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Petti E, Schiffman J, Oh H, Karcher NR. Evidence for Environmental Risk Factors and Cumulative Stress Linking Racial/Ethnic Identity and Psychotic-Like Experiences in ABCD Study Data. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00311-3. [PMID: 38852932 DOI: 10.1016/j.jaac.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/14/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Previous work has found increased endorsement of psychotic-like experiences (PLEs) among marginalized racial and ethnic groups. According to social determinants frameworks, marginalized groups are at increased risk for exposure to socio-environmental risk factors, including systemic factors (eg, poverty and poor housing conditions) and social stressors (eg, discrimination). We examine the extent to which environmental risk factors and stress account for associations between racial/ethnic groups with PLEs. METHOD Analyses included 11,876 young adolescents 9 to 10 years of age from the Adolescent Brain Cognitive Development (ABCD) study. Mediation models assessed whether stress at 1-year follow-up indirectly linked baseline environmental risk to later distressing PLEs at 2-year follow-up. Serial mediation models examined whether environmental risk and stress indirectly accounted for variation among racial/ethnic groups in self-reported distressing PLEs. RESULTS Through principal component and mediation analyses, we found evidence that the link between environmental risk (eg, poverty and exposure to crime) and distressing PLEs was mediated by stress. There was also evidence that higher endorsement of distressing PLEs within the Black and Hispanic groups was serially mediated by greater environmental risk and greater stress. CONCLUSION The analyses provide evidence that the associations between marginalized racial and ethnic identities with the endorsement of PLEs partially reflects the sequelae of systemic socio-environmental factors. Findings suggest the potential for intervening upon environmental risk factors to target the reduction of cumulative stress over time, which may in turn buffer against the development of PLEs. DIVERSITY INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way.
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Affiliation(s)
- Emily Petti
- University of California, Irvine, California.
| | | | - Hans Oh
- University of Southern California, Los Angeles, California
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Roberts T, Lee Pow J, Donald C, Hutchinson G, Morgan C. Neighbourhoods & recovery from psychosis in Trinidad: A qualitative study. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100373. [PMID: 38911287 PMCID: PMC11190840 DOI: 10.1016/j.ssmqr.2023.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 06/25/2024]
Abstract
•Various aspects of neighbourhood environments influence recovery from psychosis.•High levels of violence at the neighbourhood level may negatively affect recovery.•Social cohesion may be a protective factor that promotes recovery.•Normalisation of cannabis use and easy access to cannabis may also hinder recovery.•Community involvement is needed to design interventions targeting these factors.
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Affiliation(s)
- Tessa Roberts
- Unit for Social and Community Psychiatry, Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Joni Lee Pow
- Department of Psychiatry, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Casswina Donald
- Department of Psychiatry, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Gerard Hutchinson
- Department of Psychiatry, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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3
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Brink V, Andleeb H, Gayer-Anderson C, Arango C, Arrojo M, Berardi D, Bernardo M, Bobes J, Del-Ben CM, Ferraro L, de Haan L, La Barbera D, La Cascia C, Lasalvia A, Llorca PM, Menezes PR, Pignon B, Sanjuán J, Santos JL, Selten JP, Tarricone I, Tortelli A, Tripoli G, Velthorst E, Rutten BPF, van Os J, Quattrone D, Murray RM, Jones PB, Morgan C, Di Forti M, Jongsma HE, Kirkbride JB. The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study. Schizophr Bull 2024:sbae072. [PMID: 38788048 DOI: 10.1093/schbul/sbae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND HYPOTHESIS Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. STUDY DESIGN We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. STUDY RESULTS Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. CONCLUSIONS Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.
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Affiliation(s)
- Vera Brink
- Department of Psychosis, University Center Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Humma Andleeb
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Charlotte Gayer-Anderson
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Manuel Arrojo
- Department of Mental Health and Drug-Addiction Assistance, Health Service of Galicia, Psychiatric Genetic Group IDIS, Hospital Clínico Universitario de Santiago de Compostela, affiliated center to Centro de Investigación Biomédica en Red de Salud Mental, Servicio Gallego de Salud, Santiago de Compostela, Spain
| | | | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- CIBERSAM, ISCIII, Barcelona, Spain
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, Oviedo, Spain
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Psychiatry, University of Palermo, Palermo, Italy
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Psychiatry, University of Palermo, Palermo, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Psychiatry, University of Palermo, Palermo, Italy
| | - Antonio Lasalvia
- Department of Neuroscience, Biomedicine and Movement, Section of Psychiatry, University of Verona, Verona, Italy
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France
- CMP B CHU, Clermont-Ferrand, France
- Université Clermont Auvergne, Clermont-Ferrand, France
| | - Paolo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Núcleo de Pesquina em Saúde Mental Populacional, Universidade de São Paulo, São Paulo, Brazil
| | - Baptiste Pignon
- Fondation FondaMental, Créteil, France
- Université Paris-Est-Créteil (UPEC) and AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, Psychiatry department and INSERM, IMRB, Translational Neuropsychiatry, Créteil, France
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain
| | - José Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital "Virgen de la Luz", Cuenca, Spain
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorium Università di Bologna, Bologna, Italy
| | - Andrea Tortelli
- Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France
- Pôle Psychiatrie Précarité, Groupe Hospitalier Paris Psychiatrie Neurosciences, Paris, France
| | - Giada Tripoli
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Psychiatry, University of Palermo, Palermo, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eva Velthorst
- Department of Research, Mental Health Organization "GGZ Noord-Holland-Noord", Heerhugowaard, The Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diego Quattrone
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Psychiatry, University of Palermo, Palermo, Italy
- 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
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, 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
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Chesterton Medical Centre, Cambridge, UK
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta 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
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah E Jongsma
- Department of Psychosis, University Center Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Veldzicht Centre for Transcultural Psychiatry, Balkbrug, The Netherlands
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK
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Oluwoye O, Puzia M, Lissau A, Amram O, Weeks DL. Multidimensional Approach to Exploring Neighborhood Determinants and Symptom Severity Among Individuals With Psychosis. JAMA Netw Open 2024; 7:e2410269. [PMID: 38748424 PMCID: PMC11096989 DOI: 10.1001/jamanetworkopen.2024.10269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 05/18/2024] Open
Abstract
Importance The impact of cumulative exposure to neighborhood factors on psychosis, depression, and anxiety symptom severity prior to specialized services for psychosis is unknown. Objective To identify latent neighborhood profiles based on unique combinations of social, economic, and environmental factors, and validate profiles by examining differences in symptom severity among individuals with first episode psychosis (FEP). Design, Setting, and Participants This cohort study used neighborhood demographic data and health outcome data for US individuals with FEP receiving services between January 2017 and August 2022. Eligible participants were between ages 14 and 40 years and enrolled in a state-level coordinated specialty care network. A 2-step approach was used to characterize neighborhood profiles using census-tract data and link profiles to mental health outcomes. Data were analyzed March 2023 through October 2023. Exposures Economic and social determinants of health; housing conditions; land use; urbanization; walkability; access to transportation, outdoor space, groceries, and health care; health outcomes; and environmental exposure. Main Outcomes and Measures Outcomes were Community Assessment of Psychic Experiences 15-item, Patient Health Questionnaire 9-item, and Generalized Anxiety Disorder 7-item scale. Results The total sample included 225 individuals aged 14 to 36 years (mean [SD] age, 20.7 [4.0] years; 152 men [69.1%]; 9 American Indian or Alaska Native [4.2%], 13 Asian or Pacific Islander [6.0%], 19 Black [8.9%], 118 White [55.1%]; 55 Hispanic ethnicity [26.2%]). Of the 3 distinct profiles identified, nearly half of participants (112 residents [49.8%]) lived in urban high-risk neighborhoods, 56 (24.9%) in urban low-risk neighborhoods, and 57 (25.3%) in rural neighborhoods. After controlling for individual characteristics, compared with individuals residing in rural neighborhoods, individuals residing in urban high-risk (mean estimate [SE], 0.17 [0.07]; P = .01) and urban low-risk neighborhoods (mean estimate [SE], 0.25 [0.12]; P = .04) presented with more severe psychotic symptoms. Individuals in urban high-risk neighborhoods reported more severe depression (mean estimate [SE], 1.97 [0.79]; P = .01) and anxiety (mean estimate [SE], 1.12 [0.53]; P = .04) than those in rural neighborhoods. Conclusions and Relevance This study found that in a cohort of individuals with FEP, baseline psychosis, depression, and anxiety symptom severity differed by distinct multidimensional neighborhood profiles that were associated with where individuals reside. Exploring the cumulative effect of neighborhood factors improves our understanding of social, economic, and environmental impacts on symptoms and psychosis risk which could potentially impact treatment outcomes.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Megan Puzia
