, at Philips sites (Casey et al., 2018). The FreeSurfer software suite (version 5.3; Martinos Center for Biomedical Imaging; https://surfer.nmr.mgh.harvard.edu) was used to perform atlas-based, volumetric segmentation of subcortical structures, including the hippocampus (Fischl, 2012; Fischl et al., 2002). Volume estimates demonstrated reliability across scanners (Cannon et al., 2014). Quality control conducted by ABCD included visual inspection of T1 images and FreeSurfer outputs. Individuals with poor-quality scans were excluded from the present study.

2.4. Statistical analyses

Multilevel logistic regression models were used to examine the association between HV and risk of persistent distressing PLEs. Random intercepts for families nested within study sites were included to account for non-independence of observations due to clustering. Covariates included age, biological sex, and White non-Hispanic race/ethnicity based on prior literature (Ku et al., 2022). Intracranial volume (ICV) was also included as a covariate in all models to account for individual differences in overall brain size. All continuous variables were z-scored prior to analysis, such that a one-unit increase represented a 1-SD increase in the respective variable. To test the moderating role of physical activity, interaction terms were added between HV and total physical activity, team sports participation, and individual sports participation. For interactions reaching statistical significance, simple slopes analyses were conducted to characterize how the association between HV and persistent distressing PLEs differed across levels of physical activity participation (0 hours per week, mean, and +1 standard deviation [SD]). Simple slopes are reported as marginal effects on the probability scale.

Analyses were conducted in IBM SPSS Statistics for Windows (version 29.0.0; IBM Corp., Armonk, NY, US) and R (version 4.3.1) in August 2025. Statistical significance was evaluated at the α = .05 level, and estimates are reported with 95% confidence intervals. Given the hypothesis-driven and a priori nature of this study, corrections for multiple comparisons were not applied; instead, interpretation focused on the consistency and magnitude of effects across models, as well as their theoretical and biological plausibility.

2.5. Sensitivity analyses

Sensitivity analyses repeated the main-effect and interaction models with additional adjustment for potential confounders identified from prior literature: family history of psychosis, financial adversity, pubertal stage, and adverse childhood experiences (additional covariate details provided as Supplemental Methods). These covariates were included only in sensitivity analyses due to missing data that reduced the available sample size (n = 8922). We also conducted a sensitivity analysis examining prospective persistent distressing PLEs across follow-up visits 1–4 and adjusting for baseline PLE severity to assess whether associations were attributable to concurrent baseline symptomatology (n = 8625).

3. Results

3.1. Sample characteristics

The analytic sample included 9476 youth; 4555 (48.1%) were female at birth, and 5247 (55.4%) identified as White non-Hispanic (Table 1). Across the first four study years, 1903 participants (20.1%) met criteria for persistent distressing PLEs. Comparisons between included and excluded participants based on missing or poor-quality data indicated generally small differences in sociodemographic and behavioral characteristics (all effect sizes <0.2; Table S1).

Table 1.

Sample characteristics by persistent distressing psychotic-like experience status.

Overall Without persistent distressing PLEs With persistent distressing PLEs p-value Effect size
n (%) 9476 7573 (79.9) 1903 (20.1)
Baseline age (mean (SD)) 9.96 (0.63) 9.98 (0.63) 9.88 (0.62) <.001 0.17
Female sex (n (%)) 4555 (48.1) 3540 (46.7) 1015 (53.3) <.001 0.05
White non-Hispanic (n (%)) 5247 (55.4) 4495 (59.4) 752 (39.5) <.001 0.16
Baseline total physical activity, hrs/wk (mean (SD)) 3.14 (3.33) 3.29 (3.37) 2.55 (3.09) <.001 0.22
Baseline team sports, hrs/wk (mean (SD)) 1.82 (2.35) 1.94 (2.41) 1.34 (2.07) <.001 0.25
Baseline individual sports, hrs/wk (mean (SD)) 1.32 (2.21) 1.35 (2.22) 1.21 (2.17) .012 0.07
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Abbreviations. SD, standard deviation; PLEs, psychotic-like experiences; hrs/wk, hours per week.

Note. Effect sizes are Cohen’s d for continuous variables and Cramér’s V for categorical variables. Parent-reported average weekly hours of sports participation at baseline (age 10) were calculated from activity duration and frequency across the year (see Methods for details). Team sports were defined as activities involving coordinated play among multiple players (e.g., softball/baseball, basketball); individual sports were defined as those that can be performed independently (e.g., climbing, gymnastics).

