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Cohen G, Rowland ST, Benavides J, Lindert J, Kioumourtzoglou MA, Parks RM. Daily temperature variability and mental health-related hospital visits in New York State. ENVIRONMENTAL RESEARCH 2024; 257:119238. [PMID: 38815717 DOI: 10.1016/j.envres.2024.119238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Despite plausible behavioral and physiological pathways, limited evidence exists on how daily temperature variability is associated with acute mental health-related episodes. OBJECTIVES We aimed to explore associations between daily temperature range (DTR) and mental health-related hospital visits using data of all hospital records in New York State during 1995-2014. We further examined factors that may modify these associations, including age, sex, hospital visit type and season. METHODS Using a case-crossover design with distributed lag non-linear DTR terms (0-6 days), we estimated associations between ZIP Code-level DTR and hospital visits for mood (4.6 million hospital visits), anxiety (2.4 million), adjustment (∼368,000), and schizophrenia disorders (∼211,000), controlling for daily mean temperature, via conditional logistic regression models. We assessed potential heterogeneity by age, sex, hospital visit type (in-patient vs. out-patient), and season (summer, winter, and transition seasons). RESULTS For all included outcomes, we observed positive associations from period minimum DTR (0.1 °C) until 25th percentile (5.2 °C) and between mean DTR (7.7 °C) and 90th percentile (12.2 °C), beyond which we observed negative associations. For mood disorders, an increase in DTR from 0.1 °C to 12.2 °C was associated with a cumulative 16.0% increase (95% confidence interval [CI]: 12.8, 19.2%) in hospital visit rates. This increase was highest during transition seasons (32.5%; 95%CI: 26.4, 39.0%) compared with summer (10.7%; 95%CI: 4.8, 16.8%) and winter (-1.6%; 95%CI: -7.6, 4.7%). For adjustment and schizophrenia disorders, the strongest associations were seen among the youngest group (0-24 years) with almost no association in the oldest group (65+ years). We observed no evidence for modification by sex and hospital visit type. DISCUSSION Daily temperature variability was positively associated with mental health-related hospital visits within specific DTR ranges in New York State, after controlling for daily mean temperature. Given uncertainty on how climate change modifies temperature variability, additional research is crucial to comprehend the implications of these findings, particularly under different scenarios of future temperature variability.
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Affiliation(s)
- Gali Cohen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Israel
| | - Sebastian T Rowland
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jaime Benavides
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jutta Lindert
- Department of Health and Social Work, University of Applied Sciences Emden, Emden, Germany
| | | | - Robbie M Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Guo J, Garshick E, Si F, Tang Z, Lian X, Wang Y, Li J, Koutrakis P. Environmental Toxicant Exposure and Depressive Symptoms. JAMA Netw Open 2024; 7:e2420259. [PMID: 38958973 PMCID: PMC11222999 DOI: 10.1001/jamanetworkopen.2024.20259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/03/2024] [Indexed: 07/04/2024] Open
Abstract
Importance Recognizing associations between exposure to common environmental toxicants and mental disorders such as depression is crucial for guiding targeted mechanism research and the initiation of disease prevention efforts. Objectives To comprehensively screen and assess the associations between potential environmental toxicants and depressive symptoms and to assess whether systemic inflammation serves as a mediator. Design, Setting, and Participants A total of 3427 participants from the 2013-2014 and 2015-2016 waves of the National Health and Nutrition Examination and Survey who had information on blood or urine concentrations of environmental toxicants and depression scores assessed by the 9-item Patient Health Questionnaire (PHQ-9) were included. Statistical analysis was performed from July 1, 2023, to January 31, 2024. Exposures Sixty-two toxicants in 10 categories included acrylamide, arsenic, ethylene oxide, formaldehyde, iodine, metals, nicotine metabolites, polycyclic aromatic hydrocarbons, volatile organic compound (VOC) metabolites; and perchlorate, nitrate, and thiocyanate. Main Outcomes and Measures An exposome-wide association study and the deletion-substitution-addition algorithm were used to assess associations with depression scores (PHQ-9 ≥5) adjusted for other important covariates. A mediation analysis framework was used to evaluate the mediating role of systemic inflammation assessed by the peripheral white blood cell count. Results Among the 3427 adults included, 1735 (50.6%) were women, 2683 (78.3%) were younger than 65 years, and 744 (21.7%) were 65 years or older, with 839 (24.5%) having depressive symptoms. In terms of race and ethnicity, 570 participants (16.6%) were Mexican American, 679 (19.8%) were non-Hispanic Black, and 1314 (38.3%) were non-Hispanic White. We identified associations between 27 chemical compounds or metals in 6 of 10 categories of environmental toxicants and the prevalence of depressive symptoms, including the VOC metabolites N-acetyl-S-(2-hydroxy-3-butenyl)-l-cysteine (odds ratio [OR], 1.74 [95% CI, 1.38, 2.18]) and total nicotine equivalent-2 (OR, 1.42 [95% CI, 1.26-1.59]). Men and younger individuals appear more vulnerable to environmental toxicants than women and older individuals. Peripheral white blood cell count mediated 5% to 19% of the associations. Conclusions and Relevance In this representative cross-sectional study of adults with environmental toxicant exposures, 6 categories of environmental toxicants were associated with depressive symptoms with mediation by systemic inflammation. This research provides insight into selecting environmental targets for mechanistic research into the causes of depression and facilitating efforts to reduce environmental exposures.
