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Pignon B, Szöke A, Ku B, Melchior M, Schürhoff F. Urbanicity and psychotic disorders: Facts and hypotheses. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:122-138. [PMID: 37994794 PMCID: PMC10986450 DOI: 10.1080/19585969.2023.2272824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
In the present qualitative literature review, we summarise data on psychotic disorders and urbanicity, focusing particularly on recent findings. Longitudinal studies of the impact of urbanicity on the risk for psychotic disorders have consistently shown a significant association, with a relative risk between 2 and 2.5. However, most of the original studies were conducted in Western Europe, and no incidence studies were conducted in low- and middle-income countries. European studies suggest that neighbourhood-level social fragmentation and social capital may partly explain this association. Exposure to air pollution (positive association) and green space (negative association) may also be part of the explanation, but to date, available data do not make it possible to conclude if they act independently from urbanicity, or as part of the effect of urbanicity on psychotic disorders. Finally, several studies have consistently shown significant associations between the polygenic risk score for schizophrenia and urbanicity, with several possible explanations (pleiotropic effects, results of prodromic symptoms, or selection/intergenerational hypothesis). Thus, more studies are needed to understand the factors that explain the association between urbanicity and the risk of psychotic disorders. Further studies should account for the interdependence and/or interactions of different psychosocial and physical exposures (as well as gene-environment interactions), and explore this association in low- and middle-income countries.
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Affiliation(s)
- Baptiste Pignon
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Andrei Szöke
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Benson Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d‘Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Franck Schürhoff
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
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2
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Druss BG, Gülöksüz S, Mathalon DH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Carrión RE. Associations Between Childhood Area-Level Social Fragmentation, Maladaptation to School, and Social Functioning Among Healthy Youth and Those at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:1437-1446. [PMID: 37358832 PMCID: PMC10686327 DOI: 10.1093/schbul/sbad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although studies have identified social fragmentation as an important risk factor for schizophrenia and other psychotic disorders, it is unknown whether it may impact social functioning. This study investigates whether social fragmentation during childhood predicts maladaptation to school as well as social functioning during childhood and adulthood. STUDY DESIGN Data were collected from the North American Prodrome Longitudinal Study. Participants included adults at clinical high risk for psychosis (CHR-P) and healthy comparisons (HC). Maladaptation to school and social functioning during childhood were assessed retrospectively and social functioning in adulthood was assessed at baseline. STUDY RESULTS Greater social fragmentation during childhood was associated with greater maladaptation to school (adjusted β = 0.21; 95% CI: 0.02 to 0.40). Social fragmentation was not associated with social functioning during childhood (unadjusted β = -0.08; 95% CI: -0.31 to 0.15). However, greater social fragmentation during childhood predicted poorer social functioning in adulthood (adjusted β = -0.43; 95% CI: -0.79 to -0.07). Maladaptation to school mediated 15.7% of the association between social fragmentation and social functioning. The association between social fragmentation and social functioning was stronger among adults at CHR-P compared to HC (adjusted β = -0.42; 95% CI: -0.82 to -0.02). CONCLUSIONS This study finds that social fragmentation during childhood is associated with greater maladaptation to school during childhood, which in turn predicts poorer social functioning in adulthood. Further research is needed to disentangle aspects of social fragmentation that may contribute to social deficits, which would have implications for the development of effective interventions at the individual and community levels.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sinan Gülöksüz
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Adams EA, Yang JC, O'Donnell A, Minot S, Osborn D, Kirkbride JB. Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study. Subst Abuse Treat Prev Policy 2023; 18:59. [PMID: 37884952 PMCID: PMC10605983 DOI: 10.1186/s13011-023-00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Opioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London. METHODS We conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes. RESULTS Comorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74-9.14) for non-opioid substance use comorbidity, 8.92 (1.81-64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89-47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services. CONCLUSION Comorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys.
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Affiliation(s)
- Emma A Adams
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, UK.
| | - Justin C Yang
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, UK
| | - Sarah Minot
- Camden & Islington NHS Foundation Trust, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
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Congdon P. The ethnic density effect as a contextual influence in ecological disease models: Establishing its quantitative expression. Health Place 2023; 83:103083. [PMID: 37544099 DOI: 10.1016/j.healthplace.2023.103083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/09/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
Research suggests higher neighbourhood ethnic minority density to be associated with lessened chances of ethnic group illness. We focus on the density effect on psychosis, arguing that (at higher ethnic concentrations) it acts as a contextual influence attenuating the compositional influence whereby minority ethnicity is associated with higher psychosis risk. In terms of ecological disease regression, the ethnic density effect will then be apparent in nonlinear impacts of minority concentration. Contextual effects may also be evident in spatially varying regression coefficient models for psychosis. Nonlinearity or heterogeneity may be associated with other contextual processes where geography modifies demography (e.g. deprivation amplification). We illustrate these issues with an analysis of psychosis prevalence in 4835 London neighbourhoods. The data are collected in primary care (during 2019/20) using clinical diagnosis (e.g. based on referrals to specialists or psychosis hospitalisation), and refer to patients currently under care: such care may extend retrospectively over several years. The data offer a complete population perspective in contrast to survey data, which typically offer limited geographic perspectives. We consider impacts on psychosis prevalence of non-white ethnicity, as well as those of deprivation, social fragmentation and urbanicity. We find evidence suggesting nonlinear impacts of non-white ethnicity on psychosis (essentially flat risk above a threshold concentration), but find no evidence for deprivation amplification.
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Affiliation(s)
- Peter Congdon
- School of Geography, Queen Mary University of London, London, E1 4NS, UK.
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Jacinto RP, Ding T, Stafford J, Baio G, Kirkbride JB. The incidence of psychotic disorders in the Republic of Ireland: a systematic review. Ir J Psychol Med 2023:1-13. [PMID: 37522189 DOI: 10.1017/ipm.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Despite a substantial epidemiological literature on the incidence of psychotic disorders in Ireland, no systematic review has previously been undertaken. Such evidence can help inform understanding of need for psychosis care. METHODS We conducted a prospectively registered systematic review (PROSPERO: CRD42021245891) following PRISMA guidelines. We searched four databases (Medline, PsycInfo, Web of Science, Embase) for papers containing incidence data on non-organic psychotic disorders, in people 16-64 years, published between 1950 and 2021 in the general adult population. We conducted duplicate screening, risk of bias assessments, and extracted data to a standardised template. We undertook a narrative synthesis for each major diagnostic outcome. Random effects meta-analyses were conducted for comparisons with ≥5 incidence rates. RESULTS Our search yielded 1975 non-duplicate citations, of which 23 met inclusion criteria, containing incidence data ascertained between 1974 and 2016 (median study quality: 5/8; interquartile range: 4-6). Incidence of all psychotic disorders (N = 4 studies) varied from 22.0 (95%CI: 17.3-28.0) in Dublin to 34.1 per 100,000 person-years (95%CI: 31.0-37.5) in Cavan and Monaghan. The pooled incidence of schizophrenia (N = 6 studies, N = 8 settings) was 20.0 per 100,000 person-years, though with imprecision around this estimate (95%CI: 10.6-37.5; I2: 97.6%). Higher rates of most outcomes were observed in men. There was consistent evidence of raised rates in more deprived and fragmented social environments, but no clear pattern by rural-urban status. CONCLUSIONS Patterns of incidence of psychotic disorders in Ireland are broadly consistent with the wider literature from the Global North. Findings could help identify populations at higher risk of psychosis in Ireland.