3.2. Bivariate correlations

Team and individual sports showed a small correlation with one another (r = 0.06), and small associations with left (r = 0.16 and −0.06 for team and individual sports, respectively) and right HV (r = 0.12 and −0.03 for team and individual sports, respectively). Among the social and behavioral variables examined, only sex demonstrated modest correlations with bilateral HV (right HV r = −0.33; left HV r = −0.46), with males showing larger unadjusted volumes than females (Table S3).

3.3. Persistent distressing PLEs and HV

Each 1-SD decrease in right HV was associated with approximately 10% greater odds of persistent distressing PLEs (adjusted odds ratio [aOR] = 0.91, 95% CI: 0.85 to 0.98; Table 2, Figure 1). The association between left HV and persistent distressing PLEs was not significant after covariate adjustment (aOR = 0.95, 95% CI: 0.87 to 1.04).

Table 2.

Main and interaction effects of hippocampal volume and sports participation on persistent distressing psychotic-like experiences.

Left HV Right HV
Predictor Adjusted OR 95% CI Adjusted OR 95% CI
Main effect
HV 0.95 0.87 to 1.04 0.91 0.85 to 0.98
Interaction effects
Total physical activity × HV 1.00 0.94 to 1.07 1.05 0.99 to 1.12
Team sports × HV 1.05 0.98 to 1.12 1.07 1.01 to 1.14
Individual sports × HV 1.00 0.94 to 1.06 1.04 0.98 to 1.10
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Abbreviations. CI, confidence interval; HV, hippocampal volume; OR, odds ratio; PLEs, psychotic-like experiences.

Note. The table presents adjusted odds ratios and 95% confidence intervals from multilevel logistic regressions with site and family as random intercepts. Models adjusted for age, sex, White non-Hispanic race/ethnicity, and intracranial volume. HV models tested associations between HV and persistent distressing PLEs. Interaction models included sports participation, HV, and their interaction term. Parent-reported average weekly hours of sports participation at baseline (age 10) were calculated from activity duration and frequency across the year (see Methods for details). Team sports were defined as activities involving coordinated play among multiple players (e.g., softball/baseball, basketball); individual sports were defined as those that can be performed independently (e.g., climbing, gymnastics).

Figure 1.

Figure 1.

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Associations between hippocampal volume and persistent distressing psychotic-like experiences.

Abbreviations. CI, confidence interval.

Note. The figure displays adjusted and unadjusted odds ratios and 95% confidence intervals from multilevel logistic regression models predicting persistent distressing psychotic-like experiences. Models included random intercepts for site and family. Unadjusted models examine left (orange) and right (blue) hippocampal volume (HV) separately without covariates. Adjusted models examine left and right HV separately while adjusting for age, sex, White non-Hispanic race/ethnicity, and intracranial volume.

3.4. The moderating role of physical activity

No significant interactions were observed between HV and total physical activity participation (left HV aOR = 1.00, 95% CI: 0.94 to 1.07; right HV aOR = 1.05, 95% CI: 0.99 to 1.12) or individual sports participation (left HV aOR = 1.00, 95% CI: 0.94 to 1.06; right HV aOR = 1.04, 95% CI: 0.98 to 1.10; Table 2, Figure 2). In contrast, a significant interaction emerged between right HV and team sports participation (aOR = 1.07, 95% CI: 1.01 to 1.14), indicating that the association between right HV and persistent distressing PLEs differed by level of team sports participation. No corresponding interaction was observed for left HV (aOR = 1.05, 95% CI: 0.98 to 1.12).

Figure 2.

Figure 2.

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Interaction effects of hippocampal volume and physical activity on persistent distressing psychotic-like experiences.

Abbreviations. HV, hippocampal volume; CI, confidence interval.

Note. The figure presents adjusted odds ratios and 95% confidence intervals from multilevel logistic regression models examining interaction effects between left (orange) and right (blue) HV and physical activity participation (total physical activity, team sports, and individual sports) on persistent distressing psychotic-like experiences. Models included site and family as random intercepts and adjusted for age, sex, White non-Hispanic race/ethnicity, and intracranial volume. Parent-reported average weekly hours of sports participation at baseline (age 10) were calculated from activity duration and frequency across the year (see Methods for details). Team sports were defined as activities involving coordinated play among multiple players (e.g., softball/baseball, basketball); individual sports were defined as those that can be performed independently (e.g., climbing, gymnastics).

Simple slopes analyses indicated that reduced right HV was significantly associated with greater odds of persistent distressing PLEs among youth with no weekly team sports participation (adjusted β = −0.02, 95% CI: −0.04 to −0.01) and among those with average levels of team sports participation (adjusted β = −0.01, 95% CI: −0.02 to −0.002; Figure 3). In contrast, this association was attenuated and no longer statistically significant among youth with above-average team sports participation (1 SD above the mean; adjusted β = 0.001, 95% CI: −0.01 to 0.01).

