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Knight S, Yang XQ, Jarvis GE. "Dem sey mi mad": a scoping review of the attitudes and beliefs of English-speaking Afro-Caribbeans about psychosis. Front Psychiatry 2024; 15:1385525. [PMID: 39224480 PMCID: PMC11366823 DOI: 10.3389/fpsyt.2024.1385525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction The mental health disparities suffered by the English-speaking Afro-Caribbean diaspora living with psychosis in North America and the United Kingdom have been well described for decades, but the root causes of these disparities remain poorly understood. Part of the problem may be that the attitudes and beliefs of Caribbean communities regarding psychosis have never been systematically assessed. Such an inquiry could lay the foundation for changes to how psychiatric services for psychosis are implemented with migrant Caribbean communities. The ideal would be a re-design of services, or cultural adaptation of care, based on input from community members, patients, and their families, with the hope that disparities of care would be reduced or eliminated as clinicians co-create interventions that are more appropriate and acceptable to Caribbean people. To lay the groundwork of such an important endeavor, we investigated the shared attitudes, beliefs, experiences, practices, and traditions of English-speaking Afro-Caribbean people in relation to psychosis and psychiatric care. Methods We conducted a scoping review by searching Medline, PsychINFO and Scopus, reviewing 764 articles, and selecting 220 for thematic content analysis. Results We highlighted the heterogeneity in the Caribbean diaspora living in North America and the UK. Five principal themes emerged: (1) The enduring effects of colonialism on the psychiatric care of Afro-Caribbean migrants; (2) The effects of adaptation to migration on the experience of psychosis; (3) Pervasive cultural mistrust of psychiatry and mental health institutions; (4) A collective approach to life; and (5) The role of religion and spirituality in the understanding of psychosis. Conclusion Historical, sociocultural, and geopolitical themes characterize the English Afro-Caribbean experience of psychosis and inform culturally adapted clinical interventions for patients with psychosis and their families. Careful attention to these adaptations will reduce clinical bias and misdiagnosis, optimize adherence to treatment, engage patients and families in recovery, and ultimately, reduce treatment disparities while empowering Afro-Caribbean people and their communities. By bringing forward the themes in this chapter, individual clinicians will be given tools to change how they work with Caribbean people with psychosis in addition to laying the foundation for higher order changes in the mental health professions and society as a whole.
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Affiliation(s)
- Sommer Knight
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Xin Qiang Yang
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - G. Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
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Agarwal SM, Dissanayake J, Agid O, Bowie C, Brierley N, Chintoh A, De Luca V, Diaconescu A, Gerretsen P, Graff-Guerrero A, Hawco C, Herman Y, Hill S, Hum K, Husain MO, Kennedy JL, Kiang M, Kidd S, Kozloff N, Maslej M, Mueller DJ, Naeem F, Neufeld N, Remington G, Rotenberg M, Selby P, Siddiqui I, Szacun-Shimizu K, Tiwari AK, Thirunavukkarasu S, Wang W, Yu J, Zai CC, Zipursky R, Hahn M, Foussias G. Characterization and prediction of individual functional outcome trajectories in schizophrenia spectrum disorders (PREDICTS study): Study protocol. PLoS One 2023; 18:e0288354. [PMID: 37733693 PMCID: PMC10513234 DOI: 10.1371/journal.pone.0288354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 09/23/2023] Open
Abstract
Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous economic costs linked primarily to lost productivity and premature mortality. Efforts to delineate the contributors to disability in SSDs have highlighted prominent roles for a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. These findings have provided valuable advances in knowledge and helped define broad patterns of illness and outcomes across SSDs. Unsurprisingly, there have also been conflicting findings for many of these determinants that reflect the heterogeneous population of individuals with SSDs and the challenges of conceptualizing and treating SSDs as a unitary categorical construct. Presently it is not possible to identify the functional course on an individual level that would enable a personalized approach to treatment to alter the individual's functional trajectory and mitigate the ensuing disability they would otherwise experience. To address this ongoing challenge, this study aims to conduct a longitudinal multimodal investigation of a large cohort of individuals with SSDs in order to establish discrete trajectories of personal recovery, disability, and community functioning, as well as the antecedents and predictors of these trajectories. This investigation will also provide the foundation for the co-design and testing of personalized interventions that alter these functional trajectories and improve outcomes for people with SSDs.
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Affiliation(s)
- Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Joel Dissanayake
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Christopher Bowie
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Noah Brierley
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Araba Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Vincenzo De Luca
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Andreea Diaconescu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Philip Gerretsen
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ariel Graff-Guerrero
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Colin Hawco
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Yarissa Herman
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Hill
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kathryn Hum
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Muhammad Omair Husain
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - James L. Kennedy
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Michael Kiang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicole Kozloff
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Marta Maslej
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Daniel J. Mueller
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Farooq Naeem
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicholas Neufeld
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Martin Rotenberg
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Peter Selby
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ishraq Siddiqui
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kate Szacun-Shimizu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Arun K. Tiwari
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Wei Wang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Joanna Yu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Clement C. Zai
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Robert Zipursky
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Falgas-Bague I, Cruz-Gonzalez M, Zhen-Duan J, Nagendra A, Alvarez K, Canino G, Duarte CS, Bird H, M. De-Salazar P, Alegría M. Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100549. [PMID: 37485018 PMCID: PMC10362791 DOI: 10.1016/j.lana.2023.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/29/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023]
Abstract
Background The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings. Methods We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders. Findings We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics. Interpretation Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset. Funding The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
| | - Arundati Nagendra
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Schizophrenia and Psychosis Action Alliance, Alexandria, VA 22301, USA
| | - Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, Office A928 9th Floor, Rio Piedras, 00935, Puerto Rico
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Hector Bird
- New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Pablo M. De-Salazar
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 2 Kreutzstrasse, 4123, Allschwil, Switzerland
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Suite 506, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, 50 Staniford St, Suite 830, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA
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Tarricone I, D'Andrea G, Jongsma HE, Tosato S, Gayer-Anderson C, Stilo SA, Suprani F, Iyegbe C, van der Ven E, Quattrone D, di Forti M, Velthorst E, Rossi Menezes P, Arango C, Parellada M, Lasalvia A, La Cascia C, Ferraro L, Bobes J, Bernardo M, Sanjuán I, Santos JL, Arrojo M, Del-Ben CM, Tripoli G, Llorca PM, de Haan L, Selten JP, Tortelli A, Szöke A, Muratori R, Rutten BP, van Os J, Jones PB, Kirkbride JB, Berardi D, Murray RM, Morgan C. Migration history and risk of psychosis: results from the multinational EU-GEI study. Psychol Med 2022; 52:2972-2984. [PMID: 33563347 PMCID: PMC9693676 DOI: 10.1017/s003329172000495x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration. METHODS We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case-control study. We defined a set of three indicators of social disadvantage for each phase: pre-migration, migration and post-migration. We examined whether social disadvantage in the pre- and post-migration phases, migration adversities, and mismatch between achievements and expectations differed between first-generation migrants with first-episode psychosis and healthy first-generation migrants, and tested whether this accounted for differences in odds of psychosis in multivariable logistic regression models. RESULTS In total, 249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95% CI 1.06-2.44, p = 0.027) and post-migration social disadvantages (OR 1.89, 95% CI 1.02-3.51, p = 0.044), along with expectations/achievements mismatch (OR 1.14, 95% CI 1.03-1.26, p = 0.014) were all significantly associated with psychosis. Migration adversities (OR 1.18, 95% CI 0.672-2.06, p = 0.568) were not significantly related to the outcome. Finally, we found a dose-response effect between the number of adversities across all phases and odds of psychosis (⩾6: OR 14.09, 95% CI 2.06-96.47, p = 0.007). CONCLUSIONS The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may reduce the excess of psychosis in migrants.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Hannah E. Jongsma
- PsyLife Group, Division of Psychiatry, UCL, London, England
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
| | - Simona A. Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Federico Suprani
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paulo Rossi Menezes
- University Hospital, Section of Epidemiology, University of São Paulo, São Paulo, Brazil
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Department of Medicine, Neuroscience Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Iulio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital ‘Virgen de la Luz’, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Biomedicine, neurosciences, and advanced diagnostics, University of Palermo, Italy
| | | | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Andrei Szöke
- Univ Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Fondation FondaMental, F-94010 Creteil, France
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
| | | | - Domenico Berardi
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, UK
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5
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Rinaldo N, Gualdi‐Russo E, Khyatti M, Lakhoua C, Toselli S. Psychosocial health and quality of life among North African women. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1827-1837. [PMID: 34519114 PMCID: PMC9544681 DOI: 10.1111/hsc.13562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/16/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Studies on relationships between psychosocial factors and health among North African (NA) women are scarce. This research investigated the self-perceived psychosocial well-being of NA women by a structured questionnaire and anthropometric survey examining the possible explanatory variables of their mental health in comparison to a sample of NA migrants. The association of endogenous stress, psychological well-being, discomfort, and quality of life with migrant/non-migrant status, demographic characteristics, and adiposity indices was examined. Moreover, the internal consistency of the questionnaire was tested using Cronbach's alpha. A sample of 228 women living in Tunis and Casablanca participated in a survey in Tunisia and Morocco. According to multiple regression models, migrant/non-migrant status was the best explanatory variable of well-being and quality of life, marital status, educational level and the number of children were explanatory variables of discomfort and endogenous stress. Among anthropometric variables, central adiposity was a significant explanatory variable of well-being. The comparison with women who migrated mainly from Morocco and Tunisia to Italy (NA migrants) exhibited higher weight status and central adiposity in NA migrants. The perceived stress and discomfort were the same in the two groups; the migrants, despite reporting lower psychological well-being, presented a higher quality of life than residents. Our findings emphasise the potential to promote monitoring of the psychosocial health of NA women, planning effective interventions.