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Affiliation(s)
| | - T Ding
- Department of Statistical Sciences, UCL, London, UK
| | - J Stafford
- Division of Psychiatry, UCL, London, UK
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - G Baio
- Department of Statistical Sciences, UCL, London, UK
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Schofield P, Thisted Horsdal H, Das-Munshi J, Thygesen M, Pedersen C, Morgan C, Agerbo E. A comparison of neighbourhood level variation and risk factors for affective versus non-affective psychosis. Schizophr Res 2023; 256:126-132. [PMID: 35697569 PMCID: PMC10259518 DOI: 10.1016/j.schres.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/11/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies typically highlight area level variation in the incidence of non-affective but not affective psychoses. We compared neighbourhood-level variation for both types of disorder, and the specific effects of neighbourhood urbanicity and ethnic density, using Danish national registry data. METHODS Population based cohort (2,224,464 people) followed from 1980 to 2013 with neighbourhood exposure measured at age 15 and incidence modelled using multilevel Poisson regression. RESULTS Neighbourhood variation was similar for both disorders with an adjusted median risk ratio of 1.37 (95% CI 1.34-1.39) for non-affective psychosis and 1.43 (1.38-1.49) for affective psychosis. Associations with neighbourhood urbanicity differed: living in the most compared to the least urban quintile at age 15 was associated with a minimal increase in subsequent affective psychosis, IRR 1.13 (1.01-1.27) but a substantial increase in rates of non-affective psychosis, IRR 1.66 (1.57-1.75). Mixed results were found for neighbourhood ethnic density: for Middle Eastern migrants there was an increased average incidence of both affective, IRR 1.54 (1.19-1.99), and non-affective psychoses, 1.13 (1.04-1.23) associated with each decrease in ethnic density quintile, with a similar pattern for African migrants, but for European migrants ethnic density appeared to be associated with non-affective psychosis only. CONCLUSIONS While overall variation and the effect of neighbourhood ethnic density were similar for both types of disorder, associations with urbanicity were largely confined to non-affective psychosis. This may reflect differences in aetiological pathways although the mechanism behind these differences remains unknown.
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Affiliation(s)
- Peter Schofield
- School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
| | - Henriette Thisted Horsdal
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; South London & Maudsley NHS Trust; ESRC Centre for Society and Mental Health, Kings College London
| | - Malene Thygesen
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Carsten Pedersen
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, Kings College London; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London
| | - Esben Agerbo
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; CIRRAU - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
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Bakolis I, Murray ET, Hardy R, Hatch SL, Richards M. Area disadvantage and mental health over the life course: a 69-year prospective birth cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:735-744. [PMID: 36757437 PMCID: PMC10097760 DOI: 10.1007/s00127-023-02427-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Existing evidence on the mental health consequences of disadvantaged areas uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to investigate this association over a 69-year period. METHODS Data were obtained from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort), which consisted of 2125 participants at 69 years. We assessed longitudinal associations between area disadvantage and mental health symptoms at adolescence and adulthood with use of multilevel modelling framework. RESULTS After adjustment for father's social class, for each one percentage increase in area disadvantage at age 4, there was a 0.02 (95% CI 0.001, 0.04) mean increase in the total score of the neuroticism scale at age 13-15. After adjustment for father's social class, adult socio-economic position, cognitive ability and educational attainment, a one percentage increase in change score of area disadvantage between age 4 and 26 was associated with a mean increase in the total Psychiatric Symptom Frequency score (MD 0.06; 95% CI 0.007, 0.11). Similar associations were observed with change scores between ages 4, 53, 60 and total General Health Questionnaire-28 score at age 53 (MD 0.05; 95% CI 0.01, 0.11) and 60-64 (MD 0.06; 95% CI 0.009, 0.11). CONCLUSIONS Cohort members who experienced increasing area disadvantage from childhood were at increased risk of poor mental health over the life course. Population-wide interventions aiming at improving social and physical aspects of the early neighbourhood environment could reduce the socio-economic burden of poor mental health.
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Affiliation(s)
- Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Emily T Murray
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London, IOPPN and South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Moore D, Eaton S, Polari A, McGorry P, Nelson B, O'Donoghue B. The association between social deprivation and the rate of identification of individuals at Ultra-High Risk for psychosis and transition to psychosis. Int J Soc Psychiatry 2023; 69:294-303. [PMID: 35470718 DOI: 10.1177/00207640221087608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a higher incidence of psychotic disorders in neighbourhoods of greater social deprivation. However, it is not known whether this represents a causal relationship, as the stage at which social deprivation exerts its influence on the development of psychotic disorders is yet to be elucidated. We aimed to investigate the association between neighbourhood-level social deprivation and the rate of identification of individuals at Ultra-High Risk for psychosis (UHR), as well as the risk of transition to psychosis in UHR individuals. METHODS The cohort included all young people aged 15 to 24 identified as UHR attending an Early Intervention clinic in northwestern Melbourne over a 5-year period (2012-2016). Australian census data were used to obtain the at-risk population and social deprivation information according to the postcode of residence. Levels of social deprivation were arranged into quartiles. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS Of the 461 young people identified as UHR, 11.1% (n = 49) lived in the most affluent neighbourhoods (Quartile 1) compared to 36.7% (n = 162) in the most deprived neighbourhoods (Quartile 4). There was a 35% higher rate of identification of young people who were UHR from the most deprived neighbourhoods (aIRR = 1.35, 95% CI [0.98, 1.86]). Over a median follow-up of approximately 10 months (308 days (IQR: 188-557), 17.5% (n = 77) were known to have transitioned to a full-threshold psychotic disorder. Residing in a neighbourhood of above average deprivation had a hazard ratio of 2.05 (95% CI [0.88, 4.80]) for risk of transition, when controlling for age, sex and substance use. CONCLUSIONS These findings provide more support that EI services should be funded as per the expected incidence of psychotic disorders.
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Affiliation(s)
- Danielle Moore
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Scott Eaton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
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Roberts T, Susser E, Lee Pow J, Donald C, John S, Raghavan V, Ayinde O, Olley B, Miguel Esponda G, Lam J, Murray RM, Cohen A, Weiss HA, Hutchinson G, Thara R, Gureje O, Burns J, Morgan C. Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South. Psychol Med 2023; 53:1-9. [PMID: 36645027 PMCID: PMC10600928 DOI: 10.1017/s0033291722003749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad. METHODS Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18-64 with previously untreated psychotic disorders residing in each catchment area (May 2018-April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years). RESULTS We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68-3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51-0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93-1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area. CONCLUSIONS This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.