Figure 3.

Figure 3.

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Conditional associations between right hippocampal volume and persistent distressing psychotic-like experiences across levels of team sports participation.

Abbreviations. CI, confidence interval; PLE, psychotic-like experiences; SD, standard deviation.

Note. (A) The interaction plot depicts the association between right hippocampal volume (HV) and persistent distressing PLEs at 0 hours, mean, and high levels (+1 SD) of team sports participation. Shaded areas represent 95% confidence intervals. Team sports were defined as activities involving coordinated play among multiple players (e.g., softball/baseball, basketball, field hockey, football). (B) Estimates were obtained from simple slopes analyses adjusting for age, sex, White non-Hispanic race/ethnicity, and intracranial volume.

3.5. Sensitivity analyses

Sensitivity analyses adjusting for additional covariates yielded consistent results for both main (adjusted OR = 0.92, 95% CI: 0.86 to 0.99; Table S4) and interaction effects (adjusted OR = 1.07, 95% CI: 1.004 to 1.15; Table S5). In prospective analyses restricted to participants with PQ-BC data at the four-year follow-up, which defined persistent distressing PLEs across follow-up visits 1–4 and adjusted for baseline PLE severity (n = 8625), the association between right HV and persistent distressing PLEs remained (adjusted OR = 0.91, 95% CI: 0.83 to 0.98; Table S6). The interaction effects were generally similar in magnitude and significance to those observed in the primary analyses, including the interaction between team sports and right HV (adjusted OR = 1.10, 95% CI: 1.01 to 1.18; Table S7). In contrast to primary analyses, the interaction between total physical activity and right HV was also statistically significant (adjusted OR = 1.09, 95% CI: 1.01 to 1.17).

4. Discussion

In this study, we found that reduced right HV at age 10 was associated with increased odds of persistent distressing PLEs across early adolescence. Consistent with these findings, prior small-scale case-control studies have reported that adolescents with subclinical psychotic experiences exhibit reduced HV, either bilaterally or localized to the right hemisphere, compared to adolescents without such experiences (Calvo et al., 2020; O’Neill et al., 2022). Additional work has shown that HV reductions are associated with greater PLE severity in childhood (Damme et al., 2024a). To our knowledge, this is the first study to specifically examine the association between HV and persistent distressing PLEs in youth, extending these preliminary findings to a phenotype characterized by repeated, clinically meaningful PLEs rather than isolated or transient experiences (Karcher et al., 2022).

Such structural abnormalities in the hippocampus may disrupt neuronal plasticity and associated functions such as pattern separation and completion processes, resulting in spurious associations between memories and sensory outputs (Tamminga et al., 2010). This failure to discriminate between novel and familiar information may manifest as PLEs (Avery et al., 2021; Barkus et al., 2014; Williams et al., 2013). Although HV reductions are well documented in individuals with established psychiatric disorders such as psychosis (Roeske et al., 2021; McHugo et al., 2020; Mondelli et al., 2011; Pruessner et al., 2015), evidence for HV as a predictive marker in at-risk or prodromal populations, particularly as it relates to clinical outcomes, remains mixed (Walter et al., 2016; Vissink et al., 2022; Brunner et al., 2022). Our findings add to evidence that hippocampal alterations may be detectable earlier along the psychosis spectrum (Baldwin et al., 2022), though the prognostic significance of these alterations remains to be established.

We further observed that the association between reduced HV and persistent distressing PLEs was weaker among youth with greater team sports participation, whereas no such effect was observed for individual sports participation. In prospective sensitivity analyses, the interaction between total physical activity and right HV also reached statistical significance, so the specificity of this pattern to team sports requires replication. The team sports finding aligns with previous work in the ABCD Study cohort, in which greater physical activity participation, particularly participation in team sports, attenuated the impact of genetic risk on distressing PLEs (Ku et al., 2024c). In addition, team sports have been identified as a promising intervention among first-episode psychosis populations (Brooke et al., 2019). Together, these findings raise the possibility that features specific to team-based physical activity may be relevant to the association between neurobiological vulnerability and PLEs. One potential explanation is the social context of team sports, which typically involves shared goals, team identity, and social interaction that distinguish these activities from individual forms of exercise.