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Ari Lissau
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman
| | - Douglas L. Weeks
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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Griffiths SL, Murray GK, Logeswaran Y, Ainsworth J, Allan SM, Campbell N, Drake RJ, Katshu MZUH, Machin M, Pope MA, Sullivan SA, Waring J, Bogatsu T, Kane J, Weetman T, Johnson S, Kirkbride JB, Upthegrove R. Implementing and Evaluating a National Integrated Digital Registry and Clinical Decision Support System in Early Intervention in Psychosis Services (Early Psychosis Informatics Into Care): Co-Designed Protocol. JMIR Res Protoc 2024; 13:e50177. [PMID: 38502175 PMCID: PMC10988369 DOI: 10.2196/50177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/21/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services are nationally mandated in England to provide multidisciplinary care to people experiencing first-episode psychosis, which disproportionately affects deprived and ethnic minority youth. Quality of service provision varies by region, and people from historically underserved populations have unequal access. In other disease areas, including stroke and dementia, national digital registries coupled with clinical decision support systems (CDSSs) have revolutionized the delivery of equitable, evidence-based interventions to transform patient outcomes and reduce population-level disparities in care. Given psychosis is ranked the third most burdensome mental health condition by the World Health Organization, it is essential that we achieve the same parity of health improvements. OBJECTIVE This paper reports the protocol for the program development phase of this study, in which we aimed to co-design and produce an evidence-based, stakeholder-informed framework for the building, implementation, piloting, and evaluation of a national integrated digital registry and CDSS for psychosis, known as EPICare (Early Psychosis Informatics into Care). METHODS We conducted 3 concurrent work packages, with reciprocal knowledge exchange between each. In work package 1, using a participatory co-design framework, key stakeholders (clinicians, academics, policy makers, and patient and public contributors) engaged in 4 workshops to review, refine, and identify a core set of essential and desirable measures and features of the EPICare registry and CDSS. Using a modified Delphi approach, we then developed a consensus of data priorities. In work package 2, we collaborated with National Health Service (NHS) informatics teams to identify relevant data currently captured in electronic health records, understand data retrieval methods, and design the software architecture and data model to inform future implementation. In work package 3, observations of stakeholder workshops and individual interviews with representative stakeholders (n=10) were subject to interpretative qualitative analysis, guided by normalization process theory, to identify factors likely to influence the adoption and implementation of EPICare into routine practice. RESULTS Stage 1 of the EPICare study took place between December 2021 and September 2022. The next steps include stage 2 building, piloting, implementation, and evaluation of EPICare in 5 demonstrator NHS Trusts serving underserved and diverse populations with substantial need for EIP care in England. If successful, this will be followed by stage 3, in which we will seek NHS adoption of EPICare for rollout to all EIP services in England. CONCLUSIONS By establishing a multistakeholder network and engaging them in an iterative co-design process, we have identified essential and desirable elements of the EPICare registry and CDSS; proactively identified and minimized potential challenges and barriers to uptake and implementation; and addressed key questions related to informatics architecture, infrastructure, governance, and integration in diverse NHS Trusts, enabling us to proceed with the building, piloting, implementation, and evaluation of EPICare. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50177.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Yanakan Logeswaran
- Division of Psychiatry, University College London, London, United Kingdom
| | - John Ainsworth
- The University of Manchester, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sophie M Allan
- Department of Clinical Psychology and Psychotherapies, Medical School, University of East Anglia, Norwich, United Kingdom
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Niyah Campbell
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Richard J Drake
- The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Matthew Machin
- The University of Manchester, Manchester, United Kingdom
| | - Megan A Pope
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Sarah A Sullivan
- Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
- Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Justin Waring
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Julie Kane
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tyler Weetman
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - James B Kirkbride
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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7
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Ku BS, Ren J, Compton MT, Druss BG, Guo S, Walker EF. The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends. Psychol Med 2024:1-9. [PMID: 38362835 DOI: 10.1017/s0033291724000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents. METHODS Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends. RESULTS Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted β = 0.05; 95% CI: 0.01-0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted β = -0.02; 95% CI: -0.04 to <-0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted β = 0.07; 95% CI: 0.03-0.11). However, among those with more close friends, the association was non-significant (adjusted β = 0.03; 95% CI: -0.01 to 0.07). CONCLUSIONS Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jiyuan Ren
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shuyi Guo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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8
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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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9
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Logeswaran Y, Dykxhoorn J, Dalman C, Kirkbride JB. Social Deprivation and Population Density Trajectories Before and After Psychotic Disorder Diagnosis. JAMA Psychiatry 2023; 80:1258-1268. [PMID: 37672257 PMCID: PMC10483380 DOI: 10.1001/jamapsychiatry.2023.3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
Importance People with psychosis are more likely to be born and live in densely populated and socioeconomically deprived environments, but it is unclear whether these associations are a cause or consequence of disorder. Objective To investigate whether trajectories of exposure to deprivation and population density before and after diagnosis are associated with psychotic disorders or nonpsychotic bipolar disorder. Design, Setting, and Participants This nested case-control study included all individuals born in Sweden between January 1, 1982, and December 31, 2001, diagnosed for the first time with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychotic disorder or nonpsychotic bipolar disorder between their 15th birthday and cohort exit (December 31, 2016). One sex- and birth year-matched control participant per case was selected. Data analysis was performed from July 2021 to June 2023. Exposures The main exposures were quintiles of neighborhood-level deprivation and population density each year from birth to age 14 years and from first diagnosis until cohort exit. Main Outcomes and Measures The main outcomes were the odds of a serious mental illness outcome associated with trajectories of deprivation and population density, before and after diagnosis in cases. Group-based trajectory modeling was used to derive trajectories of each exposure in each period. Logistic regression was used to examine associations with outcomes. Results A total of 53 458 individuals (median [IQR] age at diagnosis in case patients, 23.2 [15.0-34.8] years; 30 746 [57.5%] female), including 26 729 case patients and 26 729 control participants, were studied. From birth to early adolescence, gradients were observed in exposure to deprivation and population density trajectories during upbringing and psychotic disorder, with those in the most vs least deprived (adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.28) and most vs least densely populated (AOR, 1.49; 95% CI, 1.34-1.66) trajectories at greatest risk. A strong upward mobility trajectory to less deprived neighborhoods was associated with similar risk to living in the least deprived trajectory (AOR, 1.01; 95% CI, 0.91-1.12). Only 543 case patients (2.0%) drifted into more deprived areas after diagnosis; people with psychotic disorder were more likely to belong to this trajectory (AOR, 1.38; 95% CI, 1.16-1.65) or remain in the most deprived trajectory (AOR, 1.36; 95% CI, 1.24-1.48) relative to controls. Patterns were similar for nonpsychotic bipolar disorder and deprivation but weaker for population density. Conclusions and Relevance In this case-control study, greater exposure to deprivation during upbringing was associated with increased risk of serious mental illness, but upward mobility mitigated this association. People with serious mental illness disproportionately remained living in more deprived areas after diagnosis, highlighting issues of social immobility. Prevention and treatment should be proportionately located in deprived areas according to need.
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Affiliation(s)
- Yanakan Logeswaran
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Jennifer Dykxhoorn
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
- Department of Primary Care and Population Health, UCL, University College London, London, United Kingdom
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - James B. Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
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10
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Lawrie S, Hanlon C, Manda-Taylor L, Knapp M, Pickersgill M, Stewart RC, Ahrens J, Allardyce J, Amos A, Bauer A, Breuer E, Chasweka D, Chidzalo K, Gondwe S, Jain S, Kokota D, Kulisewa K, Liwimbi O, MacBeth A, Mkandawire T, Sefasi A, Sibande W, Udedi M, Umar E. Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol. PLoS One 2023; 18:e0293370. [PMID: 38032862 PMCID: PMC10688724 DOI: 10.1371/journal.pone.0293370] [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: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.