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Affiliation(s)
- Tessa Roberts
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Joni Lee Pow
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Casswina Donald
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | | | - Olatunde Ayinde
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bola Olley
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Georgina Miguel Esponda
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Lam
- Department of Population, Practice and Policy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robin M. Murray
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alex Cohen
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A. Weiss
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | | | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jonathan Burns
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research, Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Vargas TG, Mittal VA. The Critical Roles of Early Development, Stress, and Environment in the Course of Psychosis. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:423-445. [PMID: 36712999 PMCID: PMC9879333 DOI: 10.1146/annurev-devpsych-121020-032354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Psychotic disorders are highly debilitating with poor prognoses and courses of chronic illness. In recent decades, conceptual models have shaped understanding, informed treatment, and guided research questions. However, these models have classically focused on the adolescent and early adulthood stages immediately preceding onset while conceptualizing early infancy through all of childhood as a unitary premorbid period. In addition, models have paid limited attention to differential effects of types of stress; contextual factors such as local, regional, and country-level characteristics or sociocultural contexts; and the timing of the stressor or environmental risk. This review discusses emerging research suggesting that (a) considering effects specific to neurodevelopmental stages prior to adolescence is highly informative, (b) understanding specific stressors and levels of environmental exposures (i.e., systemic or contextual features) is necessary, and (c) exploring the dynamic interplay between development, levels and types of stressors, and environments can shed new light, informing a specified neurodevelopmental and multifaceted diathesis-stress model.
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Affiliation(s)
- T G Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - V A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Departments of Psychiatry and Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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Uddin MJ, Hjorthøj C, Ahammed T, Nordentoft M, Ekstrøm CT. The use of polygenic risk scores as a covariate in psychological studies. METHODS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.metip.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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12
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The effects of social isolation stress and discrimination on mental health. Transl Psychiatry 2022; 12:398. [PMID: 36130935 PMCID: PMC9490697 DOI: 10.1038/s41398-022-02178-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Social isolation and discrimination are growing public health concerns associated with poor physical and mental health. They are risk factors for increased morbidity and mortality and reduced quality of life. Despite their detrimental effects on health, there is a lack of knowledge regarding translation across the domains of experimental research, clinical studies, and real-life applications. Here, we review and synthesize evidence from basic research in animals and humans to clinical translation and interventions. Animal models indicate that social separation stress, particularly in early life, activates the hypothalamic-pituitary-adrenal axis and interacts with monoaminergic, glutamatergic, and GABAergic neurotransmitter systems, inducing long-lasting reductions in serotonin turnover and alterations in dopamine receptor sensitivity. These findings are of particular importance for human social isolation stress, as effects of social isolation stress on the same neurotransmitter systems have been implicated in addictive, psychotic, and affective disorders. Children may be particularly vulnerable due to lasting effects of social isolation and discrimination stress on the developing brain. The effects of social isolation and loneliness are pronounced in the context of social exclusion due to discrimination and racism, during widespread infectious disease related containment strategies such as quarantine, and in older persons due to sociodemographic changes. This highlights the importance of new strategies for social inclusion and outreach, including gender, culture, and socially sensitive telemedicine and digital interventions for mental health care.
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Rosenfarb IF, Sharma-Gopinath R, Bhavsar V. First episode of psychosis in Guam: The role of ethnicity and neighbourhood factors. Early Interv Psychiatry 2022; 16:618-625. [PMID: 34414657 DOI: 10.1111/eip.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ethnicity, neighbourhood ethnic density, and four additional neighbourhood factors (urbanicity, crime, voting, and poverty) were examined in relation to the incidence of first episode of psychosis (FEP) in the Pacific Island of Guam. METHODS All first contact patients seen at the Guam Department of Mental Health and Substance Abuse (DMHSA) between January 2005 and December 2007 that met DSM-IV criteria for the diagnosis of a psychotic disorder were included. At the time of the study, DMHSA was the only psychiatric facility in Guam. RESULTS After controlling for age and gender, Chamorros, the indigenous people of Guam, had a standardized incidence rate (IR = 151/100 000 person-years, 95%CI = 129-173) of FEP over twice that of Whites (IR = 66/100 000 person-years, 95%CI = 34-99). Individuals from Palau had the highest standardized incidence rate (IR = 832/100 000 person-years, 95%CI = 581-1083). Increased neighbourhood Chamorro density was associated with decreased incidence of FEP among Chamorro individuals (IRR = 0.11, 95%CI = 0.03-0.43). After controlling for age, gender, ethnicity, and other neighbourhood factors, urbanicity (IRR = 3.82, 95%CI = 1.86-7.81), voting (IRR = 2.06, 95%CI = 1.32-3.20), poverty (IRR = 1.94, 95%CI = 1.40-2.67), and crime (IRR = 1.18, 95%CI = 1.00-1.40) remained statistically associated with FEP incidence. CONCLUSIONS The findings add to prior research that suggests that rates of mental health problems are higher in indigenous than in settler communities and are highest for indigenous people who live in neighbourhoods with few other indigenous individuals. Findings also suggest that even on a small island, with only ~150 000 people, urbanicity is associated with FEP. Finally, results are consistent with other research suggesting that the reduction of crime and social adversity can play a positive role in reducing the incidence of first episode psychosis.
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Affiliation(s)
- Irwin Ford Rosenfarb
- California School of Professional Psychology, Alliant International University, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Rita Sharma-Gopinath
- Department of Psychiatry, University of California, San Diego, California, USA.,Department of Psychology, University of Guam, Mangilao, Guam, USA
| | - Vishal Bhavsar
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
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González-Valderrama A, Jongsma HE, Mena C, Castañeda CP, Nachar R, Undurraga J, Crossley N, Aceituno D, Iruretagoyena B, Gallardo C, Mondaca P, Monje M, Irarrazaval M, Zavala C, Valmaggia L, Kirkbride JB. The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases. Psychol Med 2022; 52:914-923. [PMID: 32758314 PMCID: PMC9005445 DOI: 10.1017/s0033291720002664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. METHODS We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. RESULTS We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. CONCLUSION Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
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Affiliation(s)
- Alfonso González-Valderrama
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Hannah E. Jongsma
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Cristián Mena
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Carmen Paz Castañeda
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Rubén Nachar
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Juan Undurraga
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Nicolás Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Department of Psychosis Studies, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - David Aceituno
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Department of Health Service and Population Research, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - Barbara Iruretagoyena
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
| | - Carlos Gallardo
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Pilar Mondaca
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Matías Monje
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Matías Irarrazaval
- Department of Mental Health, Ministry of Health, Santiago, Chile
- Millennium Institute for Research in Depression and Personality, Santiago, Chile
- Faculty of Medicine, Clínica Psiquiátrica Universitaria, University of Chile, Santiago, Chile
| | - Cynthia Zavala
- Department of Mental Health, Ministry of Health, Santiago, Chile
| | - Lucia Valmaggia
- Department of Psychology, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - James B. Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
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DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, Walker EF. Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:176-197. [PMID: 35815004 PMCID: PMC9258423 DOI: 10.1080/23794925.2022.2042874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.