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Affiliation(s)
- Natascia Rinaldo
- Department of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
| | | | | | | | - Stefania Toselli
- Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
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6
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O'Donoghue B, Collett H, Boyd S, Zhou Y, Castagnini E, Brown E, Street R, Nelson B, Thompson A, McGorry P. The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia. Aust N Z J Psychiatry 2022; 56:811-817. [PMID: 34651504 DOI: 10.1177/00048674211053578] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a profound effect on global mental health, with one-third of infected individuals developing a psychiatric or neurological disorder 6 months after infection. The risk of infection and the associated restrictions introduced to reduce the spread of the virus have also impacted help-seeking behaviours. Therefore, this study aimed to determine whether there was a difference during the COVID-19 pandemic in the treated incidence of psychotic disorders and rates of admission to hospital for psychosis (including involuntary admission). METHODS Incident cases of first-episode psychosis in young people, aged 15 to 24, at an early intervention service in Melbourne from an 8-month period before the pandemic were compared with rates during the pandemic. Hospital admission rates for these periods were also compared. RESULTS Before the pandemic, the annual incidence of first-episode psychosis was 104.5 cases per 100,000 at-risk population, and during the pandemic it was 121.9 (incidence rate ratio = 1.14, 95% confidence interval = [0.92, 1.42], p = 0.24). Immediately after the implementation of restrictions, there was a non-significant reduction in the treated incidence (incidence rate ratio = 0.80, 95% confidence interval = [0.58, 1.09]), which was followed by a significant increase in the treated incidence in later months (incidence rate ratio = 1.94, 95% confidence interval = [1.52, 2.49]; incidence rate ratio = 1.64, 95% confidence interval = [1.25, 2.16]). Before the pandemic, 37.3% of young people with first-episode psychosis were admitted to hospital, compared to 61.7% during the pandemic (odds ratio = 2.71, 95% confidence interval = [1.73, 4.24]). Concerning the legal status of the admissions, before the pandemic, 27.3% were admitted involuntarily to hospital, compared to 42.5% during the pandemic (odds ratio = 1.97, 95% confidence interval = [1.23, 3.14]). CONCLUSION There was a mild increase, which did not reach statistical significance, in the overall incidence of first-episode psychosis; however, the pattern of presentations changed significantly, with nearly twice as many cases presenting in the later months of the restrictions. There was a significant increase in both voluntary and involuntary admissions, and the possible explanations for these findings are discussed.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah Collett
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sophie Boyd
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yuanna Zhou
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily Castagnini
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rebekah Street
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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7
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O'Gallagher K, Teo JTH, Shah AM, Gaughran F. Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease. J Am Heart Assoc 2022; 11:e025621. [PMID: 35699192 PMCID: PMC9238657 DOI: 10.1161/jaha.121.025621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Severe mental illnesses, such as schizophrenia or bipolar disorder, affect ≈1% of the population who, as a group, experience significant disadvantage in terms of physical health and reduced life expectancy. In this review, we explore the interaction between race, ethnicity, severe mental illness, and cardiovascular disease, with a focus on cardiovascular care pathways. Finally, we discuss strategies to investigate and address disparities in cardiovascular care for patients with severe mental illness.
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Affiliation(s)
- Kevin O'Gallagher
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - James TH. Teo
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
| | - Ajay M. Shah
- British Heart Foundation Centre of Research ExcellenceKing’s College LondonLondonUnited Kingdom
- King’s College Hospital NHS Foundation TrustLondonUnited Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUnited Kingdom
- South London and Maudsley NHS Foundation TrustLondonUnited Kingdom
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8
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Best MW, Bowie CR. Social exclusion in psychotic disorders: An interactional processing model. Schizophr Res 2022; 244:91-100. [PMID: 35640357 DOI: 10.1016/j.schres.2022.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/11/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.
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Affiliation(s)
- Michael W Best
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.
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9
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Lindhardt L, Storebø OJ, Bruun LS, Simonsen E, Mortensen OS. “ Psychosis among the disconnected youth: a systematic review.”. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2056306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Line Lindhardt
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Laura Staxen Bruun
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Denmark
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10
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Radley J, Barlow J, Johns LC. Sociodemographic characteristics associated with parenthood amongst patients with a psychotic diagnosis: a cross-sectional study using patient clinical records. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1897-1906. [PMID: 35445841 PMCID: PMC9375763 DOI: 10.1007/s00127-022-02279-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/31/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Estimates of parenthood in individuals with psychosis range from 27 to 63%. This number has likely increased due to the introduction of newer anti-psychotics and shorter hospital stays. The problems of psychosis can affect patients' capacity to offer the consistent, responsive care required for healthy child development. The following research questions were assessed: (1) what proportion of these patients have their children correctly recorded in their clinical notes, (2) what proportion of patients in secondary care with a psychotic diagnosis have children, and (3) what sociodemographic characteristics are associated with parenthood in this population. METHODS This study used CRIS (Clinical Record Interactive Search) to search for patients with a diagnosis of non-affective or affective psychosis (F20-29, F31.2 or F31.5) within a UK NHS Trust. A binomial regression model was fitted to identify the variables associated with parenthood. RESULTS Fewer than half of the parents in the sample had their children recorded in the correct field in their clinical notes. Of 5173 patients with psychosis, 2006 (38.8%) were parents. Characteristics associated with parenthood included being female, older age, higher socioeconomic status, renting or owning, having ever been married, being unemployed, not being White (British) and not having a diagnosis of schizophrenia. CONCLUSION Over one-third of patients with psychosis were parents, and the study indicates that not all NHS Trusts are recording dependants accurately. Many variables were strongly associated with parenthood and these findings may help target interventions for this population.
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Affiliation(s)
- Jessica Radley
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Jane Barlow
- grid.4991.50000 0004 1936 8948Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER UK
| | - Louise C. Johns
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX UK
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11
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Moe AM, Weiss DM, Pine JG, Wastler HM, Breitborde NJK. Social motivation and behavior in first-episode psychosis: Unique contributions to social quality of life and social functioning. J Psychiatr Res 2021; 144:441-447. [PMID: 34749220 PMCID: PMC8667854 DOI: 10.1016/j.jpsychires.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Social functioning is diminished among people early in the course of psychotic illnesses, and is likely influenced by the negative symptoms that accompany these disorders, including changes in motivation and experience of pleasure. Though social impairments have a deleterious impact on functioning, socialization is a multifaceted behavior and little is known about how the various aspects may influence social functioning and social quality of life among people with first-episode psychosis. In the present study, we investigated the associations of specific aspects of social motivation and behavior with social functioning and social quality of life in a group of 54 young people (aged 15 to 35) with first-episode psychosis. Though different aspects of social motivation and behavior correlated positively with one another, social motivation for peer interactions was uniquely associated with social functioning and social quality of life - including when a broad measure of negative symptoms was considered within the same model. When these same associations were examined longitudinally, social motivation for peer interactions again emerged as a unique predictor of change in social functioning over 6 months. Our results suggest that the unique contribution of aspects of social motivation has implications for treatment, including the importance of developmentally-informed interventions to improve peer socialization in youth and young adults with psychosis.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, USA.
| | - David M Weiss
- Department of Psychology, The Ohio State University, USA
| | - Jacob G Pine
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, USA
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12
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Hui CLM, Lam BST, Wong AKH, Tao TJ, Ho ECN, Suen YN, Lee EHM, Chan SKW, Chang WC, Chong CSY, Siu CMW, Lo WTL, Chen EYH. ReMind, a smartphone application for psychotic relapse prediction: A longitudinal study protocol. Early Interv Psychiatry 2021; 15:1659-1666. [PMID: 33369162 DOI: 10.1111/eip.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/29/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psychotic disorders are associated with a high rate of relapse. In addition to medication non-adherence, some psychosocial factors have been found to be predictive of relapse (e.g., poor premorbid adjustment, high expressed emotion and substance misuse). Impairments in cognitive functions including general memory functioning, set shifting, attention, processing speed and working memory have also been indicative of a subsequent psychotic episode. As clinical appointments do not always allow for timely or accurate detection of these early warning signs, the ReMind app is developed to explore potential relapse predictors and enhance the process of relapse monitoring. AIM The ReMind app aims (1) to assess whether verbal or visual working memory predicts psychotic relapse in 1 year and (2) to determine whether social factors such as stressful life events, level of expressed emotion and medication adherence also predict relapse in 1 year. METHODS This is a one-year prospective follow-up study involving 176 remitted patients diagnosed with schizophrenia or non-affective psychoses. Monthly relapse predictor assessments will be conducted via ReMind throughout the one-year study duration. These assessments include neurocognitive tasks and psychosocial questionnaires. RESULTS Recruitment began in August 2017 and is still ongoing. Preliminary user feedback suggested an overall positive experience with the app. CONCLUSION The ReMind app presents a step forward to the identification and sensitive detection of reliable psychosis relapse predictors. With its anticipated success, it may offer an alternative means of monitoring relapse for the Chinese-speaking population in the future.