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Affiliation(s)
- Stephen Lawrie
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry Psychology & Neuroscience, King’s College, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lucinda Manda-Taylor
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Martyn Pickersgill
- Centre for Biomedicine, Self and Society, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert C. Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Jen Ahrens
- Tower Hamlets Early Intervention Service, East London NHS Foundation Trust, London, United Kingdom
| | - Judith Allardyce
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Action Amos
- Pan African Network for Persons with Psychosocial Disabilities (PANPPD), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Annette Bauer
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Erica Breuer
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Dennis Chasweka
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kate Chidzalo
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Saulos Gondwe
- Saint John of God (SJOG) Hospital Services, Lilongwe, Malawi
| | - Sumeet Jain
- School of Social & Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Demoubly Kokota
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Kazione Kulisewa
- Department of Psychiatry & Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Olive Liwimbi
- Zomba Mental Hospital, Ministry of Health, Zomba, Malawi
| | - Angus MacBeth
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Thandiwe Mkandawire
- Mental Health Users and Carers Association (MeHUCA), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Anthony Sefasi
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wakumanya Sibande
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michael Udedi
- Curative and Medical Rehabilitation Services Directorate, Ministry of Health, Lilongwe, Malawi
- African Mental Health Research Initiative (AMARI), Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric Umar
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
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11
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Lee SC, DelPozo-Banos M, Lloyd K, Jones I, Walters JTR, John A. Trends in socioeconomic inequalities in incidence of severe mental illness - A population-based linkage study using primary and secondary care routinely collected data between 2000 and 2017. Schizophr Res 2023; 260:113-122. [PMID: 37634386 DOI: 10.1016/j.schres.2023.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. METHODS We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders. RESULTS We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %). CONCLUSIONS There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
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Affiliation(s)
- Sze Chim Lee
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Keith Lloyd
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - James T R Walters
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Ann John
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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12
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Fordham E, Gao CX, Filia K, O'Donoghue B, Smith C, Francey S, Rickwood D, Telford N, Thompson A, Brown E. Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use. Psychiatry Res 2023; 328:115478. [PMID: 37717545 DOI: 10.1016/j.psychres.2023.115478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15-25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.
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Affiliation(s)
- Eliza Fordham
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Caroline X Gao
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Filia
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Australia; Department of Psychiatry, University College Dublin, Ireland
| | - Catherine Smith
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Shona Francey
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Debra Rickwood
- Headspace National, Melbourne, Australia; University of Canberra, Australia
| | | | - Andrew Thompson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ellie Brown
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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13
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O’Donoghue B, Michel C, Thompson KN, Cavelti M, Eaton S, Betts JK, Fowler C, Luebbers S, Kaess M, Chanen AM. Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people. Aust N Z J Psychiatry 2023; 57:1263-1270. [PMID: 36864694 PMCID: PMC10466981 DOI: 10.1177/00048674231157274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. METHOD This study included young people, aged 15-24 years, who attended Orygen's Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000-1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. RESULTS The study included 282 young people, of these 78.0% (n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% (n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% (n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p < 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). CONCLUSION Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.
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Affiliation(s)
- Brian O’Donoghue
- Department of Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katherine N Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Jennifer K Betts
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | | | - Stefan Luebbers
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, VIC, Australia
| | - Michael Kaess
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, VIC, Australia
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andrew M Chanen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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14
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Andreou C, Eickhoff S, Heide M, de Bock R, Obleser J, Borgwardt S. Predictors of transition in patients with clinical high risk for psychosis: an umbrella review. Transl Psychiatry 2023; 13:286. [PMID: 37640731 PMCID: PMC10462748 DOI: 10.1038/s41398-023-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Diagnosis of a clinical high-risk (CHR) state enables timely treatment of individuals at risk for a psychotic disorder, thereby contributing to improving illness outcomes. However, only a minority of patients diagnosed with CHR will make the transition to overt psychosis. To identify patients most likely to benefit from early intervention, several studies have investigated characteristics that distinguish CHR patients who will later develop a psychotic disorder from those who will not. We aimed to summarize evidence from systematic reviews and meta-analyses on predictors of transition to psychosis in CHR patients, among characteristics and biomarkers assessed at baseline. A systematic search was conducted in Pubmed, Scopus, PsychInfo and Cochrane databases to identify reviews and meta-analyses of studies that investigated specific baseline predictors or biomarkers for transition to psychosis in CHR patients using a cross-sectional or longitudinal design. Non-peer-reviewed publications, gray literature, narrative reviews and publications not written in English were excluded from analyses. We provide a narrative synthesis of results from all included reviews and meta-analyses. For each included publication, we indicate the number of studies cited in each domain and its quality rating. A total of 40 publications (21 systematic reviews and 19 meta-analyses) that reviewed a total of 272 original studies qualified for inclusion. Baseline predictors most consistently associated with later transition included clinical characteristics such as attenuated psychotic and negative symptoms and functioning, verbal memory deficits and the electrophysiological marker of mismatch negativity. Few predictors reached a level of evidence sufficient to inform clinical practice, reflecting generalizability issues in a field characterized by studies with small, heterogeneous samples and relatively few transition events. Sample pooling and harmonization of methods across sites and projects are necessary to overcome these limitations.
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Affiliation(s)
- Christina Andreou
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sofia Eickhoff
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marco Heide
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Renate de Bock
- University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jonas Obleser
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Department of Psychology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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15
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Gutiérrez G, Goicoa T, Ugarte MD, Aranguren L, Corrales A, Gil-Berrozpe G, Librero J, Sánchez-Torres AM, Peralta V, García de Jalon E, Cuesta MJ, Martínez M, Otero M, Azcarate L, Pereda N, Monclús F, Moreno L, Fernández A, Ariz MC, Sabaté A, Aquerreta A, Aguirre I, Lizarbe T, Begué MJ. Small area variations in non-affective first-episode psychosis: the role of socioeconomic and environmental factors. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01665-z. [PMID: 37612449 DOI: 10.1007/s00406-023-01665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature. METHODS We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates. RESULTS We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates. DISCUSSION Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.
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Affiliation(s)
- Gerardo Gutiérrez
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Tomas Goicoa
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - María Dolores Ugarte
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Statistics, Computer Science and Mathematics, Public University of Navarra, Pamplona, Spain
- Institute for Advanced Material and Mathematics, INAMAT2, Public University of Navarra, Pamplona, Spain
| | - Lidia Aranguren
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Asier Corrales
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
| | - Gustavo Gil-Berrozpe
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarrabiomed, Navarra University Hospital, Public University of Navarra, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalon
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain.
- Mental Health Department, Navarra Health Service-Osasunbidea, Pamplona, Spain.
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Jeste DV, Malaspina D, Bagot K, Barch DM, Cole S, Dickerson F, Dilmore A, Ford CL, Karcher NR, Luby J, Rajji T, Pinto-Tomas AA, Young LJ. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: III. Biology. Schizophr Bull 2023; 49:867-880. [PMID: 37023360 PMCID: PMC10318888 DOI: 10.1093/schbul/sbad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Social determinants of health (SDoHs) are nonmedical factors that significantly impact health and longevity. We found no published reviews on the biology of SDoHs in schizophrenia-spectrum psychotic disorders (SSPD). STUDY DESIGN We present an overview of pathophysiological mechanisms and neurobiological processes plausibly involved in the effects of major SDoHs on clinical outcomes in SSPD. STUDY RESULTS This review of the biology of SDoHs focuses on early-life adversities, poverty, social disconnection, discrimination including racism, migration, disadvantaged neighborhoods, and food insecurity. These factors interact with psychological and biological factors to increase the risk and worsen the course and prognosis of schizophrenia. Published studies on the topic are limited by cross-sectional design, variable clinical and biomarker assessments, heterogeneous methods, and a lack of control for confounding variables. Drawing on preclinical and clinical studies, we propose a biological framework to consider the likely pathogenesis. Putative systemic pathophysiological processes include epigenetics, allostatic load, accelerated aging with inflammation (inflammaging), and the microbiome. These processes affect neural structures, brain function, neurochemistry, and neuroplasticity, impacting the development of psychosis, quality of life, cognitive impairment, physical comorbidities, and premature mortality. Our model provides a framework for research that could lead to developing specific strategies for prevention and treatment of the risk factors and biological processes, thereby improving the quality of life and increasing the longevity of people with SSPD. CONCLUSIONS Biology of SDoHs in SSPD is an exciting area of research that points to innovative multidisciplinary team science for improving the course and prognosis of these serious psychiatric disorders.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego (Retired), CA, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience and Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kara Bagot
- Department of Psychiatry, Addiction Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deanna M Barch
- Departments of Psychological and Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Steve Cole
- Departments of Psychiatry and Biobehavioral Sciences, and Medicine, University of California, Los Angeles, CA, USA
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, USA
| | - Amanda Dilmore
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Charles L Ford
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Nicole R Karcher
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Joan Luby
- Department of Psychiatry (Child), Washington University in St. Louis, St. Louis, MO, USA
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adrián A Pinto-Tomas
- Biochemistry Department, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Larry J Young
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
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Zahid U, Hosang GM, de Freitas DF, Mooney R, Bhui K. Ethnic inequality, multimorbidity and psychosis: can a syndemic framework resolve disputed evidence? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:37. [PMID: 37296141 DOI: 10.1038/s41537-023-00367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
Syndemic theory is described as population-level clustering or co-occurrence of health conditions in the context of shared aetiologies that interact and can act synergistically. These influences appear to act within specific places of high disadvantage. We suggest ethnic inequality in experiences and outcomes of multimorbidity, including psychosis, may be explained through a syndemic framework. We discuss the evidence for each component of syndemic theory in relation to psychosis, using psychosis and diabetes as an exemplar. Following this, we discuss the practical and theoretical adaptations to syndemic theory in order to apply it to psychosis, ethnic inequality and multimorbidity, with implications for research, policy, and practice.