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Affiliation(s)
- Joseph S. DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, , Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura H. Adery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Community ethnic density, ethnic segregation, and ethnic minorities' common mental disorders in the UK. Health Place 2021; 73:102723. [PMID: 34864384 DOI: 10.1016/j.healthplace.2021.102723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Studies in the UK demonstrate evidence that ethnic minorities living in communities with a higher proportion of co-ethnics report better mental health: co-ethnic density effects. This paper aims to address three gaps in this literature. Firstly, most UK research has focused on acute mental disorders (e.g., psychosis), with little work examining co-ethnic density effects for more common mental disorders. Secondly, there is a paucity of research exploring the role that residential segregation may play alongside co-ethnic density in minority mental health. Thirdly, little systematic testing has examined at what geographic-scale co-ethnic density effects are most salient for minority-group mental health. To address these potential gaps, we apply multi-level linear regression modelling to a large-scale, nationally-representative UK panel dataset, containing an ethnic minority booster-sample, to study the community-level drivers of mental health-related quality-of-life (SF-12 Mental Component Summary Score). The results demonstrate mixed support for the protective-effects of co-ethnic density on mental well-being. However, they demonstrate broadly consistent support for the impact of residential segregation on mental well-being. In particular, that segregation exerts a non-linear effect: mental well-being is at its most positive at medium-levels of segregation, somewhat more negative at low-levels of segregation, and much more negative at higher-levels of segregation. These patterns are present for the 'all ethnic minority' sample, and stronger for Black sub-groups compared to Asian sub-groups. These relationships appear most consistent at meso-local geographic scales (Middle Super Output Areas). These findings have important implications for theorising our understanding of the nexus between the community and mental health among minority-groups.
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Baker SJ, Jackson M, Jongsma H, Saville CWN. The ethnic density effect in psychosis: a systematic review and multilevel meta-analysis. Br J Psychiatry 2021; 219:632-643. [PMID: 35048877 PMCID: PMC8636614 DOI: 10.1192/bjp.2021.96] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND An 'ethnic' or 'group' density effect in psychosis has been observed, whereby the risk of psychosis in minority group individuals is inversely related to neighbourhood-level proportions of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators. AIMS To conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis and examine moderators. METHOD Four databases were systematically searched. A narrative review was conducted and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size and whether studies used clinical or non-clinical outcomes were also tested as moderators. RESULTS Thirty-two studies were included in the narrative review and ten in the meta-analysis. A 10 percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk (OR = 1.20, 95% CI 1.09-1.32, P < 0.001). This was moderated by crudely defined minority groups (F6,68 = 6.86, P < 0.001), with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed (F25,49 = 7.26, P < 0.001). CONCLUSIONS This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density varies across minority groups, with the strongest associations observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Potential mechanisms are discussed, along with the implications of findings and suggestions for future research.
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Affiliation(s)
- Sophie J. Baker
- School of Psychology, Bangor University, UK,Correspondence: Sophie J. Baker.
| | - Mike Jackson
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University; and Betsi Cadwaladr University Health Board, Bangor, UK
| | - Hannah Jongsma
- Centre for Transcultural Psychiatry Veldzicht, Balkbrug; and Department of Psychiatry, University of Groningen; and University Medical Centre Groningen, The Netherlands
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Ramain J, Conus P, Golay P. A narrative review of intervention in first-episode affective psychoses. J Psychiatr Res 2021; 143:123-137. [PMID: 34487989 DOI: 10.1016/j.jpsychires.2021.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 01/18/2023]
Abstract
While first-episode schizophrenia has received extensive attention in the literature, few studies have focused on the first episode of affective psychoses. Considering the lack of structured data regarding this diagnostic grouping commonly used in clinical settings, our aim was to scope the literature on first-episode affective psychoses to consolidate current knowledge and to identify areas to be targeted in future studies. We also planned to investigate the relevance of the "affective psychosis" concept regarding diagnostic categories and specific needs of intervention. We conducted a search on the Embase, Medline, PubMed, PsycINFO and Web Of Science databases until October 2020. We selected studies and synthesized the key findings into a narrative review regarding major topics of early intervention research: diagnostic categorization, premorbid factors, intervention, duration of untreated illness, neurobiology and neurocognition. After screening 961 titles and abstracts and 193 full-text papers, we selected 77 studies for inclusion. Our results showed heterogeneity in diagnosis-related grouping under the concept of affective psychoses, especially variability regarding the inclusion of schizoaffective disorder. Nonetheless, this concept still encompasses patients with different psychopathological and neurocognitive profiles from the non-affective patients requiring specialized intervention. This study thus provided support for the relevance of this concept as well as a need for further investigation.
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Affiliation(s)
- Julie Ramain
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland; Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Switzerland
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Buck B, Chander A, Brian RM, Wang W, Campbell AT, Ben-Zeev D. Expanding the Reach of Research: Quantitative Evaluation of a Web-Based Approach for Remote Recruitment of People Who Hear Voices. JMIR Form Res 2021; 5:e23118. [PMID: 34081011 PMCID: PMC8212619 DOI: 10.2196/23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/09/2020] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background Similar to other populations with highly stigmatized medical or psychiatric conditions, people who hear voices (ie, experience auditory verbal hallucinations [AVH]) are often difficult to identify and reach for research. Technology-assisted remote research strategies reduce barriers to research recruitment; however, few studies have reported on the efficiency and effectiveness of these approaches. Objective This study introduces and evaluates the efficacy of technology-assisted remote research designed for people who experience AVH. Methods Our group developed an integrated, automated and human complementary web-based recruitment and enrollment apparatus that incorporated Google Ads, web-based screening, identification verification, hybrid automation, and interaction with live staff. We examined the efficacy of that apparatus by examining the number of web-based advertisement impressions (ie, number of times the web-based advertisement was viewed); clicks on that advertisement; engagement with web-based research materials; and the extent to which it succeeded in representing a broad sample of individuals with AVH, assessed through the self-reported AVH symptom severity and demographic representativeness (relative to the US population) of the sample recruited. Results Over an 18-month period, our Google Ads advertisement was viewed 872,496 times and clicked on 11,183 times. A total amount of US $4429.25 was spent on Google Ads, resulting in 772 individuals who experience AVH providing consent to participate in an entirely remote research study (US $0.40 per click on the advertisement and US $5.73 per consented participant) after verifying their phone number, passing a competency screening questionnaire, and providing consent. These participants reported high levels of AVH frequency (666/756, 88.1% daily or more), distress (689/755, 91.3%), and functional interference (697/755, 92.4%). They also represented a broad sample of diversity that mirrored the US population demographics. Approximately one-third (264/756, 34.9%) of the participants had never received treatment for their AVH and, therefore, were unlikely to be identified via traditional clinic-based research recruitment strategies. Conclusions Web-based procedures allow for time saving, cost-efficient, and representative recruitment of individuals with AVH and can serve as a model for future studies focusing on hard-to-reach populations.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Rachel M Brian
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew T Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Pignon B, Eaton S, Schürhoff F, Szöke A, McGorry P, O'Donoghue B. Temporal variation in the incidence of treated psychotic disorders in young people. Schizophr Res 2021; 231:221-226. [PMID: 33895599 DOI: 10.1016/j.schres.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/05/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The incidence of psychotic disorders varies between geographical areas, however less is known about whether it varies over time in the same region. Analyzing this temporal variation of incidence could improve the allocation of healthcare resources and our understanding of the aetiology of psychotic disorders. This study aimed to determine whether there was a change in the incidence of psychotic disorders over a six-year period. METHODS Young people aged 15 to 24 presenting with a first episode of psychosis (FEP) attending an early intervention service in Melbourne between 2011 and 2016 were included. The population at-risk was determined from the two corresponding census periods and analyses were adjusted for age, sex and migrant status. RESULTS A total of 1217 young people presented with a FEP over the six-year period and the crude incidence rate in 2011 was 102.4 per 100,000 population at-risk, compared to 125.4 in 2016. There was an increase in the incidence by 33% in 2015 (aIRR = 1.33, 95% CI 1.09-1.63) and 28% in 2016 (aIRR = 1.28, 95% CI 1.05-1.56). When examined according to diagnostic groups, there was an increase in the incidence of substance-induced psychotic disorders among females in 2015 (aIRR = 4.62, 95% CI 1.02-20.8). DISCUSSION This study shows significant temporal variations in the incidence of treated psychotic disorders. These findings demonstrate that early intervention services should continually monitor incidence case numbers and funding should be provided accordingly, to ensure the required intensive and comprehensive treatments can be sustained.