The potential relevance of social experiences is consistent with evidence linking social determinants to PLEs and psychosis risk, emphasizing the role of environmental and psychosocial factors in shaping vulnerability and resilience (Hall et al., 2024; Butter et al., 2017; Heins et al., 2019). For example, childhood exposure to neighborhood indices of social fragmentation has been associated with reductions in right HV, difficulties in social functioning, and onset of psychosis (Ku et al., 2021a; Ku et al., 2023b; Ku et al., 2023a; Ku et al., 2021b; Ku et al., 2024a). In contrast, greater social support, including having more close friends, and greater extraversion have been associated with attenuated effects of social adversity, suggesting that positive social experiences may be relevant to resilience (Ku et al., 2023b; Ku et al., 2024b). One possible mechanism involves the oxytocin system, which has been implicated in social bonding, stress regulation, and hippocampal plasticity (Goh et al., 2021; Lee et al., 2015; MacDonald and Feifel, 2012). Team-based activities may promote social support and reduce stress reactivity, which could in turn shape pathways relevant to hippocampal structure and PLEs (Pepping and Timmermans, 2012; Collip et al., 2013; Damme et al., 2024a; Brooke et al., 2019; Collins et al., 2009; Gorham et al., 2019). However, the present study did not directly assess social experiences, the quality or duration of participation, or the biological mechanisms described above. Future research should therefore directly examine whether social interaction, team cohesion, stress regulation, or other features of team-based physical activity account for the observed association, while also considering alternative explanations such as physical demands and differences in access to or sustained participation in sports. Relatedly, examining measures such as BMI and cortisol may help clarify biological pathways linking physical activity with brain structure and associated outcomes.

An alternative interpretation of these findings is that reduced HV may represent a marker of early disease progression, identifying youth already in the prodromal phase of psychosis as reflected by their reports of persistent distressing PLEs. Reduced participation in team sports, from this perspective, may index co-occurring negative symptoms, such as social withdrawal or diminished motivation, which often precede clinical onset (Piskulic et al., 2012). Conversely, greater participation in team sports may reflect pre-existing protective individual or environmental characteristics, such as greater self-confidence, extraversion, or positive parental involvement. Thus, team sports participation may reflect broader characteristics of youth functioning and social context that are associated with both hippocampal structure and PLE persistence, rather than representing a specific protective influence on these associations. Future studies should examine the social, behavioral, and physiological characteristics associated with team sports participation to determine which characteristics influence participation, which reflect broader patterns of youth functioning, and which result from participation.

The prospective sensitivity analyses provide additional information about the temporal ordering of these associations. When persistent distressing PLEs were defined prospectively, the association between right HV at baseline and subsequent persistent distressing PLEs remained evident. The persistence of these associations after accounting for baseline PLEs provides evidence that they were not fully explained by pre-existing symptom severity. However, these analyses do not establish causal relationships between HV, team sports participation, and PLEs, and residual confounding remains possible. Future longitudinal studies incorporating repeated assessments of hippocampal structure, physical activity, and PLEs will be important for determining how these factors influence one another over the course of development.

This study should be interpreted with several limitations in mind. First, generalizability is limited to U.S. populations and may not extend to youth at clinical high risk for psychosis, though the large and diverse ABCD Study cohort supports generalizability within community-based youth populations. In addition, although effect sizes were small, participants included in the analytic sample differed from those excluded in racial/ethnic composition (55.4% vs. 39.2% White non-Hispanic, respectively) and prevalence of persistent distressing PLEs (20.1% vs. 27.8%, respectively), raising the possibility of selection bias and limiting the representativeness of the analytic sample. Second, physical activity and PLEs were assessed via parent- and self-report, respectively, and may therefore be subject to recall bias, social desirability effects, and underreporting. Third, our operationalization of physical activity did not capture degree of sociality or quality of engagement and was assessed only at baseline, precluding examination of changes over time. Future research should assess participants’ subjective experiences of sports participation, incorporate longitudinal and objective measures (e.g., wearable devices), and examine whether similar associations are observed for other socially embedded activities (e.g., music ensembles, clubs). Given the observed association at the level of whole-hippocampus volume, analyses of hippocampal subfields (e.g., CA1, dentate gyrus) and other brain regions may further clarify the anatomical specificity of these associations. Finally, studies extending into late adolescence and early adulthood, when psychosis risk is highest, may clarify whether these associations persist or change across development.

In conclusion, our findings suggest that reduced right HV may represent a marker of early neurodevelopmental vulnerability associated with persistent distressing PLEs. In addition, the association between reduced right HV and persistent distressing PLEs was weaker among youth with greater team-based physical activity during early adolescence. Although the mechanisms underlying this pattern remain unclear, the findings highlight team-based activity as a potentially informative context for understanding how the social and physical environment may shape the expression of neurodevelopmental vulnerability. Replication in independent cohorts together with longitudinal investigation of the social and physical components of team-based activity will be important for establishing robustness and directionality of these associations and clarifying their underlying mechanisms. If supported, this work could inform further investigation of team-based physical activity as a potentially modifiable target for promoting early mental health and neurodevelopment.