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Affiliation(s)
- Uzma Zahid
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Daniela Fonseca de Freitas
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Roisin Mooney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, Oxford, UK.
- Queen Mary University London Global Policy Institute, London, UK.
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18
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. Neighbourhood-level social capital, marginalisation, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada: a retrospective population-based cohort study. Psychol Med 2023; 53:2643-2651. [PMID: 34809726 PMCID: PMC10123822 DOI: 10.1017/s003329172100458x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Studies have shown mixed results regarding social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. We sought to examine the relationship between neighbourhood-level marginalisation, social capital, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada. METHODS We used a retrospective population-based cohort to identify incident cases of schizophrenia and schizoaffective disorder over a 10 year period and accounted for neighbourhood-level marginalisation and a proxy indicator of neighbourhood social capital. Mixed Poisson regression models were used to estimate adjusted incidence rate ratios (aIRRs). RESULTS In the cohort (n = 649 020) we identified 4841 incident cases of schizophrenia and schizoaffective disorder. A 27% variation in incidence was observed between neighbourhoods. All marginalisation dimensions, other than ethnic concentration, were associated with incidence. Compared to areas with low social capital, areas with intermediate social capital in the second [aIRR = 1.17, 95% confidence interval (CI) 1.03-1.33] and third (aIRR = 1.23, 95% CI 1.08-1.40) quintiles had elevated incidence rates after accounting for marginalisation. There was a higher risk associated with the intermediate levels of social capital (aIRR = 1.18, 95% CI 1.00-1.39) when analysed in only the females in the cohort, but the CI includes the possibility of a null effect. CONCLUSIONS The risk of developing schizophrenia and schizoaffective disorder in Toronto varies by neighbourhood and is associated with socioenvironmental exposures. Social capital was not linearly associated with risk, and risk differs by sex and social capital quintile. Future research should examine these relationships with different forms of social capital and examine how known individual-level risk factors impact these findings.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Kelly K. Anderson
- Department of Epidemiology & Biostatistics, Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
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19
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Moore D, Eaton S, Polari A, McGorry P, Nelson B, O'Donoghue B. The association between social deprivation and the rate of identification of individuals at Ultra-High Risk for psychosis and transition to psychosis. Int J Soc Psychiatry 2023; 69:294-303. [PMID: 35470718 DOI: 10.1177/00207640221087608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a higher incidence of psychotic disorders in neighbourhoods of greater social deprivation. However, it is not known whether this represents a causal relationship, as the stage at which social deprivation exerts its influence on the development of psychotic disorders is yet to be elucidated. We aimed to investigate the association between neighbourhood-level social deprivation and the rate of identification of individuals at Ultra-High Risk for psychosis (UHR), as well as the risk of transition to psychosis in UHR individuals. METHODS The cohort included all young people aged 15 to 24 identified as UHR attending an Early Intervention clinic in northwestern Melbourne over a 5-year period (2012-2016). Australian census data were used to obtain the at-risk population and social deprivation information according to the postcode of residence. Levels of social deprivation were arranged into quartiles. Poisson regression was used to calculate rate ratios and Cox regression analysis determined hazard ratios. RESULTS Of the 461 young people identified as UHR, 11.1% (n = 49) lived in the most affluent neighbourhoods (Quartile 1) compared to 36.7% (n = 162) in the most deprived neighbourhoods (Quartile 4). There was a 35% higher rate of identification of young people who were UHR from the most deprived neighbourhoods (aIRR = 1.35, 95% CI [0.98, 1.86]). Over a median follow-up of approximately 10 months (308 days (IQR: 188-557), 17.5% (n = 77) were known to have transitioned to a full-threshold psychotic disorder. Residing in a neighbourhood of above average deprivation had a hazard ratio of 2.05 (95% CI [0.88, 4.80]) for risk of transition, when controlling for age, sex and substance use. CONCLUSIONS These findings provide more support that EI services should be funded as per the expected incidence of psychotic disorders.
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Affiliation(s)
- Danielle Moore
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Scott Eaton
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, VIC, Australia
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20
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Mohan G, Barlow P. Area-level deprivation, neighbourhood factors and associations with mental health. PLoS One 2023; 18:e0281146. [PMID: 36716296 PMCID: PMC9886251 DOI: 10.1371/journal.pone.0281146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 pandemic saw residential neighbourhoods become more of a focal point in people's lives, where people were greater confined to living, working, and undertaking leisure in their locality. This study investigates whether area-level deprivation and neighbourhood conditions influence mental health, accounting for demographic, socio-economic and health circumstances of individuals. Using nationally representative data from Ireland, regression modelling revealed that area-level deprivation did not in itself have a discernible impact on mental health status (as measured using the Mental Health Inventory-5 instrument and the Energy and Vitality Index), or likelihood of having suffered depression in the previous 12 months. However, positive perceptions of area safety, service provision, and area cleanliness were associated with better mental health, as was involvement in social groups. Broad ranging policies investing in neighbourhoods, could have benefits for mental health, which may be especially important for deprived communities.
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Affiliation(s)
- Gretta Mohan
- Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College, Dublin, Ireland
- * E-mail:
| | - Peter Barlow
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
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21
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Hastings PD, Guyer AE, Parra LA. Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1215-1224. [PMID: 35718087 DOI: 10.1016/j.bpsc.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners, and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual, and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally informed research, because structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice, and policy that connect biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from classrooms through laboratories, hospitals, and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.
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Affiliation(s)
- Paul D Hastings
- Department of Psychology, University of California Davis, Davis, California; Center for Mind and Brain, University of California Davis, Davis, California.
| | - Amanda E Guyer
- Center for Mind and Brain, University of California Davis, Davis, California; Department of Human Ecology, University of California Davis, Davis, California
| | - Luis A Parra
- School of Nursing, University of Michigan, Ann Arbor, Michigan
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22
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Barbato M, Liu L, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone W, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J. Migrant status, clinical symptoms and functional outcome in youth at clinical high risk for psychosis: findings from the NAPLS-3 study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:559-568. [PMID: 36348056 DOI: 10.1007/s00127-022-02383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Migrant status is a known risk factor for psychosis, but the underlying causes of this vulnerability are poorly understood. Recently, studies have begun to explore whether migrant status predicts transition to psychosis in individuals at clinical high risk (CHR) for psychosis. Results, however, have been inconclusive. The present study assessed the impact of migrant status on clinical symptoms and functional outcome in individuals at CHR for psychosis who took part in the NAPLS-3 study. METHODS Participants' migrant status was classified as native-born, first-generation, or second-generation migrant. Clinical symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS); functional outcome was measured using the Global Functioning Scales:Social and Role (GF:S; GF:R). Assessments were conducted at baseline, 12-months, 18-months, and 24-months follow-up. Generalized linear mixed models for repeated measures were used to examine changes over time and differences between groups. RESULTS The overall sample included 710 individuals at CHR for psychosis (54.2% males; Age: M = 18.19; SD = 4.04). A mixed model analysis was conducted, and no significant differences between groups in symptoms or functioning were observed at any time point. Over time, significant improvement in symptoms and functioning was observed within each group. Transition rates did not differ across groups. CONCLUSION We discuss potential factors that might explain the lack of group differences. Overall, migrants are a heterogeneous population. Discerning the impact of migration from that of neighborhood ethnic density, social disadvantage or socio-economic status of different ethnic groups could help better understand vulnerability and resilience to psychosis.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, UAE
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA
- Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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23
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James SH, Berglund A, Chang WC, Strauss GP. Discrepancies between ideal and actual affect in schizophrenia: Implications for understanding negative symptoms. J Psychiatr Res 2022; 155:313-319. [PMID: 36174366 DOI: 10.1016/j.jpsychires.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022]
Abstract
Anhedonia is a core symptom of schizophrenia (SZ). However, psychological mechanisms underlying anhedonia are unclear, making it difficult to develop personalized psychosocial treatments. The current study explored the novel hypothesis that anhedonia is driven by discrepancies between ideal and actual affect (i.e., how positive or negative someone wants to feel compared to how they do feel), which impact the frequency of recreational, goal-directed, and social behaviors. Participants included 32 outpatients with SZ and 29 healthy controls (CN) who completed the Affect Valuation Index and measures of negative symptom severity. Results indicated that individuals with SZ displayed greater positive and negative emotion discrepancy scores than CN, suggesting that they strongly desire to feel more positive and less negative in the future than they actually do. Additionally, greater ideal relative to actual positive and negative affect was associated with greater severity of anhedonia, avolition, and asociality. The discrepancy between ideal and actual affective states may be demotivating, leading individuals with SZ to develop dysfunctional beliefs after repeated experiences of failing to achieve their desired emotional goal state. These findings suggest that ideal affect may be a novel psychological mechanism underlying negative symptoms that could be targeted in psychosocial treatments.