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Affiliation(s)
- Baptiste Pignon
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Scott Eaton
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Franck Schürhoff
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Andrei Szöke
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Patrick McGorry
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Puntis S, Oliver D, Fusar-Poli P. Third external replication of an individualised transdiagnostic prediction model for the automatic detection of individuals at risk of psychosis using electronic health records. Schizophr Res 2021; 228:403-409. [PMID: 33556673 DOI: 10.1016/j.schres.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/03/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary indicated prevention is a key target for reducing the incidence and burden of schizophrenia and related psychotic disorders. An individualised, clinically-based transdiagnostic model for the detection of individuals at risk of psychosis has been developed and validated in two large, urban healthcare providers. We tested its external validity in a geographically and demographically different non-urban population. METHOD Retrospective EHR cohort study. All individuals accessing secondary healthcare provided by Oxford Health NHS Foundation Trust between 1st January 2011 and 30th November 2019 and receiving a primary index diagnosis of a non-psychotic or non-organic mental disorder were considered eligible. The previously developed model was applied to this database and its external prognostic accuracy was measured with Harrell's C. FINDINGS The study included n = 33,710 eligible individuals, with an average age of 27.7 years (SD = 19.8), mostly white (92.0%) and female (57.3%). The mean follow-up was 1863.9 days (SD = 948.9), with 868 transitions to psychosis and a cumulative incidence of psychosis at 6 years of 2.9% (95%CI: 2.7-3.1). Compared to the urban development database, Oxford Health was characterised by a relevant case mix, lower incidence of psychosis, different distribution of baseline predictors, higher proportion of white females, and a lack of specialised clinical services for at risk individuals. Despite these differences the model retained an adequate prognostic performance (Harrell's C = 0.79, 95%CI: 0.78-0.81), with no major miscalibration. INTERPRETATION The transdiagnostic, individualised, clinically-based risk calculator is transportable outside urban healthcare providers. Further research should test transportability of this risk prediction model in an international setting.
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Affiliation(s)
- Stephen Puntis
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom; OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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22
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Zhang J, Yin Y, Wen Y, Shi F, Wang J. Anxiety and Depression in Patients With Pulmonary Arterial Hypertension in Northwest China: A Cross-Sectional Study. Front Psychiatry 2021; 12:758120. [PMID: 35185632 PMCID: PMC8854771 DOI: 10.3389/fpsyt.2021.758120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare life-threatening and incurable disease. Although symptoms of depression and anxiety have been widely reported, these traits and associated factors have not been systematically assessed in Northwest China. METHODS A cross-sectional study was conducted between March 2020 and February 2021. 106 PAH patients in Northwest China were evaluated by Self-rating Anxiety Scale (SAS) and the Self Rating Depression Scale (SDS) questionnaire. RESULTS Overall, the included patients had particularly high depressive symptoms (70.09%), while anxiety among them was 17.55%. Multivariate linear regression revealed that patients with lower age (p = 0.04), female (p < 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p < 0.01), lower left ventricular ejection fraction (p < 0.01), and lower 6-min walking distance (p < 0.01) had higher anxiety scores. Patients who lived in rural areas (p = 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p = 0.04), lower 6-min walking distance (p < 0.01), and college degree or above had higher depression scores (p = 0.02). CONCLUSIONS Mental health problems such as depression are common among patients with PAH in Northwest China. Patients' characteristics such as smoking status, WHO functional class, and 6-min walking distance were related to anxiety and depression scores. Thus, early detection of mental health problems such as depression and anxiety should be detected in PAH patients. Meanwhile, interventions against these problems should be used to improve such patients' mental status.
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Affiliation(s)
- Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, China
| | - Yuhuan Yin
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yujie Wen
- Cardiovascular Department, Gansu Provincial Hospital, Lanzhou, China
| | - Fugui Shi
- Lanzhou Hand and Foot Surgery Hospital, Lanzhou, China
| | - Jiancheng Wang
- Geriatrics Department, Gansu Provincial Hospital, Lanzhou, China
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Tan W, Lin H, Lei B, Ou A, He Z, Yang N, Jia F, Weng H, Hao T. The psychosis analysis in real-world on a cohort of large-scale patients with schizophrenia. BMC Med Inform Decis Mak 2020; 20:132. [PMID: 32646484 PMCID: PMC7477870 DOI: 10.1186/s12911-020-1125-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background With China experiencing unprecedented economic development and social change over the past three decades, Chinese policy makers and health care professionals have come to view mental health as an important outcome to monitor. Our study conducted an epidemiological study of psychosis in Guangdong province, with 20 million real-world follow-up records in the last decade. Methods Data was collected from Guangdong mental health information platform from 2010 to 2019, which had standardized disease registration and follow-up management for nearly 600,000 patients with six categories of mental diseases and 400,000 patients with schizophrenia. We conducted clinical staging for the disease course of the patients and divided the data with various factors into different stages of disease. Quantitative analysis was utilized to investigate the high relevant indicators to the disease. The results were projected on geography map for regional distribution analysis. Results The majority cases of mental disease incidence were between the age of 15 and 29, while the peak age for both male and female was between 20 to 24 years old. The disease course with the largest number of patients’ cases was between 5 to 10 years. The therapeutic effect of patients gradually decreased with the development of disease course, while the risk increased with the disease course. The analysis of influencing factors showed that poor economic conditions incurred higher risk scores, and good medication adherence was effective in improving treatment outcomes. In addition, receiving good education contributed to the reduction of the risk of schizophrenia and the improvement of the efficiency of early treatment. Through the analysis of regional distribution of schizophrenia disease, developed economic conditions and favorable resource conditions could promote the reduction of disease risk, while in economically backward regions, it often accompanied with lower therapeutic effect and higher disease risk. Conclusions Certain demographic factors had a relatively prominent impact on the therapeutic effect and risk of schizophrenia, such as high-quality medication adherence. Therapeutic effect and risk were highly correlated. Backward economic conditions often associated with poor efficacy and higher risk assessment, and the developed economy and better medical resource are beneficial for the treatment of psychotic.