Supplementary Material

supplementary material

Role of the funding source:

The funding source had no role in study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the work for publication.

References

  1. Andersen MF, Roed K, Sørensen V, et al. (2024) Required elements for an educational programme for lay exercise instructors in charge of community-based exercise targeting young adults with schizophrenia spectrum disorders–A stakeholder focus group study. BMC psychiatry 24(1): 228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Avery SN, McHugo M, Armstrong K, et al. (2021) Stable habituation deficits in the early stage of psychosis: a 2-year follow-up study. Translational Psychiatry 11(1): 20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Avloniti A, Chatzinikolaou A, Deli CK, et al. (2017) Exercise-induced oxidative stress responses in the pediatric population. Antioxidants 6(1): 6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Baldwin H, Radua J, Antoniades M, et al. (2022) Neuroanatomical heterogeneity and homogeneity in individuals at clinical high risk for psychosis. Translational Psychiatry 12(1): 297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Barkus C, Sanderson DJ, Rawlins JNP, et al. (2014) What causes aberrant salience in schizophrenia? A role for impaired short-term habituation and the GRIA1 (GluA1) AMPA receptor subunit. Molecular psychiatry 19(10): 1060–1070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Besteher B, Brambilla P and Nenadić I (2020) Twin studies of brain structure and cognition in schizophrenia. Neuroscience & biobehavioral reviews 109: 103–113. [DOI] [PubMed] [Google Scholar]
  7. Brooke LE, Lin A, Ntoumanis N, et al. (2019) Is sport an untapped resource for recovery from first episode psychosis? A narrative review and call to action. Early Interv Psychiatry 13(3): 358–368. [DOI] [PubMed] [Google Scholar]
  8. Brosch K, Stein F, Schmitt S, et al. (2022) Reduced hippocampal gray matter volume is a common feature of patients with major depression, bipolar disorder, and schizophrenia spectrum disorders. Molecular psychiatry 27(10): 4234–4243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Brunner G, Gajwani R, Gross J, et al. (2022) Hippocampal structural alterations in early-stage psychosis: Specificity and relationship to clinical outcomes. NeuroImage: Clinical 35: 103087. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Butter S, Murphy J, Shevlin M, et al. (2017) Social isolation and psychosis-like experiences: a UK general population analysis. Psychosis 9(4): 291–300. [Google Scholar]
  11. Calvo A, Roddy DW, Coughlan H, et al. (2020) Reduced hippocampal volume in adolescents with psychotic experiences: A longitudinal population-based study. PLoS One 15(6): e0233670. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cannon TD, Sun F, McEwen SJ, et al. (2014) Reliability of neuroanatomical measurements in a multisite longitudinal study of youth at risk for psychosis: Reliability of Multisite, Longitudinal MRI. Human brain mapping 35(5): 2424–2434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Casey BJ, Cannonier T, Conley MI, et al. (2018) The Adolescent Brain Cognitive Development (ABCD) study: Imaging acquisition across 21 sites. Developmental Cognitive Neuroscience 32: 43–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Chen Y, Yuan Q, Dimitrov L, et al. (2026) Interaction between neighborhood exposome and genetic risk in persistent distressing psychotic-like experiences in children. Nature Mental Health 4(1): 136–145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Chopra S, Segal A, Oldham S, et al. (2023) Network-based spreading of gray matter changes across different stages of psychosis. JAMA psychiatry 80(12): 1246–1257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Collins A, Hill LE, Chandramohan Y, et al. (2009) Exercise improves cognitive responses to psychological stress through enhancement of epigenetic mechanisms and gene expression in the dentate gyrus. PLoS One 4(1): e4330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Collip D, Habets P, Marcelis M, et al. (2013) Hippocampal volume as marker of daily life stress sensitivity in psychosis. Psychological medicine 43(7): 1377–1387. [DOI] [PubMed] [Google Scholar]
  18. Conley MI, Hindley I, Baskin-Sommers A, et al. (2020) The importance of social factors in the association between physical activity and depression in children. Child Adolesc Psychiatry Ment Health 14: 28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Cooper R, van Der Ven E and Jalbrzikowski M (2025) Trajectories of psychotic-like experiences in youth and associations with lifestyle factors. Journal of Child Psychology and Psychiatry 67(1): 5–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Damme KS, Ristanovic I and Mittal VA (2024a) Reduced hippocampal volume unmasks distinct impacts of cumulative adverse childhood events (ACEs) on psychotic-like experiences in late childhood and early adolescence. Psychoneuroendocrinology 169: 107149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Damme