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Affiliation(s)
- Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alysia Berglund
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
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Associations of four indexes of social determinants of health and two community typologies with new onset type 2 diabetes across a diverse geography in Pennsylvania. PLoS One 2022; 17:e0274758. [PMID: 36112581 PMCID: PMC9480999 DOI: 10.1371/journal.pone.0274758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/04/2022] [Indexed: 11/19/2022] Open
Abstract
Evaluation of geographic disparities in type 2 diabetes (T2D) onset requires multidimensional approaches at a relevant spatial scale to characterize community types and features that could influence this health outcome. Using Geisinger electronic health records (2008–2016), we conducted a nested case-control study of new onset T2D in a 37-county area of Pennsylvania. The study included 15,888 incident T2D cases and 79,435 controls without diabetes, frequency-matched 1:5 on age, sex, and year of diagnosis or encounter. We characterized patients’ residential census tracts by four dimensions of social determinants of health (SDOH) and into a 7-category SDOH census tract typology previously generated for the entire United States by dimension reduction techniques. Finally, because the SDOH census tract typology classified 83% of the study region’s census tracts into two heterogeneous categories, termed rural affordable-like and suburban affluent-like, to further delineate geographies relevant to T2D, we subdivided these two typology categories by administrative community types (U.S. Census Bureau minor civil divisions of township, borough, city). We used generalized estimating equations to examine associations of 1) four SDOH indexes, 2) SDOH census tract typology, and 3) modified typology, with odds of new onset T2D, controlling for individual-level confounding variables. Two SDOH dimensions, higher socioeconomic advantage and higher mobility (tracts with fewer seniors and disabled adults) were independently associated with lower odds of T2D. Compared to rural affordable-like as the reference group, residence in tracts categorized as extreme poverty (odds ratio [95% confidence interval] = 1.11 [1.02, 1.21]) or multilingual working (1.07 [1.03, 1.23]) were associated with higher odds of new onset T2D. Suburban affluent-like was associated with lower odds of T2D (0.92 [0.87, 0.97]). With the modified typology, the strongest association (1.37 [1.15, 1.63]) was observed in cities in the suburban affluent-like category (vs. rural affordable-like–township), followed by cities in the rural affordable-like category (1.20 [1.05, 1.36]). We conclude that in evaluating geographic disparities in T2D onset, it is beneficial to conduct simultaneous evaluation of SDOH in multiple dimensions. Associations with the modified typology showed the importance of incorporating governmentally, behaviorally, and experientially relevant community definitions when evaluating geographic health disparities.
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25
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Qi X, Jia Y, Pan C, Li C, Wen Y, Hao J, Liu L, Cheng B, Cheng S, Yao Y, Zhang F. Index of multiple deprivation contributed to common psychiatric disorders: A systematic review and comprehensive analysis. Neurosci Biobehav Rev 2022; 140:104806. [PMID: 35926729 DOI: 10.1016/j.neubiorev.2022.104806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/08/2022] [Accepted: 07/31/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders. METHODS 56,613-106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0. RESULT Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education. CONCLUSION Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism.
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Affiliation(s)
- Xin Qi
- Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chune Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jingcan Hao
- Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yao Yao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
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26
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Schneider M, Müller CP, Knies AK. Low income and schizophrenia risk: a narrative review. Behav Brain Res 2022; 435:114047. [PMID: 35933046 DOI: 10.1016/j.bbr.2022.114047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.
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Affiliation(s)
- Miriam Schneider
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria.
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Andrea K Knies
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria
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The Comprehensive Effect of Socioeconomic Deprivation on Smoking Behavior: an Observational and Genome-Wide by Environment Interaction Analyses in UK Biobank. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Role of polygenic and environmental factors in the co-occurrence of depression and psychosis symptoms: a network analysis. Transl Psychiatry 2022; 12:259. [PMID: 35732632 PMCID: PMC9217963 DOI: 10.1038/s41398-022-02022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/29/2022] [Accepted: 06/08/2022] [Indexed: 11/08/2022] Open
Abstract
Depression and psychosis are often comorbid; they also have overlapping genetic and environmental risk factors, including trauma and area-level exposures. The present study aimed to advance understanding of this comorbidity via a network approach, by (1) identifying bridge nodes that connect clusters of lifetime depression and psychosis symptoms and (2) evaluating the influence of polygenic and environmental risk factors in these symptoms. This study included data from European ancestry participants in UK Biobank, a large population-based sample (N = 77,650). In Step 1, a network model identified bridge nodes between lifetime symptoms of depression and psychosis and functional impairment. In Step 2, genetic and environmental risk factors were incorporated to examine the degree to which symptoms associated with polygenic risk scores for depression and schizophrenia, lifetime exposure to trauma and area-level factors (including deprivation, air pollution and greenspace). Feelings of worthlessness, beliefs in unreal conspiracy against oneself, depression impairment and psychosis impairment emerged as bridges between depression and psychosis symptoms. Polygenic risk scores for depression and schizophrenia were predominantly linked with depression and psychosis impairment, respectively, rather than with specific symptoms. Cumulative trauma emerged as a bridge node associating deprivation with feelings of worthlessness and beliefs in unreal conspiracy, indicating that the experience of trauma is prominently linked with the co-occurrence of depression and psychosis symptoms related to negative views of oneself and others. These key symptoms and risk factors provide insights into the lifetime co-occurrence of depression and psychosis.
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Rosenfarb IF, Sharma-Gopinath R, Bhavsar V. First episode of psychosis in Guam: The role of ethnicity and neighbourhood factors. Early Interv Psychiatry 2022; 16:618-625. [PMID: 34414657 DOI: 10.1111/eip.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ethnicity, neighbourhood ethnic density, and four additional neighbourhood factors (urbanicity, crime, voting, and poverty) were examined in relation to the incidence of first episode of psychosis (FEP) in the Pacific Island of Guam. METHODS All first contact patients seen at the Guam Department of Mental Health and Substance Abuse (DMHSA) between January 2005 and December 2007 that met DSM-IV criteria for the diagnosis of a psychotic disorder were included. At the time of the study, DMHSA was the only psychiatric facility in Guam. RESULTS After controlling for age and gender, Chamorros, the indigenous people of Guam, had a standardized incidence rate (IR = 151/100 000 person-years, 95%CI = 129-173) of FEP over twice that of Whites (IR = 66/100 000 person-years, 95%CI = 34-99). Individuals from Palau had the highest standardized incidence rate (IR = 832/100 000 person-years, 95%CI = 581-1083). Increased neighbourhood Chamorro density was associated with decreased incidence of FEP among Chamorro individuals (IRR = 0.11, 95%CI = 0.03-0.43). After controlling for age, gender, ethnicity, and other neighbourhood factors, urbanicity (IRR = 3.82, 95%CI = 1.86-7.81), voting (IRR = 2.06, 95%CI = 1.32-3.20), poverty (IRR = 1.94, 95%CI = 1.40-2.67), and crime (IRR = 1.18, 95%CI = 1.00-1.40) remained statistically associated with FEP incidence. CONCLUSIONS The findings add to prior research that suggests that rates of mental health problems are higher in indigenous than in settler communities and are highest for indigenous people who live in neighbourhoods with few other indigenous individuals. Findings also suggest that even on a small island, with only ~150 000 people, urbanicity is associated with FEP. Finally, results are consistent with other research suggesting that the reduction of crime and social adversity can play a positive role in reducing the incidence of first episode psychosis.