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Affiliation(s)
- Jianhui Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Massachusetts
| | - Feifei Si
- Peking University Sixth Hospital Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ziqi Tang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Xinyao Lian
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yaqi Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Yang C, Wang J, Yang H, Liao J, Wang X, Jiao K, Ma X, Liao J, Liu X, Ma L. Association of NO 2 with daily hospital admissions for mental disorders: Investigation of the modification effects of green spaces and long-term NO 2 exposure. J Psychiatr Res 2022; 156:698-704. [PMID: 36410308 DOI: 10.1016/j.jpsychires.2022.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Air pollution is a risk factor for increased hospital admissions due to mental disorders, while green spaces have been linked with better mental health. We linked daily hospital admission records from Wuhan's 74 municipal hospitals from 2017 to 2019 with modeled annual average NO2 concentrations and added data on the residential surrounding green spaces with 250 m and 500 m buffers based on the normalized difference vegetation index (NDVI) using a land use regression model (LUR). The conditional logistic regression model was used to estimate the acute effect of short-term NO2 exposure, and stratification analyses were applied to explore the modification effect of long-term NO2 exposure and green spaces by estimating the odds ratios in the single- and dual-environmental factor groups. A total of 42,705 hospital admissions for mental disorders were identified. Short-term exposure to NO2 was associated with an increased risk of hospital admission for mental disorders. A 10 μg/m3 increase in NO2 (lag01 day) was associated with an increase in hospital admissions of 2.86% (95% CI, 2.05-3.68) for the total mental disorders. Compared with patients in the "low-NDVI/low-NO2" group (ER = 2.27%, 95% CI, 0.27-4.31), patients in the "high-NDVI/low-NO2" group (ER = 1.93%, -0.10-3.99) showed a lower and insignificant increase in hospitalizations for the total mental disorders, while greenness had a slight moderating effect in the high-level long-term NO2 exposure areas. This study suggested that green spaces may moderate the acute effect of NO2 exposure for mental disorder hospitalizations, especially in low-level long-term NO2 exposure areas.
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Affiliation(s)
- Can Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Jing Wang
- School of Public Health, Wuhan University, Wuhan, China
| | - Haoming Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Jianpeng Liao
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaodie Wang
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Xuxi Ma
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China
| | - Jingling Liao
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Xingyuan Liu
- Wuhan Information Control Health & Family Planning, Wuhan, China
| | - Lu Ma
- School of Public Health, Wuhan University, Wuhan, China.