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Affiliation(s)
| | | | | | | | | | - Yi-Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | - Sherry Kit-Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | | | | | | | - Eric Yu-Hai Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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13
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Tonini E, Quidé Y, Whitford TJ, Green MJ. Cumulative sociodemographic disadvantage partially mediates associations between childhood trauma and schizotypy. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:444-464. [PMID: 34820861 DOI: 10.1111/bjc.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/31/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Risk for psychosis in the general population is characterized by a set of multidimensional traits that are referred to as schizotypy. Higher levels of schizotypy are associated with socioeconomic disadvantage and childhood trauma, just as these risk factors are associated with schizophrenia and bipolar disorder. Here, we set out to investigate whether cumulative sociodemographic disadvantage mediates associations between childhood trauma and schizotypy in adulthood. METHODS A sociodemographic cumulative risk (SDCR) score was derived from six risk indices spanning employment, education, income, socioeconomic status, marital, and living circumstances for 197 participants that included both healthy (n = 57) and clinical samples with schizophrenia or schizoaffective disorder (n = 65) or bipolar disorder (n = 75). A series of multiple linear regressions was used to examine the direct and indirect associations among childhood trauma (measured with the Childhood Trauma Questionnaire), the SDCR index, and levels of schizotypy (measured with the Schizotypal Personality Questionnaire). RESULTS Schizotypy was independently associated with trauma and the SDCR index. In addition, the SDCR index partially mediated associations between trauma and schizotypy. CONCLUSIONS These findings in a mixed sample of healthy and clinical participants represent the full spectrum of schizotypy across health and illness and suggest that effects of childhood trauma on schizotypal personality organization may operate via cumulative socioeconomic disadvantage in adulthood. PRACTITIONER POINTS The strong associations between trauma and schizotypy suggest that systematic health screening of children exposed to early life trauma may assist to identify those at risk of developing psychosis. Clinicians should pay attention to various indicators of sociodemographic disadvantage in patients prone to psychosis, in addition to any exposure to trauma during childhood.
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Affiliation(s)
- Emiliana Tonini
- School of Psychiatry, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Yann Quidé
- School of Psychiatry, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Thomas J Whitford
- School of Psychology, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales (UNSW), Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
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14
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Pratap P, Dickson A, Love M, Zanoni J, Donato C, Flynn MA, Schulte PA. Public Health Impacts of Underemployment and Unemployment in the United States: Exploring Perceptions, Gaps and Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10021. [PMID: 34639322 PMCID: PMC8508259 DOI: 10.3390/ijerph181910021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation. METHODS An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemployment and unemployment. METHODS included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice. RESULTS Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage depression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development. DISCUSSION AND CONCLUSIONS Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry.
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Affiliation(s)
- Preethi Pratap
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Alison Dickson
- Champaign School of Labor and Employment Relations, University of Illinois Urbana, Chicago, IL 60607, USA;
| | - Marsha Love
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Joe Zanoni
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Caitlin Donato
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (M.L.); (J.Z.); (C.D.)
| | - Michael A. Flynn
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA; (M.A.F.); (P.A.S.)
| | - Paul A. Schulte
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA; (M.A.F.); (P.A.S.)
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15
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Simor P, Polner B, Báthori N, Sifuentes-Ortega R, Van Roy A, Albajara Sáenz A, Luque González A, Benkirane O, Nagy T, Peigneux P. Home confinement during the COVID-19: day-to-day associations of sleep quality with rumination, psychotic-like experiences, and somatic symptoms. Sleep 2021; 44:zsab029. [PMID: 33567067 PMCID: PMC7928634 DOI: 10.1093/sleep/zsab029] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
Due to the coronavirus disease 2019 (COVID-19) pandemic, populations from many countries have been confined at home for extended periods of time in stressful environmental and media conditions. Cross-sectional studies already evidence deleterious psychological consequences, with poor sleep as a risk factor for impaired mental health. However, limitations of cross-sectional assessments are response bias tendencies and the inability to track daily fluctuations in specific subjective experiences in extended confinement conditions. In a prospective study conducted across three European countries, we queried participants (N = 166) twice a day through an online interface about their sleep quality and their negative psychological experiences for two consecutive weeks. The focus was set on between- and within-person associations of subjective sleep quality with daytime experiences, such as rumination, psychotic-like experiences, and somatic complaints about the typical symptoms of the coronavirus. The results show that daily reports of country-specific COVID-19 deaths predicted increased negative mood, psychotic-like experiences, and somatic complaints during the same day and decreased subjective sleep quality the following night. Disrupted sleep was globally associated with negative psychological outcomes during the study period, and a relatively poorer night of sleep predicted increased rumination, psychotic-like experiences, and somatic complaints the following day. This temporal association was not paralleled by daytime mental complaints predicting relatively poorer sleep quality on the following night. Our findings show that night-to-night changes in sleep quality predict how individuals cope the next day with daily challenges induced by home confinement.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertalan Polner
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Noémi Báthori
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Rebeca Sifuentes-Ortega
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Anke Van Roy
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Ariadna Albajara Sáenz
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Alba Luque González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Oumaima Benkirane
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Tamás Nagy
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN – Center for Research in Cognition and Neurosciences and UNI – ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
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16
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Oduola S, Craig TKJ, Morgan C. Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:931-941. [PMID: 32681277 PMCID: PMC8192380 DOI: 10.1007/s00127-020-01922-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK. METHODS We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders. RESULTS There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral. CONCLUSION Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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17
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Riches S, Pisani S, Bird L, Rus-Calafell M, Garety P, Valmaggia L. Virtual reality-based assessment and treatment of social functioning impairments in psychosis: a systematic review. Int Rev Psychiatry 2021; 33:337-362. [PMID: 34121587 DOI: 10.1080/09540261.2021.1918648] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with psychosis can experience social functioning impairments. Virtual reality (VR) has been used to assess and treat these difficulties. This systematic review (Prospero CRD42015026288) provides an evaluation of these VR applications. PsycINFO, MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched until May 2020. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess studies. Database searching identified 3810 titles. Fifty-eight studies (published 2005-2020; N = 2,853), comprising twenty-six head-mounted display studies (20 assessment, 6 treatment) and thirty-two immersive 2D screen studies (23 assessment, 9 treatment), were included. There were forty-eight observational studies and ten randomised controlled trials, with 1570 participants (of which, 185 were at ultra-high risk of psychosis) in VR test groups. Nearly half the studies were published since 2016. Assessments targeted cognitive and behavioural indicators of social functioning, e.g. paranoia, eye gaze, or interpersonal distance. Treatments promoted cognitive-behavioural social skills or job interview training. Studies indicate feasibility, acceptability, and effectiveness of VR for social functioning impairments in psychosis. Limitations of studies include the narrow scope of social functioning, small sample sizes, and limited randomised controlled trials and standardised interventions. Findings suggest VR has potential to be integrated with existing psychological approaches.
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Affiliation(s)
- Simon Riches
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Sara Pisani
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Leanne Bird
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Mar Rus-Calafell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
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18
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Ajnakina O, Stubbs B, Francis E, Gaughran F, David AS, Murray RM, Lally J. Employment and relationship outcomes in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Schizophr Res 2021; 231:122-133. [PMID: 33839370 DOI: 10.1016/j.schres.2021.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/20/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
As employment and relationship status are important long-term outcomes in individuals with a diagnosis of first episode psychosis (FEP) disorders, there is a need to elucidate more accurately the extent of these social deficits in people with FEP. This in turn can aid treatment planning and policy development ultimately ensuring more complete and sustainable recoveries. We carried out a systematic review and meta-analysis of longitudinal studies in FEP reporting on employment and relationship status during the illness course. Random effects meta-analyses and meta-regression analyses were employed. Seventy-four studies were included with a sample totalling 15,272 (range = 20-1724) FEP cases with an average follow-up duration of 8.3 years (SD = 7.2). 32.5% (95%CI = 28.5-36.9) of people with a diagnosis of FEP disorders were employed and 21.3% (95%CI = 16.5-27.1) were in a relationship at the end of follow-up. Studies from high-income countries and Europe had a higher proportion of people in employment at the end of follow-up compared to middle-income nations and non-European countries. The inverse was found for relationship status. The proportion of people with a diagnosis of FEP in employment decreased significantly with longer follow-up. Living with family, being in a relationship at first contact and Black and White ethnicities were identified as significant moderators of these outcomes. These findings highlight marked functional recovery deficits for people with FEP, although cultural factors need to be considered. They support the need for interventions to improve employment opportunities, and social functioning, both in early psychosis and during the longitudinal illness course.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, University of London, London, United Kingdom; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emma Francis
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony S David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland
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19
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Abstract
This paper introduces a new construct, the 'pivotal mental state', which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.