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Affiliation(s)
- Irwin Ford Rosenfarb
- California School of Professional Psychology, Alliant International University, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Rita Sharma-Gopinath
- Department of Psychiatry, University of California, San Diego, California, USA.,Department of Psychology, University of Guam, Mangilao, Guam, USA
| | - Vishal Bhavsar
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
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Newbury JB, Arseneault L, Caspi A, Moffitt TE, Odgers CL, Belsky DW, Sugden K, Williams B, Ambler AP, Matthews T, Fisher HL. Association between genetic and socioenvironmental risk for schizophrenia during upbringing in a UK longitudinal cohort. Psychol Med 2022; 52:1527-1537. [PMID: 32972469 PMCID: PMC9226384 DOI: 10.1017/s0033291720003347] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Associations of socioenvironmental features like urbanicity and neighborhood deprivation with psychosis are well-established. An enduring question, however, is whether these associations are causal. Genetic confounding could occur due to downward mobility of individuals at high genetic risk for psychiatric problems into disadvantaged environments. METHODS We examined correlations of five indices of genetic risk [polygenic risk scores (PRS) for schizophrenia and depression, maternal psychotic symptoms, family psychiatric history, and zygosity-based latent genetic risk] with multiple area-, neighborhood-, and family-level risks during upbringing. Data were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins born in 1994-1995 and followed to age 18 (93% retention). Socioenvironmental risks included urbanicity, air pollution, neighborhood deprivation, neighborhood crime, neighborhood disorder, social cohesion, residential mobility, family poverty, and a cumulative environmental risk scale. At age 18, participants were privately interviewed about psychotic experiences. RESULTS Higher genetic risk on all indices was associated with riskier environments during upbringing. For example, participants with higher schizophrenia PRS (OR = 1.19, 95% CI = 1.06-1.33), depression PRS (OR = 1.20, 95% CI = 1.08-1.34), family history (OR = 1.25, 95% CI = 1.11-1.40), and latent genetic risk (OR = 1.21, 95% CI = 1.07-1.38) had accumulated more socioenvironmental risks for schizophrenia by age 18. However, associations between socioenvironmental risks and psychotic experiences mostly remained significant after covariate adjustment for genetic risk. CONCLUSION Genetic risk is correlated with socioenvironmental risk for schizophrenia during upbringing, but the associations between socioenvironmental risk and adolescent psychotic experiences appear, at present, to exist above and beyond this gene-environment correlation.
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Affiliation(s)
- J. B. Newbury
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - L. Arseneault
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - A. Caspi
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - T. E. Moffitt
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - C. L. Odgers
- Social Science Research Institute, Duke University, Durham, NC, USA
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA, USA
| | - D. W. Belsky
- Department of Epidemiology and Robert N Butler Aging Center, Columbia University, Mailman School of Public Health, NY, USA
| | - K. Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - B. Williams
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - A. P. Ambler
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - T. Matthews
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - H. L. Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Misra S, Etkins OS, Yang LH, Williams DR. Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans. Am J Public Health 2022; 112:624-632. [PMID: 35319958 PMCID: PMC8961835 DOI: 10.2105/ajph.2021.306631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).
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Affiliation(s)
- Supriya Misra
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Onisha S Etkins
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Lawrence H Yang
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - David R Williams
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:216-225. [PMID: 33896210 PMCID: PMC8935600 DOI: 10.1177/07067437211011852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. METHODS We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. RESULTS There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. CONCLUSIONS There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada.,Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tee H, Chevalier A, Webber M, Xanthopoulou P, Priebe S, Giacco D. Who wants more social contacts? A cross-sectional study of people with psychotic disorders in England. Schizophr Res 2022; 240:46-51. [PMID: 34923207 DOI: 10.1016/j.schres.2021.11.047] [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: 10/30/2020] [Revised: 10/02/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered.
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Affiliation(s)
- Helena Tee
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Penny Xanthopoulou
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter EX2 4TH, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7HL, United Kingdom.
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Giacco D, Kirkbride JB, Ermakova AO, Webber M, Xanthopoulou P, Priebe S. Neighbourhood characteristics and social isolation of people with psychosis: a multi-site cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1907-1915. [PMID: 34791516 PMCID: PMC9375739 DOI: 10.1007/s00127-021-02190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE People with psychosis are vulnerable to social isolation, which is associated with worse clinical outcomes. In general populations, people living in areas with higher population density have more social contacts, while those living in more socially deprived and fragmented areas are less satisfied with their relationships. We assessed whether and how neighbourhood factors are associated with social contacts and satisfaction with friendships for people with psychosis. METHODS We carried out a cross-sectional study including people with psychosis aged 18-65 years in urban and rural sites in England. Population density and social deprivation and fragmentation indexes were described within Lower Level Super Output Areas (LSOA). Their associations with participants' social contacts and satisfaction with friendships were tested with negative binomial and ordinal regression models, respectively. RESULTS We surveyed 511 participants with psychotic disorders. They had a median of two social contacts in the previous week (interquartile range [IQR] = 1-4), and rated satisfaction with friendships as 5 out of 7 (Manchester Short Assessment of Quality of Life; IQR = 4-6). Higher population density was associated with fewer social contacts (Z-standardised relative risk [RR] = 0.88; 95% CI = 0.79-0.99, p = 0.03), but not with satisfaction with friendships (RR = 1.08; 95% CI = 0.93-1.26, p = 0.31). No associations were found for social contacts or satisfaction with friendships with social deprivation or fragmentation indexes. CONCLUSIONS Clinicians in urban areas should be aware that their patients with psychosis are more socially isolated when more people live around them, and this could impact their clinical outcomes. These findings may inform housing programmes.
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Affiliation(s)
- Domenico Giacco
- Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, England.
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England.
- Coventry and Warwickshire Partnership NHS Trust, Coventry, England.
| | - James B Kirkbride
- Division of Psychiatry, University College London, London, W1T 7BN, England
| | - Anna O Ermakova
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, Silwood Park, Buckhurst Road, Ascot, Berks, SL5 7PY, England
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, Heslington, YO10 5DD, York, UK
| | - Penny Xanthopoulou
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, EX2 4TH, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England
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Ostinelli EG, D’Agostino A, Pesce L, Zangani C, Miragoli P, Durbano F, Biffi G, Mencacci C, Scarone S, Gambini O. Mental health services and the city: a neighbourhood-level epidemiological study. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Socioeconomic Deprivation and Dropout from Contemporary Psychological Intervention for Common Mental Disorders: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:490-505. [PMID: 34837573 PMCID: PMC9005422 DOI: 10.1007/s10488-021-01178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 10/29/2022]
Abstract
Dropout during psychological intervention is a significant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative synthesis and random effects meta-analysis of peer-reviewed English language journal articles published June 2010-June 2020 was conducted. Data sources included medline, PsycInfo, databases indexed by web of science, ProQuest social science database and sociology collection, and the Cochrane Library, supplemented by forward and backward citation searching. Five studies were eligible for inclusion (mean N = 170, 68% female, 60% White Caucasian, 32% dropout rate, predominantly cognitive behaviour therapy/cognitive processing therapy). Narrative synthesis indicated an overall non-significant effect of deprivation on dropout. Meta-analytic significance of controlled (k = 3) and uncontrolled (k = 4) effects depended on the measure of deprivation included for those studies using more than one measure (controlled OR 1.21-1.32, p = 0.019-0.172, uncontrolled OR 1.28-1.76, p = 0.024-0.423). The low number of included studies meant sub-group comparisons were limited, despite some tentative indications of potential differential effects. A comparator set of excluded studies showed similar uncertainty. There was limited evidence that did not overall suggest a clear significant effect of deprivation on dropout from contemporary individual CMD interventions. However, more contemporary research is needed, as effects may vary according to clinical and methodological factors, and for dropout versus non-initiation.