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Scott J, Etain B, Miklowitz D, Crouse JJ, Carpenter J, Marwaha S, Smith D, Merikangas K, Hickie I. A systematic review and meta-analysis of sleep and circadian rhythms disturbances in individuals at high-risk of developing or with early onset of bipolar disorders. Neurosci Biobehav Rev 2022; 135:104585. [PMID: 35182537 PMCID: PMC8957543 DOI: 10.1016/j.neubiorev.2022.104585] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically searched for studies of self, observer or objective estimates of SCRD in asymptomatic or symptomatic offspring of parents with BD (OSBD), individuals with presentations meeting recognized BD-at-risk criteria (BAR) and youth with recent onset of full-threshold BD (FT-BD). Of 76 studies eligible for systematic review, 35 (46%) were included in random effects meta-analyses. Pooled analyses of self-ratings related to circadian rhythms demonstrated greater preference for eveningness and more dysregulation of social rhythms in BAR and FT-BD groups; analyses of actigraphy provided some support for these findings. Meta-analysis of prospective studies showed that pre-existing SCRD were associated with a 40% increased risk of onset of BD, but heterogeneity in assessments was a significant concern. Overall, we identified longer total sleep time (Hedges g: 0.34; 95% confidence intervals:.1,.57), especially in OSBD and FT-BD and meta-regression analysis indicated the effect sizes was moderated by the proportion of any sample manifesting psychopathology or receiving psychotropic medications. This evolving field of research would benefit from greater attention to circadian rhythm as well as sleep quality measures.
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Affiliation(s)
- Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, NE1 7RU, UK.
| | - Bruno Etain
- Université de Paris, Paris, France; AP-HP Nord, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - David Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
| | - Joanne Carpenter
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, and Birmingham and Solihull Mental Health Trust, UK
| | - Daniel Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kathleen Merikangas
- Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, 94-100 Mallett Street, Camperdown, 2050, NSW, Australia
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Scott J, Kallestad H, Vedaa O, Sivertsen B, Etain B. Sleep disturbances and first onset of major mental disorders in adolescence and early adulthood: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101429. [PMID: 33549912 DOI: 10.1016/j.smrv.2021.101429] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
Despite several high-quality reviews of insomnia and incidence of mental disorders, prospective longitudinal relationships between a wider range of sleep disturbances and first onset of a depressive, bipolar, or psychotic disorders during the peak age range for onset of these conditions has not been addressed. Database searches were undertaken to identify publications on insomnia, but also on other sleep problems such as hypersomnia, short sleep duration, self-identified and/or generic 'sleep problems' and circadian sleep-wake cycle dysrhythmias. We discovered 36 studies that were eligible for systematic review and from these publications, we identified 25 unique datasets that were suitable for meta-analysis (Number>45,000; age ∼17). Individuals with a history of any type of sleep disturbance (however defined) had an increased odds of developing a mood or psychotic disorder in adolescence or early adulthood (Odds ratio [OR]:1.88; 95% Confidence Intervals:1.67, 2.25) with similar odds for onset of bipolar disorders (OR:1.72) or depressive disorders (OR:1.62). The magnitude of associations differed according to type of exposure and was greatest for sleep disturbances that met established diagnostic criteria for a sleep disorder (OR: 2.53). However, studies that examined observer or self-rated symptoms, also reported a significant association between hypersomnia symptoms and the onset of a major mental disorder (OR:1.39). Overall study quality was moderate with evidence of publication bias and meta-regression identified confounders such as year of publication. We conclude that evidence indicates that subjective, observer and objective studies demonstrate a modest but significant increase in the likelihood of first onset of mood and psychotic disorders in adolescence and early adulthood in individuals with broadly defined sleep disturbances. Although findings support proposals for interventions for sleep problems in youth, we suggest a need for greater consensus on screening strategies and for more longitudinal, prospective studies of circadian sleep-wake cycle dysrhythmias in youth.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK; Universite de Paris, Paris, France; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Havard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Oystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Voss District Psychiatric Hospital, NKS Bjorkeli, Voss, Norway
| | - Borge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
| | - Bruno Etain
- Universite de Paris, Paris, France; AP-HP Paris Nord, GH Saint-Louis-Lariboisiere-Fernand-Widal, Departement de Psychiatrie et de Medicine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