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Affiliation(s)
- Ari Brouwer
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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20
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Sile L, Bezina K, Kvartalovs D, Erts R, Kikuste S, Sapele I, Rancans E. Naturalistic follow-up study of rehospitalization rates and assigned disability status of patients with first-episode schizophrenia spectrum psychosis in South East Latvia: preliminary results. Nord J Psychiatry 2021; 75:87-96. [PMID: 32729764 DOI: 10.1080/08039488.2020.1799429] [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: 10/23/2022]
Abstract
BACKGROUND Patients with first-episode schizophrenia spectrum psychosis (FEP) are at risk of not visiting an out-patient psychiatrist and are assigned disability status within a short period after diagnosis. OBJECTIVE The aim of this study was to conduct a naturalistic follow-up of FEP patients to explore their use of mental healthcare services and the rate of assigned disability status after FEP. METHODS This was the first study in Latvia to include all consecutive patients with FEP admitted to the largest regional hospital in South East Latvia, Daugavpils Psychoneurological Hospital (DPNH). Patients received standard treatment in a real-world environment. The mean follow-up time was 33 months (Min = 20 months, Max = 40 months). RESULTS From the 94 consecutive FEP patients admitted to DPNH (1 January 2016 to 31 December 2017), 68 participated and provided informed consent to be followed up. During the first 12 months after discharge from the acute psychiatric ward, 23% (n = 14) never visited a psychiatrist, and 6.5% (n = 4) had a single visit to get prescription for medication. Furthermore, 36.1% (n = 22) had a rehospitalization during the first 12 months. At the end of follow-up period, 34.4% (n = 21) of patients were assigned disability status within a median time of 8 months (IQR 4.5‒20.0). CONCLUSION Approximately, one-third of patients did not continue treatment as out-patients after FEP. One-third of FEP patients were assigned disability status. We suggest that Latvia needs improved treatment options for FEP patients, such as early intervention.
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Affiliation(s)
- Liene Sile
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia.,Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Karina Bezina
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Dmitrijs Kvartalovs
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Renars Erts
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Sarmite Kikuste
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Inna Sapele
- Department of Mental Health Care, Daugavpils Psychoneurological Hospital, Daugavpils, Latvia
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
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21
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Vinkers DJ, Van de Vorst M, Hoek HW, Van Os J. Social Defeat, Psychotic Symptoms, and Crime in Young Caribbean Immigrants to Rotterdam. Front Psychiatry 2021; 12:498096. [PMID: 33897475 PMCID: PMC8058196 DOI: 10.3389/fpsyt.2021.498096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The negative experience of being excluded from the majority group (social defeat) may be associated with psychosis in immigrants. The social defeat hypothesis is supported by the high frequency of perceived discrimination and acculturation problems in psychotic immigrants. In addition, social defeat may lead to crime through social problems such as unemployment, school dropout, a broken family structure, or psychotic symptoms. Methods: We assessed the association between social defeat and acculturation on the one hand and broadly defined psychotic symptoms and crime on the other in Caribbean immigrants to Rotterdam who are aged 18-24 years. The municipality of Rotterdam provided data about Caribbean immigrants to Rotterdam. Acculturation, social defeat (perceived discrimination, sense of control, and evaluation of self and others), psychotic symptoms, and crime were assessed using online questionnaires. Results: Social defeat was associated with psychotic symptoms in women (β = 0.614, p < 0.001). This relation applied particularly to the negative self-perception domain of social defeat. Acculturation was associated with neither social defeat nor psychotic symptoms or crime and did not mediate the association between social defeat and psychosis. Conclusion: The social defeat hypothesis of psychosis may be gender-specific valid but does not extend to crime.
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Affiliation(s)
- David J Vinkers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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22
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Oduola S, Das-Munshi J, Bourque F, Gayer-Anderson C, Tsang J, Murray RM, Craig TKJ, Morgan C. Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. Psychol Med 2021; 51:300-309. [PMID: 31739818 PMCID: PMC7893508 DOI: 10.1017/s0033291719003234] [Citation(s) in RCA: 12] [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: 04/11/2019] [Revised: 08/08/2019] [Accepted: 10/22/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time. METHODS We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier. RESULTS From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6-55.3) to 63.1 (95% CI 57.3-69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4-8.3) to 2.8 (2.1-3.6) and the 'mixed' group from 2.7 (1.8-4.2) to 1.4 (0.9-2.1). In the black African group, there was a negligible difference from 4.1 (3.2-5.3) to 3.5 (2.8-4.5). CONCLUSIONS We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, NorwichNR4 7TJ, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, LondonSE5 8AZ, UK
| | - Jayati Das-Munshi
- South London & Maudsley NHS Foundation Trust, Denmark Hill, LondonSE5 8AZ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Francois Bourque
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- Division of Social and Cultural Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal (Quebec), H4H 1R3, Canada
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Jason Tsang
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Tom K. J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
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23
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Mattei G, Venturi G, Alfieri S, Colombini N, Ferrari S, Rigatelli M, Starace F, Galeazzi GM. Clinical and Socio-demographic Variables Associated with the Outcome of Vocational Rehabilitation Programs: A Community-Based Italian Study. Community Ment Health J 2020; 56:1380-1390. [PMID: 32086675 DOI: 10.1007/s10597-020-00577-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
This study aims to identify clinical and socio-demographic variables associated with the outcome of vocational rehabilitation programs (VRPs). All users of an Italian Community Mental Health Centre (CMHC) included in VRPs delivered according to the model of Supported Employment in years 2011-2016 were retrospectively enrolled. Fifty users who ended the program with employment were compared with fifty users who dropped out, with respect to clinical and socio-demographic variables. VRPs lasting less than 6 months and oriented toward the competitive labor market had a higher probability of employment. Among users who successfully ended the VRP, the median of health interventions significantly decreased after employment. In the same group of users, less non-health interventions strictly linked to the VRP were required, when compared with users who dropped out. We conclude that employment is associated with improvement of users' clinical conditions and reduced workload for the CMHC.
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Affiliation(s)
- G Mattei
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy. .,Ph.D. School in Labor, Development and Innovation, "Marco Biagi" Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Modena, Italy. .,Association for Research in Psychiatry, Castelnuovo Rangone, Modena, Italy.
| | - G Venturi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Alfieri
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - N Colombini
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - S Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - M Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - F Starace
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - G M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
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24
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DeLuca JS, Andorko ND, Chibani D, Jay SY, Rakhshan Rouhakhtar PJ, Petti E, Klaunig MJ, Thompson EC, Millman ZB, Connors KM, Akouri-Shan L, Fitzgerald J, Redman SL, Roemer C, Bridgwater MA, DeVylder JE, King CA, Pitts SC, Reinblatt SP, Wehring HJ, Bussell KL, Solomon N, Edwards SM, Reeves GM, Buchanan RW, Schiffman J. Telepsychotherapy with Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices during the COVID-19 Pandemic. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2020; 30:304-331. [PMID: 34305369 PMCID: PMC8297958 DOI: 10.1037/int0000211] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis-those at Clinical High Risk for psychosis (CHR)-given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the COVID-19 pandemic and its subsequent physical isolation measures, due to heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this paper, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic; best practices for treatment and adaptations for telepsychotherapy for individuals at CHR; and highlight real clinical issues that we are currently experiencing in a United States-based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.
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Affiliation(s)
- Joseph S. DeLuca
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Nicole D. Andorko
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Doha Chibani
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha Y. Jay
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | - Emily Petti
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Mallory J. Klaunig
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Elizabeth C. Thompson
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI
| | | | - Kathleen M. Connors
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - LeeAnn Akouri-Shan
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - John Fitzgerald
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha L. Redman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Caroline Roemer
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | | | - Cheryl A. King
- University of Michigan, Departments of Psychiatry and Psychology, Ann Arbor, MI
| | - Steven C. Pitts
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Shauna P. Reinblatt
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Natalee Solomon
- Maryland Department of Health, Behavioral Health Administration, Transition-Aged Youth and Young Adult Services, Baltimore, MD
| | - Sarah M. Edwards
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Gloria M. Reeves
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
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25
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Further Exploration of Personal and Social Functioning: The Role of Interpersonal Violence, Service Engagement, and Social Network. J Nerv Ment Dis 2019; 207:832-837. [PMID: 31365432 DOI: 10.1097/nmd.0000000000001036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Social functioning (SF) has mainly been studied in major psychoses in relation to symptom severity, but other factors may interfere with the achievement of a functional remission. The aim of this study is to explore interpersonal violence (IV), service engagement (SE), and social network (SN), together with demographics, as predictors of SF in a sample of subjects with severe mental illness (SMI). Consecutive adult inpatients were evaluated using self-report and clinician-rated questionnaires. Findings suggest that IV, SE, SN, male sex, and illness duration explained 39.1% of SF variance in people affected by SMI. IV was the strongest predictor, followed by sex and duration of illness. Lifetime expression of violence is a stronger predictor than lifetime exposure to violence. Positive SE and SN were found to predict SF, whereas age was not associated. This study underlines the need of other non-symptom-related variables for the comprehension of SF in mental disorders.