KS, Vargas TG, Walther S, et al. (2024b) Physical and mental health in adolescence: novel insights from a transdiagnostic examination of FitBit data in the ABCD study. Translational Psychiatry 14(1): 75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Damme KSF, Gupta T, Ristanovic I, et al. (2022) Exercise Intervention in Individuals at Clinical High Risk for Psychosis: Benefits to Fitness, Symptoms, Hippocampal Volumes, and Functional Connectivity. Schizophrenia bulletin 48(6): 1394–1405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Dastamooz S, Wong SH, Yang Y, et al. (2025) Efficacy of a short-term physical exercise intervention on stress biomarkers and mental health in adolescents with ADHD: A randomized controlled trial. Journal of affective disorders 393: 120285. [DOI] [PubMed] [Google Scholar]
  24. Ditzen B and Heinrichs M (2014) Psychobiology of social support: the social dimension of stress buffering. Restorative neurology and neuroscience 32(1): 149–162. [DOI] [PubMed] [Google Scholar]
  25. Dominguez MD, Wichers M, Lieb R, et al. (2011) Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia bulletin 37(1): 84–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Downs JM, Cullen AE, Barragan M, et al. (2013) Persisting psychotic-like experiences are associated with both externalising and internalising psychopathology in a longitudinal general population child cohort. Schizophr Res 144(1-3): 99–104. [DOI] [PubMed] [Google Scholar]
  27. Eime RM, Young JA, Harvey JT, et al. (2013) A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. International journal of behavioral nutrition and physical activity 10(1): 98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Firth J, Schuch F and Mittal VA (2020) Using exercise to protect physical and mental health in youth at risk for psychosis. Res Psychother 23(1): 433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Fischl B (2012) FreeSurfer. Neuroimage 62(2): 774–781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Fischl B, Salat DH, Busa E, et al. (2002) Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron 33(3): 341–355. [DOI] [PubMed] [Google Scholar]
  31. Fisher E, Wood SJ, Elsworthy RJ, et al. (2020) Exercise as a protective mechanism against the negative effects of oxidative stress in first-episode psychosis: a biomarker-led study. Translational Psychiatry 10(1): 254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Goh KK, Chen C-H and Lane H-Y (2021) Oxytocin in schizophrenia: pathophysiology and implications for future treatment. International Journal of Molecular Sciences 22(4): 2146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Gorham LS, Jernigan T, Hudziak J, et al. (2019) Involvement in Sports, Hippocampal Volume, and Depressive Symptoms in Children. Biol Psychiatry Cogn Neurosci Neuroimaging 4(5): 484–492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Gutman BA, van Erp TGM, Alpert K, et al. (2022) A meta-analysis of deep brain structural shape and asymmetry abnormalities in 2,833 individuals with schizophrenia compared with 3,929 healthy volunteers via the ENIGMA Consortium. Hum Brain Mapp 43(1): 352–372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Hall LM, Moussa-Tooks AB and Sheffield JM (2024) Associations between social engagement, internalizing symptoms, and delusional ideation in the general population. Social psychiatry and psychiatric epidemiology 59(6): 989–1002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Heckers S and Konradi C (2015) GABAergic mechanisms of hippocampal hyperactivity in schizophrenia. Schizophrenia research 167(1-3): 4–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Heins M, Achterhof R, Collip D, et al. (2019) Social functioning and subclinical psychosis in adolescence: A longitudinal general adolescent population study. Acta psychiatrica scandinavica 140(3): 275–282. [DOI] [PubMed] [Google Scholar]
  38. Hopkins ME, Nitecki R and Bucci DJ (2011) Physical exercise during adolescence versus adulthood: differential effects on object recognition memory and brain-derived neurotrophic factor levels. Neuroscience 194: 84–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Huppertz C, Bartels M, de Zeeuw EL, et al. (2016) Individual Differences in Exercise Behavior: Stability and Change in Genetic and Environmental Determinants From Age 7 to 18. Behav Genet 46(5): 665–679. [DOI] [PubMed] [Google Scholar]
  40. Janković M, Sijtsema J, Haselhorst C, et al. (2025) Patterns of sports participation across the lifespan and their links to psychopathology, resilience, and childhood trauma: a cross-sectional approach. International Journal of Sport and Exercise Psychology 23(8): 1545–1566. [Google Scholar]
  41. Karcher NR, Barch DM, Avenevoli S, et al. (2018) Assessment of the Prodromal Questionnaire-Brief Child Version for Measurement of Self-reported Psychoticlike Experiences in Childhood. JAMA psychiatry 75(8): 853–861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Karcher NR, Loewy RL, Savill M, et al. (2022) Persistent and distressing psychotic-like experiences using adolescent brain cognitive development study data. Mol Psychiatry 27(3): 1490–1501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Kline E, Thompson E, Bussell K, et al. (2014) Psychosis-like experiences and distress among adolescents using mental health services. Schizophrenia research 152(2-3): 498–502. [DOI] [PubMed] [Google Scholar]