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Hüfner K, Caramazza F, Stawinoga AE, Pircher Nöckler ER, Fusar-Poli P, Bhandari SS, Basnyat B, Brodmann Maeder M, Strapazzon G, Tomazin I, Sperner-Unterweger B, Brugger H. Assessment of Psychotic Symptoms in Individuals Exposed to Very High or Extreme Altitude: A Field Study. High Alt Med Biol 2021; 22:369-378. [PMID: 34324390 PMCID: PMC8742264 DOI: 10.1089/ham.2020.0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hüfner, Katharina, Fabio Caramazza, Agnieszka E. Stawinoga, Evelyn R. Pircher Nöckler, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Barbara Sperner-Unterweger, and Hermann Brugger. Assessment of psychotic symptoms in individuals exposed to very high or extreme altitude: A field study. High Alt Med Biol. xx:xxx-xxx, 2021. Background: Symptoms of psychosis such as hallucinations can occur at high or extreme altitude and have been linked to accidents on the mountain. No data are available on how to assess such symptoms in the field and what their prevalence or predisposing factors might be. Methods: In this field study at Everest Base Camp (5,365 m) in Nepal, 99 participants of organized expeditions underwent 279 assessments: The High Altitude Psychosis Questionnaire (HAPSY-Q), the Prodromal Questionnaire, 16-items (PQ-16), and the Mini International Neuropsychiatric Interview (M.I.N.I., psychosis section) were collected together with further clinical data. Statistical analysis was done for each phase, that is, altitude range of the climb, and overall data. Results: One of 97 climbers fulfilled the M.I.N.I. diagnostic criteria for psychosis during one acclimatization climb. At least one endorsed item on the HAPSY-Q and the PQ-16, indicating the presence of symptoms of psychosis in the absence of a psychotic disorders, were identified in 10/97 (10.3%) and 18/87 (20.7%) participants respectively. The scores of the HAPSY-Q and the PQ-16 were correlated (r = 0.268, p < 0.001). Odds ratio analysis identified an increased risk for accidents in individuals with endorsed items on the HAPSY-Q. Conclusions: The diagnosis of high altitude psychosis is rare in climbers during organized expeditions. Nevertheless, subdiagnostic symptoms of psychosis occurred in a significant proportion of climbers. Future research is needed to validate these pilot findings.
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Affiliation(s)
- Katharina Hüfner
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Fabio Caramazza
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | | | - Evelyn R Pircher Nöckler
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Buddha Basnyat
- Mountain Medicine Society of Nepal, Kathmandu, Nepal.,Oxford University Clinical Research Unit, Patan Academy of Health Science, Nepal International, Kathmandu, Nepal
| | - Monika Brodmann Maeder
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Department of Emergency Medicine, University Hospital Bern and Bern University, Bern, Switzerland
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Iztok Tomazin
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Mountain Rescue Association of Slovenia, Kranj, Slovenia
| | - Barbara Sperner-Unterweger
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck Medical University, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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Pignon B, Eaton S, Schürhoff F, Szöke A, McGorry P, O'Donoghue B. Temporal variation in the incidence of treated psychotic disorders in young people. Schizophr Res 2021; 231:221-226. [PMID: 33895599 DOI: 10.1016/j.schres.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/05/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The incidence of psychotic disorders varies between geographical areas, however less is known about whether it varies over time in the same region. Analyzing this temporal variation of incidence could improve the allocation of healthcare resources and our understanding of the aetiology of psychotic disorders. This study aimed to determine whether there was a change in the incidence of psychotic disorders over a six-year period. METHODS Young people aged 15 to 24 presenting with a first episode of psychosis (FEP) attending an early intervention service in Melbourne between 2011 and 2016 were included. The population at-risk was determined from the two corresponding census periods and analyses were adjusted for age, sex and migrant status. RESULTS A total of 1217 young people presented with a FEP over the six-year period and the crude incidence rate in 2011 was 102.4 per 100,000 population at-risk, compared to 125.4 in 2016. There was an increase in the incidence by 33% in 2015 (aIRR = 1.33, 95% CI 1.09-1.63) and 28% in 2016 (aIRR = 1.28, 95% CI 1.05-1.56). When examined according to diagnostic groups, there was an increase in the incidence of substance-induced psychotic disorders among females in 2015 (aIRR = 4.62, 95% CI 1.02-20.8). DISCUSSION This study shows significant temporal variations in the incidence of treated psychotic disorders. These findings demonstrate that early intervention services should continually monitor incidence case numbers and funding should be provided accordingly, to ensure the required intensive and comprehensive treatments can be sustained.
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Affiliation(s)
- Baptiste Pignon
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Scott Eaton
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Franck Schürhoff
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Andrei Szöke
- Univ Paris-Est-Créteil (UPEC), AP-HP, Hôpitaux Universitaires "H.Mondor", DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Patrick McGorry
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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O'Donoghue B, Downey L, Eaton S, Mifsud N, Kirkbride JB, McGorry P. Risk of psychotic disorders in migrants to Australia. Psychol Med 2021; 51:1192-1200. [PMID: 31996272 DOI: 10.1017/s0033291719004100] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Certain migrant groups are at an increased risk of psychotic disorders compared to the native-born population; however, research to date has mainly been conducted in Europe. Less is known about whether migrants to other countries, with different histories and patterns of migration, such as Australia, are at an increased risk for developing a psychotic disorder. We tested this for first-generation migrants in Melbourne, Victoria. METHODS This study included all young people aged 15-24 years, residing in a geographically-defined catchment area of north western Melbourne who presented with a first episode of psychosis (FEP) to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 January 2011 and 31 December 2016. Data pertaining to the at-risk population were obtained from the Australian 2011 Census and incidence rate ratios were calculated and adjusted for age, sex and social deprivation. RESULTS In total, 1220 young people presented with an FEP during the 6-year study period, of whom 24.5% were first-generation migrants. We found an increased risk for developing psychotic disorder in migrants from the following regions: Central and West Africa (adjusted incidence rate ratio [aIRR] = 3.53, 95% CI 1.58-7.92), Southern and Eastern Africa (aIRR = 3.06, 95% CI 1.99-4.70) and North Africa (aIRR = 5.03, 95% CI 3.26-7.76). Migrants from maritime South East Asia (aIRR = 0.39, 95% CI 0.23-0.65), China (aIRR = 0.25, 95% CI 0.13-0.48) and Southern Asia (aIRR = 0.44, 95% CI 0.26-0.76) had a decreased risk for developing a psychotic disorder. CONCLUSION This clear health inequality needs to be addressed by sufficient funding and accessible mental health services for more vulnerable groups. Further research is needed to determine why migrants have an increased risk for developing psychotic disorders.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen Youth Health, Melbourne, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, England
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Karcher NR, Schiffman J, Barch DM. Environmental Risk Factors and Psychotic-like Experiences in Children Aged 9-10. J Am Acad Child Adolesc Psychiatry 2021; 60:490-500. [PMID: 32682894 PMCID: PMC7895444 DOI: 10.1016/j.jaac.2020.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/30/2020] [Accepted: 07/09/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Research implicates environmental risk factors, including correlates of urbanicity, deprivation, and environmental toxins, in psychotic-like experiences (PLEs). The current study examined associations between several types of environmental risk factors and PLEs in school-age children, whether these associations were specific to PLEs or generalized to other psychopathology, and examined possible neural mechanisms for significant associations. METHOD The current study used cross-sectional data from 10,328 children 9-10 years old from the Adolescent Brain Cognitive Development (ABCD) Study. Hierarchical linear models examined associations between PLEs and geocoded environmental risk factors and whether associations generalized to internalizing/externalizing symptoms. Mediation models examined evidence of structural magnetic resonance imaging abnormalities (eg, intracranial volume) potentially mediating associations between PLEs and environmental risk factors. RESULTS Specific types of environmental risk factors, namely, measures of urbanicity (eg, drug offense exposure, less perception of neighborhood safety), deprivation (eg, overall deprivation, poverty rate), and lead exposure risk, were associated with PLEs. These associations showed evidence of stronger associations with PLEs than internalizing/externalizing symptoms (especially overall deprivation, poverty, drug offense exposure, and lead exposure risk). There was evidence that brain volume mediated between 11% and 25% of associations of poverty, perception of neighborhood safety, and lead exposure risk with PLEs. CONCLUSION Although in the context of cross-sectional analyses, this evidence is consistent with neural measures partially mediating the association between PLEs and environmental exposures. This study also replicated and extended recent findings of associations between PLEs and environmental exposures, finding evidence for specific associations with correlates of urbanicity, deprivation, and lead exposure risk.