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26
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Oduola S, Craig TKJ, Das-Munshi J, Bourque F, Gayer-Anderson C, Morgan C. Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:871-881. [PMID: 30895353 PMCID: PMC6656788 DOI: 10.1007/s00127-019-01685-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue. METHODS We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders. PARTICIPANTS Two hundred sixty-six patients with first episode psychosis, aged 18-64 years, who presented to mental health services in south London in 1997-1999 and 446 with FEP who presented in 2010-2012. RESULTS When the two samples were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80-8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52-6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56-6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71-3.98) and did not meet conventional levels for statistical significance. CONCLUSION Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.
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Affiliation(s)
- Sherifat Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Jayati Das-Munshi
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Francois Bourque
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Division of Social and Cultural Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, H4H 1R3, Canada
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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27
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Bögle S, Boden Z. ‘It was like a lightning bolt hitting my world’: Feeling shattered in a first crisis in psychosis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2019. [DOI: 10.1080/14780887.2019.1631418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Bögle
- London South Bank University, Division of Psychology, School of Applied Science, London, UK
| | - Zoë Boden
- University of Brighton, School of Applied Social Science, Brighton, UK
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28
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Reininghaus U, Böhnke JR, Chavez‐Baldini U, Gibbons R, Ivleva E, Clementz BA, Pearlson GD, Keshavan MS, Sweeney JA, Tamminga CA. Transdiagnostic dimensions of psychosis in the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). World Psychiatry 2019; 18:67-76. [PMID: 30600629 PMCID: PMC6313235 DOI: 10.1002/wps.20607] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The validity of the classification of non-affective and affective psychoses as distinct entities has been disputed, but, despite calls for alternative approaches to defining psychosis syndromes, there is a dearth of empirical efforts to identify transdiagnostic phenotypes of psychosis. We aimed to investigate the validity and utility of general and specific symptom dimensions of psychosis cutting across schizophrenia, schizoaffective disorder and bipolar I disorder with psychosis. Multidimensional item-response modeling was conducted on symptom ratings of the Positive and Negative Syndrome Scale, Young Mania Rating Scale, and Montgomery-Åsberg Depression Rating Scale in the multicentre Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium, which included 933 patients with a diagnosis of schizophrenia (N=397), schizoaffective disorder (N=224), or bipolar I disorder with psychosis (N=312). A bifactor model with one general symptom dimension, two distinct dimensions of non-affective and affective psychosis, and five specific symptom dimensions of positive, negative, disorganized, manic and depressive symptoms provided the best model fit. There was further evidence on the utility of symptom dimensions for predicting B-SNIP psychosis biotypes with greater accuracy than categorical DSM diagnoses. General, positive, negative and disorganized symptom dimension scores were higher in African American vs. Caucasian patients. Symptom dimensions accurately classified patients into categorical DSM diagnoses. This study provides evidence on the validity and utility of transdiagnostic symptom dimensions of psychosis that transcend traditional diagnostic boundaries of psychotic disorders. Findings further show promising avenues for research at the interface of dimensional psychopathological phenotypes and basic neurobiological dimensions of psychopathology.
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Affiliation(s)
- Ulrich Reininghaus
- Central Institute of Mental Health, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany,Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands,Centre for Epidemiology and Public Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jan R. Böhnke
- Dundee Centre for Health and Related Research, School of Nursing and Health SciencesUniversity of DundeeDundeeUK,Department of Health SciencesUniversity of YorkYorkUK
| | - UnYoung Chavez‐Baldini
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Robert Gibbons
- Department of Medicine and Public Health SciencesUniversity of ChicagoChicagoILUSA
| | - Elena Ivleva
- Department of PsychiatryUT Southwestern UniversityDallasTXUSA
| | - Brett A. Clementz
- Departments of Psychology and NeuroscienceBio‐Imaging Research Center, University of GeorgiaAthensGAUSA
| | | | | | - John A. Sweeney
- Department of Psychiatry and Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOHUSA
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de Sousa P, Sellwood W, Eldridge A, Bentall RP. The role of social isolation and social cognition in thought disorder. Psychiatry Res 2018; 269:56-63. [PMID: 30145302 DOI: 10.1016/j.psychres.2018.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
Abstract
A better understanding of how social factors relate to the psychological processes in thought disorder (TD) is necessary for the development of effective psychological interventions. Sixty-eight participants diagnosed with psychosis (18-65; 47.1% female) were recruited and evaluated on social cognition (Hinting Task, HT; and reading the mind in the eyes test, RMET), social isolation (size of social network, frequency and quality of contact), psychotic symptoms (Positive and Negative Syndrome Scale, PANSS) and TD (Thought, Language and Communication Disorders Scale, TLC). A mediation model was tested with isolation as the predictor, TD as the outcome, and performance on HT and RMET as the mediators. The final model, with adjustment for comorbid symptoms (i.e. delusions, suspiciousness, hallucinations, and negative symptoms), supported full mediation and explained a significant amount of the observed variance (60%). Performance on the HT was a significant mediator of the relationship between social isolation and TD. From the covariates, delusions contributed independently and significantly to TD. The implications of the findings for psychological practice, and TD-specific interventions, are discussed as well as the limitations of the study. Further avenues for symptom-specific research are discussed, in particular with reference to more complex psychosocial models.
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Affiliation(s)
- Paulo de Sousa
- Department of Clinical Psychology, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom.
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA1 4YG, United Kingdom
| | - Alaw Eldridge
- Resettle, Merseycare NHS Foundation Trust, Liverpool, L24 8RN, United Kingdom
| | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2L, United Kingdom
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30
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Carrà G, Battaglia C, Hinton M, Sheridan Rains L, Crocamo C, Johnson S. Social network confidants, duration of untreated psychosis and cannabis use in people with first episode psychosis: An exploratory study. Early Interv Psychiatry 2018; 12:942-946. [PMID: 28858430 DOI: 10.1111/eip.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 12/16/2022]
Abstract
AIM Reduced social network (SN) might be associated with a longer duration of untreated psychosis (DUP) in people with first episode psychosis (FEP). We aimed at exploring the specific role of SN confidants on DUP, taking into account cannabis misuse, which is known to influence DUP and might be associated with social functioning. METHODS People with FEP recently referred to an inner London Early Intervention Service were assessed with standardized instruments exploring SN characteristics, DUP and cannabis misuse. RESULTS Taking into account cannabis misuse, we found an association between confidants and DUP (P = 0.020), with the higher the number of confidants, the shorter the DUP. CONCLUSIONS Confidants may provide access to, and perceptions of, social support and this may increase early engagement for people with FEP, reducing DUP and possibly improving outcomes. Future research should identify correlates of small networks of confidants, which could inform early detection community initiatives.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudia Battaglia
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mark Hinton
- Camden and Islington Early Intervention Service, London, UK
| | | | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington Early Intervention Service, London, UK
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31
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Renwick L, Owens L, Lyne J, O'Donoghue B, Roche E, Drennan J, Sheridan A, Pilling M, O'Callaghan E, Clarke M. Predictors of change in social networks, support and satisfaction following a first episode psychosis: A cohort study. Int J Nurs Stud 2017; 76:28-35. [PMID: 28910597 DOI: 10.1016/j.ijnurstu.2017.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/04/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention. METHODS During the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n=158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician's evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured. RESULTS A number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n=129, Median=24.5mths, IQR=7.25-69.25; Mann-Whitney U=11.78, p=0.008). Social support at baseline and at one year was predicted by homelessness (t=-2.98, p=0.001, CI -4.74 to -1.21), duration of untreated psychosis (t=-0.86, p=0.031, CI -1.65 to -0.08) and premorbid adjustment (t=-2.26, p=0.017, CI -4.11 to -0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome. CONCLUSIONS Improved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.
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Affiliation(s)
- Laoise Renwick
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
| | - Liz Owens
- DETECT Early Psychosis Service, Dublin, Ireland
| | - John Lyne
- DETECT Early Psychosis Service, Dublin, Ireland; North Dublin Mental Health Services, Dublin, Ireland
| | - Brian O'Donoghue
- DETECT Early Psychosis Service, Dublin, Ireland; Orygen, the National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Eric Roche
- DETECT Early Psychosis Service, Dublin, Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland
| | - Mark Pilling
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Eadbhard O'Callaghan
- DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Psychosis Service, Dublin, Ireland; St. John of God Hospital, Dublin, Ireland; Department of Psychiatry, University College Dublin, Dublin, Ireland
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"With a little help from my friends" social predictors of clinical recovery in first-episode psychosis. Psychiatry Res 2017; 255:209-214. [PMID: 28578180 DOI: 10.1016/j.psychres.2017.05.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/24/2017] [Accepted: 05/28/2017] [Indexed: 11/23/2022]
Abstract
Social functioning is a conglomerate of factors central to clinical recovery after a first-episode psychosis. There is a lack of studies investigating the relative impact of factors related to social interaction. Disentangling these could facilitate improvement of psychosocial interventions. This study aims to investigate the impact of social interactions on two-year clinical recovery in first-episode psychosis, by examining frequency and satisfaction of relationships with family and friends. A baseline sample of 178 first-episode psychosis individuals were followed up over two years regarding social functioning and clinical status. We longitudinally compared those who were to those who were not recovered using generalized estimating equations analyses. Our results showed that frequency of social interactions with friends was a significant positive predictor of clinical recovery over a two-year period. Perceived satisfaction with relationships, and frequency of family interaction did not show significant effects. We conclude that interaction with friends is a malleable factor that could be targeted for early intervention. This would facilitate protective factors through the preservation of existing social networks and thus reduce the risk of disability associated with long-term psychosis. Findings indicate that even individuals with an inclination towards social withdrawal and isolation could benefit from this type of intervention.