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Pagliaccio D, Herbstman JB, Perera F, Tang D, Goldsmith J, Peterson BS, Rauh V, Margolis AE. Prenatal exposure to polycyclic aromatic hydrocarbons modifies the effects of early life stress on attention and Thought Problems in late childhood. J Child Psychol Psychiatry 2020; 61:1253-1265. [PMID: 31907931 PMCID: PMC7338249 DOI: 10.1111/jcpp.13189] [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: 09/23/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Risk for childhood psychopathology is complex and multifactorial, implicating direct and interacting effects of familial and environmental factors. The role of environmental neurotoxicants in psychiatric risk is of growing concern, including polycyclic aromatic hydrocarbons (PAH), common in air pollution. Prenatal PAH exposure is linked to adverse physical, behavioral, and cognitive outcomes as well as increasing psychiatric risk. It is unclear whether environmental exposures, like PAH, magnify the effects of exposure to early life stress (ELS), a critical risk factor for psychopathology. The current work aimed to test potential interactions between prenatal PAH exposure and psychosocial/socioeconomic stress on psychiatric symptoms in school-age children. METHODS Data were from the Columbia Center for Children's Environmental Health Mothers and Newborns longitudinal birth cohort study. Prenatal PAH exposure was ascertained though air monitoring during pregnancy and maternal PAH-DNA adducts at delivery. Mothers reported on ELS (child age 5) and on child psychiatric symptoms across childhood (child age 5, 7, 9, and 11) using the Child Behavior Checklist (CBCL). RESULTS Significant prenatal airborne PAH × ELS interactions (FDR-corrected) predicted CBCL Attention (β = 0.22, t(307) = 3.47, p < .001, pfdr = .003) and Thought Problems T-scores (β = 0.21, t(307) = 3.29, p = .001, pfdr = .004) at age 11 (n = 319). Relative to those with lower exposure, children with higher prenatal PAH exposure exhibited stronger positive associations between ELS and CBCL Attention and Thought Problem T-scores. This interaction was also significant examining convergent ADHD measures (Conners, DuPaul) and examining maternal PAH-DNA adducts (β = 0.29, t(261) = 2.48, p = .01; n = 273). A three-way interaction with assessment wave indicated that the PAH × ELS interaction on Attention Problems was stronger later in development (β = 0.03, t(1,601) = 2.19, p = .03; n = 477). CONCLUSIONS Prenatal exposure to PAH, a common neurotoxicant in air pollution, may magnify or sustain the effects of early life psychosocial/socioeconomic stress on psychiatric outcomes later in child development. This work highlights the critical role of air pollution exposure on child mental health.
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Affiliation(s)
- David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA;,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Bradley S. Peterson
- Department of Psychiatry, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - Virginia Rauh
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amy E. Margolis
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA;,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Bout A, Aarab C, Rammouz I, Aalouane R. De la nécessité de parler de la prévention de la dépression. Encephale 2020; 46:314-315. [DOI: 10.1016/j.encep.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 10/24/2022]
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Poletti M, Gebhardt E, Pelizza L, Preti A, Raballo A. Looking at Intergenerational Risk Factors in Schizophrenia Spectrum Disorders: New Frontiers for Early Vulnerability Identification? Front Psychiatry 2020; 11:566683. [PMID: 33192689 PMCID: PMC7649773 DOI: 10.3389/fpsyt.2020.566683] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Offspring of individuals with serious mental illness (SMI) constitute a special population with a higher risk of developing psychiatric disorders, which is also highly prevalent among referrals to child and adolescent mental health services (CAMHS). They often exhibit more or less subclinical conditions of vulnerability, fueled by mutually potentiating combinations of risk factors, such as presumed genetic risk, poor or inadequate affective and cognitive parenting, and low socio-economic status. Despite this evidence, neither specific preventive programs for offspring of parents with SMI are usually implemented in CAMHS, nor dedicated supportive programs for parenting are generally available in adult mental health services (AMHS). Needless to say, while both service systems tend to focus on individual recovery and clinical management (rather than on the whole family system), these blind spots add up to frequent gaps in communication and continuity of care between CAMHS and AMHS. This is particularly problematic in an age-range in which an offspring's vulnerabilities encounter the highest epidemiological peak of incident risk of SMI. This paper offers a clinical-conceptual perspective aimed to disentangle the complex intertwine of intergenerational risk factors that contribute to the risk of developing SMI in offspring, taking schizophrenia spectrum disorders as a paradigmatic example.
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Affiliation(s)
- Michele Poletti
- Child and Adolescent Neuropsychiatry Unit, Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eva Gebhardt
- Department of Mental Health, ASL Roma 4, Civitavecchia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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