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Affiliation(s)
- Wenyan Tan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Haicheng Lin
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Baoxin Lei
- School of Computer Science, South China Normal University, Guangzhou, China
| | - Aihua Ou
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehui He
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ning Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
| | - Heng Weng
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Tianyong Hao
- School of Computer Science, South China Normal University, Guangzhou, China.
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Ban KY, Osborn DPJ, Hameed Y, Pandey S, Perez J, Jones PB, Kirkbride JB. Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PLoS One 2020; 15:e0234047. [PMID: 32502161 PMCID: PMC7274401 DOI: 10.1371/journal.pone.0234047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
AIM Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services. METHODS Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed. RESULTS Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density. CONCLUSIONS Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.
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Affiliation(s)
- Ka-Young Ban
- Division of Psychiatry, UCL, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Yasir Hameed
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Santvana Pandey
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
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25
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Xenaki LA, Kollias CT, Stefanatou P, Ralli I, Soldatos RF, Dimitrakopoulos S, Hatzimanolis A, Triantafyllou TF, Kosteletos I, Vlachos II, Selakovic M, Foteli S, Mantonakis L, Ermiliou V, Voulgaraki M, Psarra E, Gülöksüz S, van Os J, Stefanis NC. Organization framework and preliminary findings from the Athens First-Episode Psychosis Research Study. Early Interv Psychiatry 2020; 14:343-355. [PMID: 31402581 DOI: 10.1111/eip.12865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/18/2019] [Accepted: 07/14/2019] [Indexed: 12/12/2022]
Abstract
AIMS Athens First-Episode Psychosis (FEP) Research study, aims to explore the potential associations between multiple genetic, environmental and neurometabolic risk factors of psychotic disorders, through the clinical management of FEP patients with minimal exposure (<2 weeks) to antipsychotic treatment at entry. The goal of this paper is to introduce the background, rationale and design of the study and present its preliminary findings. METHODS We developed a longitudinal cohort study of FEP patients 16-45 years old, presenting at the emergency units of five psychiatric hospitals across Athens, Greece. Research timeline includes baseline, 1-month and 1-year follow-up. Clinical, genetic, environmental, cognitive and biochemical parameters are measured, using psychometric tools, clinical interviews and laboratory tests. A descriptive analysis of baseline and 1-month assessments was performed including demographic characteristics, family history, medication, clinical picture, traumatic experiences, drug use and cognitive functioning. RESULTS During the last 3 years, 130 subjects have been enrolled in the study. Data so far reveal that, despite the severity of baseline presentation, at 1-month the majority (57.4%) met the Andreasen symptom severity criteria for remission, without the time criterion and showed mild functional improvement. Several environmental adversities and poor cognitive performance were identified, which need to be further elaborated. CONCLUSIONS Athens FEP Research study is the first gene-environment interaction study in Greece. In this article we introduce the organization and methodological framework of the project, along with its basic initial findings. Future analysis will allow the validation of tractable predictors and risk factors implicated in the development and outcome of psychosis.
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Affiliation(s)
- Lida-Alkisti Xenaki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Costas T Kollias
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Irene Ralli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Rigas-Filippos Soldatos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.,Psychiatric Clinic, 414 Military Hospital of Athens, Penteli, Greece
| | - Alex Hatzimanolis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
| | | | - Ioannis Kosteletos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Ilias I Vlachos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Stefania Foteli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Leonidas Mantonakis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Vassiliki Ermiliou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Marina Voulgaraki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Evagelia Psarra
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Sinan Gülöksüz
- Department Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Nikos C Stefanis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
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Ku BS, Pauselli L, Manseau M, Compton MT. Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophr Res 2020; 218:247-254. [PMID: 31948900 PMCID: PMC7299734 DOI: 10.1016/j.schres.2019.12.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). METHODS Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. RESULTS 143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. CONCLUSIONS This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.
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Affiliation(s)
- Benson S. Ku
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Benson Ku, M.D., , 100 Woodruff Circle Suite 327, Atlanta, GA 30322, (404) 727-8381, Fax: 289-802-1992
| | - Luca Pauselli
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA,Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, Department of Psychiatry, New York, NY, USA
| | - Marc Manseau
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England. Psychol Med 2020; 50:293-302. [PMID: 30744718 PMCID: PMC7083582 DOI: 10.1017/s0033291719000023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND We aimed to spatially describe mental illness prevalence in England at small-area geographical level, as measured by prevalence of depression, severe mental illness (SMI) and antidepressant prescription volume in primary care records, and how much of their variation was explained by deprivation, social fragmentation and sociodemographic characteristics. METHODS Information on prevalence of depression and SMI was obtained from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/16 and the national dispensing dataset for 2015/16. Linear regression models were fitted to examine ecological associations between deprivation, social fragmentation, other sociodemographic characteristics and mental illness prevalence. RESULTS Mental illness prevalence varied within and between regions, with clusters of high prevalence identified across England. Our models explained 33.4-68.2% of variability in prevalence, but substantial variability between regions remained after adjusting for covariates. People in socially cohesive and socially deprived areas were more likely to be diagnosed with depression, while people in more socially fragmented and more socially deprived areas were more likely to be diagnosed with SMI. CONCLUSIONS Our findings suggest that to tackle mental health inequalities, attention needs to be targeted at more socially deprived localities. The role of social fragmentation warrants further investigation, and it is possible that depression remains undiagnosed in more socially fragmented areas. The wealth of routinely collected data can provide robust evidence to aid optimal resource allocation. If comparable data are available in other countries, similar methods could be deployed to identify high prevalence clusters and target funding to areas of greater need.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, Centre for Health Economics, University of Manchester, Manchester, UK
| | - Roger T. Webb
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Nav Kapur
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Division of Psychology and Mental Health, Centre for Suicide Prevention, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Trust
| | - Darren M. Ashcroft
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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Stafford J, Howard R, Dalman C, Kirkbride JB. The Incidence of Nonaffective, Nonorganic Psychotic Disorders in Older People: A Population-based Cohort Study of 3 Million People in Sweden. Schizophr Bull 2019; 45:1152-1160. [PMID: 30339239 PMCID: PMC6737541 DOI: 10.1093/schbul/sby147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation. METHODS We followed up a cohort of 3 007 378 people living in Sweden, born 1920-1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments. RESULTS We identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1-38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4-2.7), North America (HR = 1.4, 95% CI = 1.0-1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2-1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4-1.9), and Finland (HR = 1.6, 95% CI = 1.5-1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9-3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0-1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0-1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8-1.9) or children (HR = 2.4, 95% CI = 2.3-2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2-2.6). INTERPRETATION We identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.