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33
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Stilo SA, Gayer-Anderson C, Beards S, Hubbard K, Onyejiaka A, Keraite A, Borges S, Mondelli V, Dazzan P, Pariante C, Di Forti M, Murray RM, Morgan C. Further evidence of a cumulative effect of social disadvantage on risk of psychosis. Psychol Med 2017; 47:913-924. [PMID: 27916012 PMCID: PMC5341492 DOI: 10.1017/s0033291716002993] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A growing body of evidence suggests that indicators of social disadvantage are associated with an increased risk of psychosis. However, only a few studies have specifically looked at cumulative effects and long-term associations. The aims of this study are: To compare the prevalence of specific indicators of social disadvantage at, and prior to, first contact with psychiatric services in patients suffering their first episode of psychosis and in a control sample. To explore long-term associations, cumulative effects, and direction of effects. METHOD We collected information on social disadvantage from 332 patients and from 301 controls recruited from the local population in South London. Three indicators of social disadvantage in childhood and six indicators of social disadvantage in adulthood were analysed. RESULTS Across all the domains considered, cases were more likely to report social disadvantage than were controls. Compared with controls, cases were approximately two times more likely to have had a parent die and approximately three times more likely to have experienced a long-term separation from one parent before the age of 17 years. Cases were also more likely than controls to report two or more indicators of adult social disadvantage, not only at first contact with psychiatric services [odds ratio (OR) 9.5], but also at onset of psychosis (OR 8.5), 1 year pre-onset (OR 4.5), and 5 years pre-onset (OR 2.9). CONCLUSIONS Greater numbers of indicators of current and long-term exposure are associated with progressively greater odds of psychosis. There is some evidence that social disadvantage tends to cluster and accumulate.
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Affiliation(s)
- S. A. Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - C. Gayer-Anderson
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S. Beards
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - K. Hubbard
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A. Onyejiaka
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A. Keraite
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S. Borges
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - V. Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P. Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - C. Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. Di Forti
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R. M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - C. Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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van der Ven E, Veling W, Tortelli A, Tarricone I, Berardi D, Bourque F, Selten JP. Evidence of an excessive gender gap in the risk of psychotic disorder among North African immigrants in Europe: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1603-1613. [PMID: 27372300 DOI: 10.1007/s00127-016-1261-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 06/20/2016] [Indexed: 01/15/2023]
Abstract
PURPOSE Epidemiological studies in the Netherlands have reported an excessive gender gap in the risk for non-affective psychotic disorder (NAPD) among immigrants from Morocco with a higher risk elevation in males compared to females. We examined the consistency of these findings and their generalizability to immigrants from the Maghreb (Mauritania, Morocco, Algeria, Tunisia and Libya) in other European countries. METHODS Systematic review and meta-analysis. Medline, PsychINFO and EMBASE databases were searched for publications in the period from January 1970 to April 2014. We included incidence and prevalence studies of non-affective psychotic disorder (NAPD) among migrants from the Maghreb in Europe and studies of subclinical psychotic symptoms (SPS) in representative samples. A meta-analysis was performed on the subgroup of incidence studies. RESULTS Five incidence and three prevalence studies of NAPD, and two prevalence studies of SPS, conducted in the Netherlands (n=7), Belgium (n=1), France (n=1) and Italy (n=1) met our inclusion criteria. Across all research designs, the risks of NAPD and SPS were consistently increased among male, not female immigrants from the Maghreb. The meta-analysis of incidence studies of NAPD yielded male-to-female risk ratios of 5.1 [95 % confidence interval (CI) 3.1-8.4] for migrants from the Maghreb, 2.0 (95 % CI 1.6-2.5) for other migrant groups, and 1.8 (95 % CI 1.3-2.5) for non-migrant Europeans. CONCLUSIONS The marked gender gap in psychosis risk among migrants from the Maghreb appears a consistent finding, foremost among the Moroccan-Dutch. The small number of studies limits the strength of conclusions that can be drawn about countries other than the Netherlands. Achievement-expectation mismatch, social marginalization and an increased prevalence of illicit drug use are possible explanations.
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Affiliation(s)
- E van der Ven
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,GGZ Leiden, Rivierduinen Psychiatric Institute, Sandifortdreef 19, Leiden, 2333 ZZ, The Netherlands.
| | - W Veling
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Tortelli
- EPS Maison Blanche, INSERM U955, Paris, France
| | - I Tarricone
- Institute of Psychiatry, Bologna University, Bologna, Italy.,West Bologna Mental Health Department, AUSL, Bologna, Italy
| | - D Berardi
- Institute of Psychiatry, Bologna University, Bologna, Italy.,West Bologna Mental Health Department, AUSL, Bologna, Italy
| | - F Bourque
- Institute of Psychiatry, King's College London, London, UK
| | - J P Selten
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,GGZ Leiden, Rivierduinen Psychiatric Institute, Sandifortdreef 19, Leiden, 2333 ZZ, The Netherlands
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Bjornestad J, Joa I, Larsen TK, Langeveld J, Davidson L, Ten Velden Hegelstad W, Anda LG, Veseth M, Melle I, Johannessen JO, Bronnick K. "Everyone Needs a Friend Sometimes" - Social Predictors of Long-Term Remission In First Episode Psychosis. Front Psychol 2016; 7:1491. [PMID: 27757090 PMCID: PMC5047905 DOI: 10.3389/fpsyg.2016.01491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background: Predictors of long-term symptomatic remission are crucial to the successful tailoring of treatment in first episode psychosis. There is lack of studies distinguishing the predictive effects of different social factors. This prevents a valid evaluating of their independent effects. Objectives: To test specific social baseline predictors of long-term remission. We hypothesized that first, satisfaction with social relations predicts remission; second, that frequency of social interaction predicts remission; and third, that the effect of friend relationship satisfaction and frequency will be greater than that of family relations satisfaction and frequency. Material and Methods: A sample of first episode psychosis (n = 186) completed baseline measures of social functioning, as well as clinical assessments. We compared groups of remitted and non-remitted individuals using generalized estimating equations analyses. Results: Frequency of social interaction with friends was a significant positive predictor of remission over a two-year period. Neither global perceived social satisfaction nor frequency of family interaction showed significant effects. Conclusions: The study findings are of particular clinical importance since frequency of friendship interaction is a possibly malleable factor. Frequency of interaction could be affected through behavioral modification and therapy already from an early stage in the course, and thus increase remission rates.
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Affiliation(s)
- Jone Bjornestad
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Network for Medical Sciences, University of StavangerStavanger, Norway
| | - Inge Joa
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Network for Medical Sciences, University of StavangerStavanger, Norway
| | - Tor K Larsen
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
| | - Johannes Langeveld
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Larry Davidson
- School of Medicine and Institution for Social and Policy Studies, Yale University, New Haven CT, USA
| | - Wenche Ten Velden Hegelstad
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Liss G Anda
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University Hospital Stavanger, Norway
| | - Marius Veseth
- Faculty of Health and Social Sciences, Bergen University College Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, University of Oslo Oslo, Norway
| | - Jan O Johannessen
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
| | - Kolbjorn Bronnick
- Tidlig Oppdagelse og Behandling av Psykoser - Centre for Clinical Research in Psychosis, Stavanger University HospitalStavanger, Norway; Section of Psychiatry, Department of Clinical Medicine, University of BergenBergen, Norway
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Reininghaus U, Böhnke JR, Hosang G, Farmer A, Burns T, McGuffin P, Bentall RP. Evaluation of the validity and utility of a transdiagnostic psychosis dimension encompassing schizophrenia and bipolar disorder. Br J Psychiatry 2016; 209:107-13. [PMID: 26989099 DOI: 10.1192/bjp.bp.115.167882] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/19/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, the Kraepelinian dichotomy has been challenged in light of evidence on shared genetic and environmental factors for schizophrenia and bipolar disorder, but empirical efforts to identify a transdiagnostic phenotype of psychosis remain remarkably limited. AIMS To investigate whether schizophrenia spectrum and bipolar disorder lie on a transdiagnostic spectrum with overlapping non-affective and affective psychotic symptoms. METHOD Multidimensional item-response modelling was conducted on symptom ratings of the OPerational CRITeria (OPCRIT) system in 1168 patients with schizophrenia spectrum and bipolar disorder. RESULTS A bifactor model with one general, transdiagnostic psychosis dimension underlying affective and non-affective psychotic symptoms and five specific dimensions of positive, negative, disorganised, manic and depressive symptoms provided the best model fit and diagnostic utility for categorical classification. CONCLUSIONS Our findings provide support for including dimensional approaches into classification systems and a directly measurable clinical phenotype for cross-disorder investigations into shared genetic and environmental factors of psychosis.