  44. Ku BS, Aberizk K, Addington J, et al. (2022) The Association Between Neighborhood Poverty and Hippocampal Volume Among Individuals at Clinical High-Risk for Psychosis: The Moderating Role of Social Engagement. Schizophrenia bulletin 48(5): 1032–1042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Ku BS, Aberizk K, Feurer C, et al. (2024a) Aspects of Area Deprivation Index in Relation to Hippocampal Volume Among Children. JAMA network open 7(6): e2416484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Ku BS, Addington J, Bearden CE, et al. (2023a) Associations Between Childhood Area-Level Social Fragmentation, Maladaptation to School, and Social Functioning Among Healthy Youth and Those at Clinical High Risk for Psychosis. Schizophrenia bulletin 49(6): 1437–1446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Ku BS, Addington J, Bearden CE, et al. (2021a) Association between residential instability at individual and area levels and future psychosis in adolescents at clinical high risk from the North American Prodrome Longitudinal Study (NAPLS) consortium. Schizophr Res 238: 137–144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Ku BS, Compton MT, Walker EF, et al. (2021b) Social Fragmentation and Schizophrenia: A Systematic Review. The Journal of clinical psychiatry 83(1). [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Ku BS, Ren J, Compton MT, et al. (2024b) The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends. Psychological medicine 54(9): 2172–2180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Ku BS, Walker EF, Druss BG, et al. (2023b) Residential instability during adolescence predicts earlier age at onset of psychosis: The moderating role of extraversion. Early intervention in psychiatry 17(5): 527–531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Ku BS, Yuan Q, Arias-Magnasco A, et al. (2024c) Associations between genetic risk, physical activities, and distressing psychotic-like experiences. Schizophrenia bulletin 52(1). [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Ku BS, Yuan QE, Christensen G, et al. (2025) Exposure profiles of social-environmental neighborhood factors and persistent distressing psychotic-like experiences across four years among young adolescents in the US. Psychological medicine 55: e53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Kunitoki K, Hughes D, Elyounssi S, et al. (2023) Youth Team Sports Participation Associates With Reduced Dimensional Psychopathology Through Interaction With Biological Risk Factors. Biological Psychiatry Global Open Science 3(4): 875–883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Lee S-Y, Park S-H, Chung C, et al. (2015) Oxytocin protects hippocampal memory and plasticity from uncontrollable stress. Scientific Reports 5(1): 18540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Lieberman J, Girgis R, Brucato G, et al. (2018) Hippocampal dysfunction in the pathophysiology of schizophrenia: a selective review and hypothesis for early detection and intervention. Molecular psychiatry 23(8): 1764–1772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Lodge DJ and Grace AA (2011) Hippocampal dysregulation of dopamine system function and the pathophysiology of schizophrenia. Trends in pharmacological sciences 32(9): 507–513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Loewy RL, Pearson R, Vinogradov S, et al. (2011) Psychosis risk screening with the Prodromal Questionnaire--brief version (PQ-B). Schizophr Res 129(1): 42–46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Ma C-L, Ma X-T, Wang J-J, et al. (2017) Physical exercise induces hippocampal neurogenesis and prevents cognitive decline. Behavioural brain research 317: 332–339. [DOI] [PubMed] [Google Scholar]
  59. MacDonald K and Feifel D (2012) Oxytocin in schizophrenia: a review of evidence for its therapeutic effects. Acta neuropsychiatrica 24(3): 130–146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Mathew I, Gardin TM, Tandon N, et al. (2014) Medial temporal lobe structures and hippocampal subfields in psychotic disorders: findings from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. JAMA psychiatry 71(7): 769–777. [DOI] [PubMed] [Google Scholar]