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Affiliation(s)
- Jean Stafford
- Division of Psychiatry, University College London, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Wang C, Wang Q, Li X, Zhang Y, Wei W, Deng W, Guo W, He L, Tang W, Chen T, Li T. Rural birth/upbringing and childhood adversities are associated with psychotic experiences in university students in China. Schizophr Res 2019; 209:105-112. [PMID: 31101515 DOI: 10.1016/j.schres.2019.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/28/2019] [Accepted: 05/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Urbanicity has been reported to associate with an increased risk of psychotic experiences (PEs) in developed countries but less is known about the situation in developing countries. The present study aimed to investigate the effects of birth/upbringing place and other environmental factors on PEs in Chinese university students. METHODS A computer-assisted cross-sectional survey was conducted on 4620 second-year undergraduates, using a stratified cluster sampling. Birth places and residential mobility before 16 years old were recorded. PEs were measured using the subscales of psychoticism and paranoid ideation in the Symptom Checklist-90-R (SCL-90-R). Six questions extracted from the childhood section of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) were used to assess childhood trauma. RESULTS Generalized ordered logit model of multiple regression analysis revealed that participants with rural birth/upbringing (e.g. rural upbringing, on graded factor score of psychoticism and paranoid ideation [GFSPPI], 0 versus 1 & 2, odds ratio [OR] 1.409, 95% CI 1.219-1.628, p < 0.00001; 0 & 1 versus 2, OR 1.584, 95% CI 1.179-2.128, p < 0.00001) and those who reported childhood trauma (e.g. on GFSPPI, 0 versus 1 & 2, OR 1.737, 95% CI 1.498-2.014, p < 0.00001; 0 & 1 versus 2, OR 1.618, 95% CI 1.224-2.140, p < 0.00001) were apt to present more severe PEs. While upbringing places and childhood trauma affected both the presence and the severity of PEs, gender affected the presence or absence of PEs only (e.g. females, on GFSPPI, 0 versus 1 & 2, OR 1.887, 95% CI 1.631-2.183, p < 0.00001; 0 & 1 versus 2, OR 0.927, 95% CI 0.702-1.223, p = 0.593). Besides, the number of risk factors was associated with the severity of PEs in the cumulative odds logistic regression analysis (e.g. 3 risk factors versus 0 risk factor, on GFSPPI, OR 4.126, 95% CI 3.075-5.537, p < 0.00001). CONCLUSIONS Female, rural birth/upbringing and childhood trauma are risk factors of PEs in university students in China. The discrepancy in the findings between developed countries and China has important implications for urbanicity as a risk factor for PEs.
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Affiliation(s)
- Chengyu Wang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Qiang Wang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Xiaojing Li
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yamin Zhang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Wei
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjun Guo
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lingshuang He
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, Sichuan, China
| | - Ting Chen
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Eaton S, Harrap B, Downey L, Thien K, Bowtell M, Bardell-Williams M, Ratheesh A, McGorry P, O'Donoghue B. Incidence of treated first episode psychosis from an Australian early intervention service and its association with neighbourhood characteristics. Schizophr Res 2019; 209:206-211. [PMID: 31130401 DOI: 10.1016/j.schres.2019.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 03/26/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Psychotic disorder incidence varies geographically and is associated with neighbourhood characteristics, including social deprivation, population density, unemployment, social capital or social fragmentation. Yet it is not known whether these findings are applicable to Australia's unique geography. This study aimed to determine whether the incidence of first episode psychosis (FEP) varies according to neighbourhood characteristics in an Australian cohort. METHOD This study included all young people, aged 15 to 24, with an FEP who attended Orygen Youth Health in Melbourne, from a geographically defined catchment area encompassing Northern and Western Melbourne, over a 44-month period. Neighbourhood demographic data was collected from the 2011 Australian National Census. Negative binomial regression was used to determine incidence rate ratios controlled for age, sex and migrant status. RESULTS A total of 747 young people had an FEP during the 44-month study period and 722 were included in this study. Of these, 58.0% were males and 67.9% had a non-affective psychotic disorder; the mean age of the cohort was 19.1 years. The incidence of FEP in young people aged 15 to 24 in the catchment area was 123.2 per 100,000 person-years. There was a higher incidence of FEP in neighbourhoods of greatest social deprivation (IRR = 1.65, CI = 1.06-2.51, p = .02), highest unemployment (IRR = 1.56, CI = 1.04-2.35, p = .03) and above average social fragmentation (IRR = 1.42, CI = 1.02-1.97, p = .04), when controlled for age, sex and migrant status. CONCLUSIONS This study highlights variation in psychotic disorder incidence and the need for this disparity to be reflected in appropriate resource allocation.
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Affiliation(s)
- Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Benjamin Harrap
- Melbourne Epicentre, Melbourne Health and The University of Melbourne, 300 Grattan Street, Royal Melbourne Hospital, Victoria 3052, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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Abstract
PURPOSE OF REVIEW Epidemiological studies associate city living with an elevated psychosis risk. Urban (social/economic) stress and exposure to environmental toxins, pollution or disease agents have been proposed to underlie this association. This review provides an update on the recent evidence (May 2017 - November 2018). RECENT FINDINGS Of 647 screened studies, 17 on: urbanicity-psychosis associations in worldwide high, middle and low-income countries; explanatory mechanisms, including nature exposure, social and economic stressors and genetic risk; urbanicity effects on the brain and coping; and urbanicity and resources, were included. The reviewed evidence revealed complex patterns of urbanicity-psychosis associations with considerable international variation within Europe and between low, middle and high-income countries worldwide. Social and economic stressors (e.g. migration, ethnic density and economic deprivation), nature exposure and access to resources could only explain part of the urbanicity effects. Risk factors differed between countries and between affective and non-affective psychosis. SUMMARY Urbanicity-psychosis associations are heterogeneous and driven by multiple risk and protective factors that seem to act differently in different ethnic groups and countries. Interdisciplinary research combining approaches, for example from experimental neuroscience and epidemiology, are needed to unravel specific urban mechanisms that increase or decrease psychosis risk.
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Torous J, Woodyatt J, Keshavan M, Tully LM. A new hope for early psychosis care: the evolving landscape of digital care tools. Br J Psychiatry 2019; 214:269-272. [PMID: 30739613 PMCID: PMC6478506 DOI: 10.1192/bjp.2019.8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Improving understanding of and outcomes for early-course psychosis (ECP) is a recognised global mental health priority. We argue digital health technologies can advance care for ECP by better accounting for clinical heterogeneity, offering better predictive models, increasing access to early interventions and enhancing existing treatment options.Declaration of interestL.M.T. owns shares in Safari Health Inc - a digital health technology company.
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Affiliation(s)
- John Torous
- Director of the Digital Psychiatry Division,Department of Psychiatry,Beth Israel Deaconess Medical Center,Harvard Medical School,USA
| | - Jessica Woodyatt
- Lab Manager,Social Cognition in Psychopathology Lab,Department of Psychology,University of Rochester,USA
| | - Matcheri Keshavan
- Vice Chair of Public Psychiatry,Department of Psychiatry,Beth Israel Deaconess Medical Center and the Massachusetts Mental Health Center,Harvard Medical School,USA
| | - Laura M Tully
- Assistant Professor in Psychiatry,Department of Psychiatry,University of California; andDirector of Clinical Training,UC Davis Imaging Research Center,USA
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Psychoses sans Frontieres: towards an interdisciplinary understanding of psychosis risk amongst migrants and their descendants. Epidemiol Psychiatr Sci 2019; 28:146-152. [PMID: 30208980 PMCID: PMC6330066 DOI: 10.1017/s2045796018000501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Understanding the excess risk of psychotic disorders in migrant and ethnic minority groups has long been an important research focus in psychiatric epidemiology and public mental health. Heterogeneity between migrant groups based on the region of origin, minority status and other socioeconomic factors may provide clues as to the underlying aetiological mechanisms explaining this risk, as well as informing our general understanding of psychotic disorders. Nonetheless, disentangling the mechanisms underlying this association has been the focus of more speculation and theory to date than empirical research. Now more than ever, we need to move beyond studies which demonstrate excess rates in migrant and ethnic minority groups to novel population-based studies which identify the determinants and mechanisms through which this risk is shaped. In this paper, we review the main hypotheses proposed to explain these disparities and the current level of support for them. We then highlight recent evidence from epidemiology and neuroscience which provides important new clues in our understanding of the aetiology of psychotic disorders. We concluded with suggestions for future interdisciplinary research to prevent this public mental health inequality within a generation.