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Affiliation(s)
- Ulrich Reininghaus
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Jan R Böhnke
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Georgina Hosang
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Anne Farmer
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Tom Burns
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Peter McGuffin
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
| | - Richard P Bentall
- Ulrich Reininghaus, PhD, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands; Jan R. Böhnke, PhD, Hull York Medical School & Department of Health Sciences, University of York, UK; Georgina Hosang, PhD, Department of Psychology, Goldsmiths, University of London, London, UK; Anne Farmer, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Tom Burns, FRCPsych, Department of Psychiatry, University of Oxford, Oxford, UK; Peter McGuffin, FRCPsych, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Richard P. Bentall, PhD, University of Liverpool, Institute of Psychology, Health & Society, Liverpool, UK
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Reininghaus U, Kempton MJ, Valmaggia L, Craig TKJ, Garety P, Onyejiaka A, Gayer-Anderson C, So SH, Hubbard K, Beards S, Dazzan P, Pariante C, Mondelli V, Fisher HL, Mills JG, Viechtbauer W, McGuire P, van Os J, Murray RM, Wykes T, Myin-Germeys I, Morgan C. Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study. Schizophr Bull 2016; 42:712-22. [PMID: 26834027 PMCID: PMC4838104 DOI: 10.1093/schbul/sbv190] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
While contemporary models of psychosis have proposed a number of putative psychological mechanisms, how these impact on individuals to increase intensity of psychotic experiences in real life, outside the research laboratory, remains unclear. We aimed to investigate whether elevated stress sensitivity, experiences of aberrant novelty and salience, and enhanced anticipation of threat contribute to the development of psychotic experiences in daily life. We used the experience sampling method (ESM) to assess stress, negative affect, aberrant salience, threat anticipation, and psychotic experiences in 51 individuals with first-episode psychosis (FEP), 46 individuals with an at-risk mental state (ARMS) for psychosis, and 53 controls with no personal or family history of psychosis. Linear mixed models were used to account for the multilevel structure of ESM data. In all 3 groups, elevated stress sensitivity, aberrant salience, and enhanced threat anticipation were associated with an increased intensity of psychotic experiences. However, elevated sensitivity to minor stressful events (χ(2)= 6.3,P= 0.044), activities (χ(2)= 6.7,P= 0.036), and areas (χ(2)= 9.4,P= 0.009) and enhanced threat anticipation (χ(2)= 9.3,P= 0.009) were associated with more intense psychotic experiences in FEP individuals than controls. Sensitivity to outsider status (χ(2)= 5.7,P= 0.058) and aberrantly salient experiences (χ(2)= 12.3,P= 0.002) were more strongly associated with psychotic experiences in ARMS individuals than controls. Our findings suggest that stress sensitivity, aberrant salience, and threat anticipation are important psychological processes in the development of psychotic experiences in daily life in the early stages of the disorder.
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Affiliation(s)
- Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands;
| | - Matthew J Kempton
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucia Valmaggia
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom K J Craig
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philippa Garety
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adanna Onyejiaka
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Gayer-Anderson
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathryn Hubbard
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Beards
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John G Mills
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Philip McGuire
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Robin M Murray
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Til Wykes
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Center for Contextual Psychiatry, Department of Neuroscience, Catholic University of Leuven, Leuven, Belgium
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Reininghaus U, Depp CA, Myin-Germeys I. Ecological Interventionist Causal Models in Psychosis: Targeting Psychological Mechanisms in Daily Life. Schizophr Bull 2016; 42:264-9. [PMID: 26707864 PMCID: PMC4753613 DOI: 10.1093/schbul/sbv193] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Integrated models of psychotic disorders have posited a number of putative psychological mechanisms that may contribute to the development of psychotic symptoms, but it is only recently that a modest amount of experience sampling research has provided evidence on their role in daily life, outside the research laboratory. A number of methodological challenges remain in evaluating specificity of potential causal links between a given psychological mechanism and psychosis outcomes in a systematic fashion, capitalizing on longitudinal data to investigate temporal ordering. In this article, we argue for testing ecological interventionist causal models that draw on real world and real-time delivered, ecological momentary interventions for generating evidence on several causal criteria (association, time order, and direction/sole plausibility) under real-world conditions, while maximizing generalizability to social contexts and experiences in heterogeneous populations. Specifically, this approach tests whether ecological momentary interventions can (1) modify a putative mechanism and (2) produce changes in the mechanism that lead to sustainable changes in intended psychosis outcomes in individuals' daily lives. Future research using this approach will provide translational evidence on the active ingredients of mobile health and in-person interventions that promote sustained effectiveness of ecological momentary interventions and, thereby, contribute to ongoing efforts that seek to enhance effectiveness of psychological interventions under real-world conditions.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA; VA San Diego Healthcare System, San Diego, CA
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Belgium
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Boycott N, Akhtar A, Schneider J. "Work is good for me": views of mental health service users seeking work during the UK recession, a qualitative analysis. J Ment Health 2016; 24:93-7. [PMID: 25915816 DOI: 10.3109/09638237.2015.1019044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Individual placement and support (IPS) is an effective form of supported employment for people with severe mental illness. Little is known about service users' experiences of these programmes during economic recession. AIMS Obtain service users' views of an IPS programme implemented in the UK during recession. METHOD Thirty-one service users enrolled in an IPS programme were interviewed using a semi-structured protocol. The questions covered several areas of their experience, including problems faced in seeking work, perceived barriers in returning to work and what they found helpful in employment support. RESULTS Unsurprisingly, a large number of service users had problems in finding work due to the number of appropriate jobs available. Nevertheless, many service users felt positively about the support they had received (90% were satisfied with IPS), and would advise others in their position to seek employment. Personal and practical support from employment specialists (ES) was the most useful aspect of the service. CONCLUSIONS Despite economic recession, an IPS service was implemented and regarded as satisfactory to service users seeking work. Although many found obtaining employment difficult, they would still advise others that work is worthwhile, suggesting that the context of recession has not discouraged them.
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Affiliation(s)
- Naomi Boycott
- CLAHRC-NDL, Institute of Mental Health, University of Nottingham , Nottingham , UK
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de Sousa P, Spray A, Sellwood W, Bentall RP. 'No man is an island'. Testing the specific role of social isolation in formal thought disorder. Psychiatry Res 2015; 230:304-13. [PMID: 26384574 DOI: 10.1016/j.psychres.2015.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 07/27/2015] [Accepted: 09/06/2015] [Indexed: 11/24/2022]
Abstract
Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research.
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Affiliation(s)
- Paulo de Sousa
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK.
| | - Amy Spray
- School of Psychology, Eleanor Rathbone Building, University of Liverpool, Bedford Street South, Liverpool L69 7ZA, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA1 4YG, UK
| | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
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Bhui K, Ullrich S, Kallis C, Coid JW. Criminal justice pathways to psychiatric care for psychosis. Br J Psychiatry 2015; 207:523-9. [PMID: 26294370 PMCID: PMC4664857 DOI: 10.1192/bjp.bp.114.153882] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Some patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis. AIMS To investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs. METHOD Two-year population-based survey of people presenting with a first-episode of psychosis. A total of 481 patients provided information on pathways to psychiatric care. The main outcome was a CJP at first contact compared with other services on the care pathway. RESULTS CJPs were more common if there was violence at first presentation (odds ratio (OR) = 4.23, 95% CI 2.74-6.54, P<0.001), drug use in the previous year (OR = 2.28, 95% CI 1.50-3.48, P<0.001) and for high psychopathy scores (OR = 2.54, 95% CI 1.43-4.53, P = 0.002). Compared with White British, CJPs were more common among Black Caribbean (OR = 2.97, 95% CI 1.54-5.72, P<0.001) and Black African patients (OR = 1.95, 95% CI 1.02-3.72, P = 0.01). Violence mediated 30.2% of the association for Black Caribbeans, but was not a mediator for Black African patients. These findings were sustained after adjustment for age, marital status, gender and employment. CONCLUSIONS CJPs were more common in violent presentations, for greater psychopathy levels and drug use. Violence presentations did not fully explain ethnic vulnerability to CJPs.