  61. McHugo M, Armstrong K, Roeske MJ, et al. (2020) Hippocampal volume in early psychosis: a 2-year longitudinal study. Translational Psychiatry 10(1): 306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Mondelli V, Cattaneo A, Murri MB, et al. (2011) Stress and Inflammation Reduce Brain-Derived Neurotrophic Factor Expression in First-Episode Psychosis: A Pathway to Smaller Hippocampal Volume. The Journal of clinical psychiatry 72(12): 1677–1684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. O’Neill A, Dooley N, Healy C, et al. (2022) Longitudinal gray matter development associated with psychotic experiences in young people. Biological Psychiatry Global Open Science 3(2): 264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Oh H, Karcher NR, Soffer-Dudek N, et al. (2024) Distress related to psychotic experiences: Enhancing the world health organization composite international diagnostic interview psychosis screen. International Journal of Methods in Psychiatric Research 33(1): e1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Palmer CE, Sheth C, Marshall AT, et al. (2021) A Comprehensive Overview of the Physical Health of the Adolescent Brain Cognitive Development Study Cohort at Baseline. Front Pediatr 9: 734184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Pepping G-J and Timmermans EJ (2012) Oxytocin and the biopsychology of performance in team sports. The Scientific World Journal 2012(1): 567363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Pines AR, Frandsen SB, Drew W, et al. (2025) Mapping lesions that cause psychosis to a human brain circuit and proposed stimulation target. JAMA psychiatry 82(4): 368–378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Piskulic D, Addington J, Cadenhead KS, et al. (2012) Negative symptoms in individuals at clinical high risk of psychosis. Psychiatry Research 196(2-3): 220–224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Pruessner M, Lepage M, Collins DL, et al. (2015) Reduced hippocampal volume and hypothalamus–pituitary–adrenal axis function in first episode psychosis: Evidence for sex differences. NeuroImage: Clinical 7: 195–202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Roeske MJ, Konradi C, Heckers S, et al. (2021) Hippocampal volume and hippocampal neuron density, number and size in schizophrenia: a systematic review and meta-analysis of postmortem studies. Molecular psychiatry 26(7): 3524–3535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Smith ME (2005) Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: A meta-analysis of structural MRI studies. Hippocampus 15(6): 798–807. [DOI] [PubMed] [Google Scholar]
  72. Tamminga CA, Stan AD and Wagner AD (2010) The hippocampal formation in schizophrenia. American journal of psychiatry 167(10): 1178–1193. [DOI] [PubMed] [Google Scholar]
  73. Trotta A, Arseneault L, Caspi A, et al. (2020) Mental Health and Functional Outcomes in Young Adulthood of Children With Psychotic Symptoms: A Longitudinal Cohort Study. Schizophrenia bulletin 46(2): 261–271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Van Erp TGM, Hibar DP, Rasmussen JM, et al. (2016) Subcortical brain volume abnormalities in 2028 individuals with schizophrenia and 2540 healthy controls via the ENIGMA consortium. Molecular psychiatry 21(4): 547–553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Videbech P and Ravnkilde B (2004) Hippocampal volume and depression: a meta-analysis of MRI studies. American journal of psychiatry 161(11): 1957–1966. [DOI] [PubMed] [Google Scholar]
  76. Vissink CE, Winter-van Rossum I, Cannon TD, et al. (2022) Structural brain volumes of individuals at clinical high risk for psychosis: a meta-analysis. Biological Psychiatry Global Open Science 2(2): 147–152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  77. Von Elm E, Altman DG, Egger M, et al. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet 370(9596): 1453–1457. [DOI] [PubMed] [Google Scholar]
  78. Wade KL, Kramer M and Ku B (2025) Social-spatial residence patterns and adolescent mental health: Investigating the influences of residential segregation, neighborhood social cohesion, and race on persistent, distressing psychotic-like experiences in the United States. Social science & medicine 386: 118623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Walker E, Mittal V and Tessner K (2008) Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia. Annu. Rev. Clin. Psychol. 4(1): 189–216. [DOI] [PubMed] [Google Scholar]
  80. Walter A, Suenderhauf C, Harrisberger F, et al. (2016) Hippocampal volume in subjects at clinical high-risk for psychosis: A systematic review and meta-analysis. Neuroscience & biobehavioral reviews 71: 680–690. [DOI] [PubMed] [Google Scholar]
  81. Williams LE, Blackford JU, Luksik A, et al. (2013) Reduced habituation in patients with schizophrenia. Schizophrenia research 151(1-3): 124–132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Yau S-Y, Lau BW-M and So K-F (2011) Adult hippocampal neurogenesis: a possible way how physical exercise counteracts stress. Cell Transplantation 20(1): 99–111. [DOI] [PubMed] [Google Scholar]
  83. Ye Y and Tang H (2023) The Relationship between Exercise and Psychotic Symptoms in College Students: A Cross-Sectional Analysis. International Journal of Mental Health Promotion 25(7): 873–879. [Google Scholar]
  84. Zhang G, Feng W, Zhao L, et al. (2024) The association between physical activity, self-efficacy, stress self-management and mental health among adolescents. Scientific Reports 14(1): 5488. [DOI] [PMC free article] [PubMed] [Google Scholar]

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