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Pitman A, Mann F, Johnson S. Advancing our understanding of loneliness and mental health problems in young people. Lancet Psychiatry 2018; 5:955-956. [PMID: 30477651 DOI: 10.1016/s2215-0366(18)30436-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandra Pitman
- Division of Psychiatry, University College London, London W1T7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
| | - Farhana Mann
- Division of Psychiatry, University College London, London W1T7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London W1T7NF, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Kirkbride JB, Keyes KM, Susser E. City Living and Psychotic Disorders-Implications of Global Heterogeneity for Theory Development. JAMA Psychiatry 2018; 75:1211-1212. [PMID: 30304485 DOI: 10.1001/jamapsychiatry.2018.2640] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Katherine M Keyes
- Mailman School of Public Health, Columbia University, New York, New York
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, New York.,New York State Psychiatric Institute, New York
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Price C, Dalman C, Zammit S, Kirkbride JB. Association of Residential Mobility Over the Life Course With Nonaffective Psychosis in 1.4 Million Young People in Sweden. JAMA Psychiatry 2018; 75:1128-1136. [PMID: 30140915 PMCID: PMC6248097 DOI: 10.1001/jamapsychiatry.2018.2233] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Residential mobility (changing residence) during childhood and early adolescence is a possible risk factor for several adverse health outcomes, including psychotic disorders. However, it is unclear whether sensitive periods to residential mobility exist over the life course, including in adulthood, or if greater moving distances, which might disrupt social networks, are associated with a greater psychosis risk. OBJECTIVE To examine the association between residential mobility over the life course and the risk of nonaffective psychosis. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included all people born in Sweden between January 1, 1982, and December 31, 1995, who were alive and resided in Sweden on their 16th birthday who were followed up until up to age 29 years (ending December 2011). Participants were followed until receiving a first diagnosis of an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) nonaffective psychotic disorder (F20-29), emigration, death, or the end of 2011, whichever was sooner. National register linkage provided exposure, outcome, and covariate data (complete data were available for 1 440 383 participants [97.8%]). EXPOSURES The exposures to distance moved and the number of residential moves were examined for participants at the following periods over the life course: 0 to 6 years, 7 to 15 years, 16 to 19 years, and 20 years and older. RESULTS This study included 1 440 383 participants, of whom 4537 (0.31%) had nonaffective psychotic disorder (median age, 20.9 [interquartile range, 19.0-23.3]). More frequent moves during childhood and adolescence were associated with an increased risk of nonaffective psychosis that showed dose-response associations independent of covariates. The most sensitive period of risk occurred during late adolescence; those who moved during each year between age 16 to 19 years had an increased adjusted hazard ratio (HR) of 1.99 (95% CI, 1.30-3.05) compared with those who never moved. One move during adulthood was not associated with psychosis risk (adjusted HR, 1.04; 95% CI, 0.94-1.14), but moving 4 or more times during adulthood was associated with increased risk (adjusted hazard ratio, 1.82; 95% CI, 1.51-2.23). Independently, moving greater distances before age 16 years was associated with an increased risk (adjusted HR, 1.11; 95% CI, 1.05-1.19), with evidence of a nonlinear threshold effect for moves longer than 30 km. The distance moved after age 20 years was associated with a decreased risk (adjusted HR, 0.67; 95% CI, 0.63-0.71). CONCLUSIONS AND RELEVANCE Children and adolescents with less disruption in their residential environments are less likely to experience psychotic disorders in early adulthood. Moves that may necessitate changes in school and social networks were most strongly associated with future risk.
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Affiliation(s)
- Ceri Price
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales
| | - Christina Dalman
- Epidemiology of Mental Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Stanley Zammit
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales,Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, England
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DeVylder JE, Kelleher I, Lalane M, Oh H, Link BG, Koyanagi A. Association of Urbanicity With Psychosis in Low- and Middle-Income Countries. JAMA Psychiatry 2018; 75:678-686. [PMID: 29799917 PMCID: PMC6145671 DOI: 10.1001/jamapsychiatry.2018.0577] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/21/2018] [Indexed: 12/16/2022]
Abstract
Importance Urban residence is one of the most well-established risk factors for psychotic disorder, but most evidence comes from a small group of high-income countries. Objective To determine whether urban living is associated with greater odds for psychosis in low- and middle-income countries (LMICs). Design, Setting, and Participants This international population-based study used cross-sectional survey data collected as part of the World Health Organization (WHO) World Health Survey from May 2, 2002, through December 31, 2004. Participants included nationally representative general population probability samples of adults (≥18 years) residing in 42 LMICs (N = 215 682). Data were analyzed from November 20 through December 5, 2017. Exposures Urban vs nonurban residence, determined by the WHO based on national data. Main Outcomes and Measures Psychotic experiences, assessed using the WHO Composite International Diagnostic Interview psychosis screen, and self-reported lifetime history of a diagnosis of a psychotic disorder. Results Among the 215 682 participants (50.8% women and 49.2% men; mean [SD] age, 37.9 [15.7] years), urban residence was not associated with psychotic experiences (odds ratio [OR], 0.99; 95% CI, 0.89-1.11) or psychotic disorder (OR, 0.89; 95% CI, 0.76-1.06). Results of all pooled analyses and meta-analyses of within-country effects approached a null effect, with an overall OR of 0.97 (95% CI, 0.87-1.07), OR for low-income countries of 0.98 (95% CI, 0.82-1.15), and OR for middle-income countries of 0.96 (95% CI, 0.84-1.09) for psychotic experiences and an overall OR of 0.92 (95% CI, 0.73-1.16), OR for low-income countries of 0.92 (95% CI, 0.66-1.27), and OR for middle-income countries of 0.92 (95% CI, 0.67-1.27) for psychotic disorder. Conclusions and Relevance Our results provide evidence that urbanicity, a well-established risk factor for psychosis, may not be associated with elevated odds for psychosis in developing countries. This finding may provide better understanding of the mechanisms by which urban living may contribute to psychosis risk in high-income countries, because urban-rural patterns of cannabis use, racial discrimination, and socioeconomic disparities may vary between developing and developed nations.
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Affiliation(s)
- Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons, Dublin, Ireland
| | - Monique Lalane
- Graduate School of Social Service, Fordham University, New York, New York
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles
| | - Bruce G. Link
- Department of Sociology, University of California, Riverside
- Department of Public Policy, University of California, Riverside
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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