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Affiliation(s)
- Kamaldeep Bhui
- Kamaldeep Bhui, MD, Simone Ullrich, PhD, Constantinos Kallis, PhD, Jeremy W. Coid, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Simosi M, Rousseau DM, Daskalaki M. When career paths cease to exist: A qualitative study of career behavior in a crisis economy. JOURNAL OF VOCATIONAL BEHAVIOR 2015. [DOI: 10.1016/j.jvb.2015.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kates WR, Russo N, Wood WM, Antshel KM, Faraone SV, Fremont WP. Neurocognitive and familial moderators of psychiatric risk in velocardiofacial (22q11.2 deletion) syndrome: a longitudinal study. Psychol Med 2015; 45:1629-1639. [PMID: 25394491 DOI: 10.1017/s0033291714002724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although risk for psychosis in velocardiofacial (22q11.2 deletion) syndrome (VCFS) is well established, the cognitive and familial factors that moderate that risk are poorly understood. METHOD A total of 75 youth with VCFS were assessed at three time points, at 3-year intervals. Time 1 (T1) psychiatric risk was assessed with the Behavior Assessment System for Children (BASC). Data reduction of BASC scores yielded avoidance-anxiety and dysregulation factors. Time 2 (T2) neuropsychological and family function and time 3 (T3) prodromal/overt psychosis were assessed. Poisson regression models tested associations between T3 positive prodromal symptoms/overt psychosis and T1 psychiatric risk, T2 cognitive and familial factors, and their interactions. RESULTS T1 avoidance-anxiety ratings predicted T3 prodromal/overt psychosis. T2 verbal learning scores moderated this association, such that individuals with low avoidance-anxiety scores and stronger verbal learning skills were the least likely to demonstrate prodromal/overt psychosis at T3. Low scores on a T2 visual vigilance task also predicted T3 prodromal/overt psychosis, independently of the effect of T1 avoidance-anxiety scores. T1 dysregulation scores did not predict T3 prodromal/overt psychosis in a linear manner. Instead, the association between dysregulation and prodromal/overt psychosis was amplified by T2 levels of family organization, such that individuals with low dysregulation scores and low family organization scores were the most likely to exhibit T3 prodromal/overt psychosis. CONCLUSIONS Significant moderators of psychiatric risk in VCFS include verbal learning skills as well as levels of family organization, carrying implications for early identification and preventative treatment of youth with VCFS at highest risk for psychosis.
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Affiliation(s)
- W R Kates
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - N Russo
- Department of Psychology,Syracuse University,Syracuse,NY,USA
| | - W M Wood
- Department of Psychology,Syracuse University,Syracuse,NY,USA
| | - K M Antshel
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - S V Faraone
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
| | - W P Fremont
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA
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Tortelli A, Morgan C, Szoke A, Nascimento A, Skurnik N, de Caussade EM, Fain-Donabedian E, Fridja F, Henry M, Ezembe F, Murray RM. Different rates of first admissions for psychosis in migrant groups in Paris. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1103-9. [PMID: 24270936 PMCID: PMC4283097 DOI: 10.1007/s00127-013-0795-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/06/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The association between migration and psychosis has been reported in the past decades in many European countries. Despite large-scale migration into France, epidemiological data on the incidence of psychosis in this population are lacking. In this study, we compare the incidence rates of first admission for psychosis among natives and first generation migrants. METHODS Two-hundred and fifty-eight patients aged 15+ with first admission for psychosis were identified in the catchment area of the 20th district of Paris between 2005 and 2009. Standardised incidence rates and incidence rate ratios were calculated for migrant and native groups. RESULTS We found higher rates of admissions for psychosis in the migrant group (IRR 2.9, 95 % CI 0.9-9.8) compared to individuals born in France. Among migrants, incidence was higher in individuals from Sub-Saharan Africa compared to natives (IRR 7.1, CI 95 % 2.3-21.8), whereas the incidence was similar for those from Europe (IRR 1.2, CI 95 % 0.3-5.1) and from North Africa (IRR 1.4, CI 95 % 0.4-5.6). CONCLUSIONS Our findings suggest that Sub-Saharan migrants were identified as the most vulnerable migrant group for developing psychosis in France, but additional work is warranted to confirm these trends.
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Bhugra D, Gupta S, Schouler-Ocak M, Graeff-Calliess I, Deakin N, Qureshi A, Dales J, Moussaoui D, Kastrup M, Tarricone I, Till A, Bassi M, Carta M. EPA Guidance Mental Health Care of Migrants. Eur Psychiatry 2014; 29:107-15. [DOI: 10.1016/j.eurpsy.2014.01.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractMigration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.
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Abstract
In recent years, there has been increasing interest in research on geographical variation in the incidence of schizophrenia and other psychoses. In this paper, we review the evidence on variation in incidence of schizophrenia and other psychoses in terms of place, as well as the individual- and area-level factors that account for this variation. We further review findings on potential mechanisms that link adverse urban environment and psychosis. There is evidence from earlier and more recent studies that urbanicity is associated with an increased incidence of schizophrenia and non-affective psychosis. In addition, considerable variation in incidence across neighbourhoods has been observed for these disorders. Findings suggest it is unlikely that social drift alone can fully account for geographical variation in incidence. Evidence further suggests that the impact of adverse social contexts - indexed by area-level exposures such as population density, social fragmentation and deprivation - on risk of psychosis is explained (confounding) or modified (interaction) by environmental exposures at the individual level (i.e., cannabis use, social adversity, exclusion and discrimination). On a neurobiological level, several studies suggest a close link between social adversity, isolation and stress on the one hand, and monoamine dysfunction on the other, which resembles findings in schizophrenia patients. However, studies directly assessing correlations between urban stress or discrimination and neurobiological alterations in schizophrenia are lacking to date.
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Affiliation(s)
- Andreas Heinz
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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Abstract
Background. There is strong evidence that those with a long-standing psychotic disorder have fewer social contacts and less social support than comparison groups. There is less research on the extent of social contacts and support prior to or at the onset of psychosis. In the light of recent evidence implicating a range of social experiences and contexts at the onset of psychosis, it is relevant to establish whether social networks and support diminished before or at the time of onset and whether the absence of such supports might contribute to risk, either directly or indirectly. We, therefore, conducted a systematic review of this literature to establish what is currently known about the relationship between social networks, support and early psychosis. Methods. We identified all studies investigating social networks and support in first episode psychosis samples and in general population samples with measures of psychotic experiences or schizotype by conducting systematic searches of electronic databases using pre-defined search terms and criteria. Findings were synthesized using non-quantitative approaches. Results. Thirty-eight papers were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons. Nonetheless, the existing literature suggests social networks (particularly close friends) and support diminished both among first episode samples and among non-clinical samples reporting psychotic experiences or with schizotype traits, compared with varying comparison groups. These differences may be more marked for men and for those from minority ethnic populations. Conclusions. Tentatively, reduced social networks and support appear to pre-date onset of psychotic disorder. However, the substantial methodological heterogeneity among the existing studies makes comparisons difficult and suggests a need for more robust and comparable studies on networks, support and early psychosis.
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Blustein DL, Kozan S, Connors-Kellgren A. Unemployment and underemployment: A narrative analysis about loss. JOURNAL OF VOCATIONAL BEHAVIOR 2013. [DOI: 10.1016/j.jvb.2013.02.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boydell J, Bebbington P, Bhavsar V, Kravariti E, van Os J, Murray RM, Dutta R. Unemployment, ethnicity and psychosis. Acta Psychiatr Scand 2013; 127:202-9. [PMID: 22924878 DOI: 10.1111/j.1600-0447.2012.01921.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study describes the incidence of psychosis in unemployed people and determines whether unemployment has a greater impact on the development of psychosis amongst Black minority groups than White groups. METHOD Patients with a first diagnosis of Research Diagnostic Criteria psychosis, in a defined area of London from 1998 to 2004, were identified. Crude and standardised incidence rates of psychosis amongst unemployed people for each ethnic group were calculated. Poisson regression modelling tested for interactions between unemployment and ethnicity. RESULTS Hundred cases occurred amongst employed people and 78 cases occurred amongst the unemployed people. When standardised to the employed White population of the area, White unemployed people had a standardised incidence ratio (SIR) of 11.7 (95% CI 6.4-19.7), Black Caribbean people had a SIR of 60.1(95% CI 39.3-88) and Black African people had a SIR of 40.7 (95% CI 25.8-61.1). There was no interaction however between ethnicity and unemployment (Likelihood ratio test P = 0.54). CONCLUSION Rates of psychosis are high amongst unemployed people in south London and extremely high amongst Black Caribbean and Black African unemployed people. There was no evidence however that the minority groups were particularly sensitive to the stresses, limitations or meaning of unemployment.
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Affiliation(s)
- J Boydell
- Department of Psychosis Studies, Institute of Psychiatry, London, UK.
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Abstract
BACKGROUND Population-based studies have identified that delusional-like experiences (DLEs) are common in the general population. While there is a large literature exploring the relationship between poor social support and risk of mental illness, there is a lack of empirical data examining the association of poor social support and DLEs. The aim of the study was to explore the association between social support and DLEs using a large, nationally representative community sample. METHODS Subjects were drawn from a national multistage probability survey of 8841 adults aged between 16 and 85 years. The Composite International Diagnostic Interview was used to identify DLEs, common psychiatric disorders and physical disorders. Eight questions assessed various aspects of social support with spouse/partners and other family and friends. We examined the relationship between DLEs and social support using logistic regression, adjusting for potential confounding factors. RESULTS Of the sample, 8.4% (n = 776) positively endorsed one or more DLEs. Individuals who (a) had the least contact with friends, or (b) could not rely on or confide in spouse/partner, family or friends were significantly more likely to endorse DLEs. The associations remained significant after adjusting for a range of potential confounding factors. CONCLUSIONS DLEs are associated with impoverished social support in the general population. While we cannot exclude the possibility that the presence of isolated DLEs results in a reduction of social support, we speculate that poor social support may contribute in a causal fashion to the risk of DLEs.
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