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Affiliation(s)
| | - Jason Schiffman
- University of Maryland, Baltimore County; University of California, Irvine
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Izquierdo A, Cabello M, Leal I, Ayora M, Rodriguez-Jimenez R, Ibáñez Á, Díaz-Marsá M, Bravo-Ortiz MF, Baca-García E, Madrigal JLM, Fares-Otero NE, Díaz-Caneja CM, Arango C, Ayuso Mateos JL. How does neighbourhood socio-economic status affect the interrelationships between functioning dimensions in first episode of psychosis? A network analysis approach. Health Place 2021; 69:102555. [PMID: 33744489 DOI: 10.1016/j.healthplace.2021.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
The links between psychosis and socio-economic disadvantage have been widely studied. No previous study has analysed the interrelationships and mutual influences between functioning dimensions in first episode of psychosis (FEP) according to their neighbourhood household income, using a multidimensional and transdiagnostic perspective. 170 patients and 129 controls, participants in an observational study (AGES-CM), comprised the study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas participants' postcodes were used to obtain the average household income for each neighbourhood, collected by the Spanish National Statistics Institute (INE). Network analyses were conducted with the aim of defining the interrelationships between the different dimensions of functioning according to the neighbourhood household income. Our results show that lower neighbourhood socioeconomic level is associated with lower functioning in patients with FEP. Moreover, our findings suggest that "household responsibilities" plays a central role in the disability of patients who live in low-income neighbourhoods, whereas "dealing with strangers" is the most important node in the network of patients who live in high-income neighbourhoods. These results could help to personalize treatments, by allowing the identification of potential functioning areas to be prioritized in the treatment of FEP according to the patient's neighbourhood characteristics.
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Affiliation(s)
- Ana Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Cabello
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Itziar Leal
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Miriam Ayora
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, CogPsy Group, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángela Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, CIBERSAM, School of Medicine, Universidad de Alcalá, Madrid, Spain
| | - Marina Díaz-Marsá
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Del Hospital Clínico San Carlos (IdISSC), CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - María-Fé Bravo-Ortiz
- Department of Psychiatry, Clinical Psychology and Mental Health, Hospital Universitario de La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Diaz, Hospital Universitario Rey Juan Carlos, Hospital General de Villalba, Hospital Universitario Infanta Elena, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Universidad Católica Del Maule, Talca, Chile
| | - José L M Madrigal
- Department of Pharmacology and Toxicology (FarmaMED), School of Medicine, Universidad Complutense de Madrid, CIBERSAM, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), IUIN-UCM, Madrid, Spain
| | - Natalia E Fares-Otero
- Department of Psychiatry, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, CogPsy Group, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jose Luis Ayuso Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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White R, Haddock G, Campodonico C, Haarmans M, Varese F. The influence of romantic relationships on mental wellbeing for people who experience psychosis: A systematic review. Clin Psychol Rev 2021; 86:102022. [PMID: 33819779 DOI: 10.1016/j.cpr.2021.102022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Whilst it is generally accepted that supportive relationships facilitate recovery from psychosis, much less is known about the role of romantic relationships in people with psychosis. This review aimed to synthesise quantitative literature regarding the impact of romantic relationships on the mental health and general wellbeing of people who experience psychosis. METHOD A systematic review of electronic databases (PsychINFO, PubMed, Web of Science) was carried out using search terms relating to psychosis and romantic relationships. Papers were selected for inclusion by independent reviewers. Quality assessment was completed and a narrative synthesis produced. RESULTS Fifty-eight studies reporting the association between romantic relationships and psychotic symptoms, depression, posttraumatic stress disorder, suicidality, quality of life, satisfaction with life and self-esteem were included. Results were mixed but indicated having a romantic partner may be associated with reduced positive and negative symptoms of psychosis, but increased depressive symptoms. Tentative explanations for these findings, such as functioning prior to onset of psychosis, social support and relationship quality are explored. CONCLUSION Findings highlight the importance of this often-overlooked area in clinical practice. Studies with robust design, which specifically aim to understand the relationship between romantic relationships and wellbeing for people who experience psychosis are needed.
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Affiliation(s)
- Rebecca White
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
| | - Carolina Campodonico
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Maria Haarmans
- Cathie Marsh Institute, Centre on Dynamics of Ethnicity (CoDE), Department of Sociology, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Manchester, UK
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Jones N, Kamens S, Oluwoye O, Mascayano F, Perry C, Manseau M, Compton MT. Structural Disadvantage and Culture, Race, and Ethnicity in Early Psychosis Services: International Provider Survey. Psychiatr Serv 2021; 72:254-263. [PMID: 33430649 PMCID: PMC9119303 DOI: 10.1176/appi.ps.202000211] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns. METHODS An online survey of specialized EIP providers was disseminated in the United Kingdom, United States, Canada, Australia, and Chile. A total of 164 providers, representing 110 unique sites, completed the survey. Closed-ended questions gathered demographic and program data, including information on formal assessment of trauma or adversity, integration of trauma-informed care, integration of formal cultural assessment tools, training focused on culture, programmatic changes to address culture-related issues, and consultation with cultural insiders. Open-ended questions addressed the demographic mix of the program's client population; the perceived role and influence of trauma, structural disadvantage, and cultural differences; and concerns and needs related to these topics. Frequencies were examined for closed-ended items; open-ended responses were systematically coded. RESULTS Overall, survey findings suggested low levels of implementation of a variety of assessment and support practices related to cultural diversity in EIP programs. Coding of open-ended responses revealed numerous concerns regarding the impacts of disadvantage and cultural difference on clients and perceived gaps in policy and implementation. CONCLUSIONS An expansion of research and service development aimed at better meeting the disadvantage- and culture-related needs of young people with early psychosis and their families should be a priority for the field.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Sarah Kamens
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Oladunni Oluwoye
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Franco Mascayano
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Chris Perry
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Marc Manseau
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
| | - Michael T Compton
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Department of Psychology, State University of New York Old Westbury, Old Westbury (Kamens); Department of Medical Education and Clinical Sciences, Washington State University, Pullman (Oluwoye); Mailman School of Public Health, Columbia University, New York City (Mascayano); Path Program, Department of Psychiatry, University of California, San Francisco, San Francisco (Perry); Department of Psychiatry, New York University School of Medicine, New York City (Manseau); Department of Psychiatry, Columbia University, New York City (Compton)
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Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood. Dev Psychopathol 2020; 32:465-479. [PMID: 31014409 DOI: 10.1017/s095457941900021x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research showing that risk for schizophrenia, bipolar disorder with psychosis, and other psychosis-spectrum diagnoses in adulthood is multidetermined has underscored the necessity of studying the additive and interactive factors in childhood that precede and predict future disorders. In this study, risk for the development of psychosis-spectrum disorders was examined in a 2-generation, 30-year prospective longitudinal study of 3,905 urban families against a sociocultural backdrop of changing economic and social conditions. Peer nominations of aggression, withdrawal, and likeability and national census information on neighborhood-level socioeconomic disadvantage in childhood, as well as changes in neighborhood socioeconomic conditions over the lifespan, were examined as predictors of diagnoses of schizophrenia, bipolar disorder, and other psychosis-spectrum disorders in adulthood relative to developing only nonpsychotic disorders or no psychiatric disorders. Individuals who were both highly aggressive and highly withdrawn were at greater risk for other psychosis-spectrum diagnoses when they experienced greater neighborhood disadvantage in childhood or worsening neighborhood conditions over maturation. Males who were highly aggressive but low on withdrawal were at greater risk for schizophrenia diagnoses. Childhood neighborhood disadvantage predicted both schizophrenia and bipolar diagnoses, regardless of childhood social behavior. Results provided strong support for multiple-domain models of psychopathology, and suggest that universal preventive interventions and social policies aimed at improving neighborhood conditions may be particularly important for decreasing the prevalence of psychosis-spectrum diagnoses in the future.
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Chung RYN, Marmot M, Mak JKL, Gordon D, Chan D, Chung GKK, Wong H, Wong SYS. Deprivation is associated with anxiety and stress. A population-based longitudinal household survey among Chinese adults in Hong Kong. J Epidemiol Community Health 2020; 75:jech-2020-214728. [PMID: 33099506 DOI: 10.1136/jech-2020-214728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/06/2020] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mental illness is a major disease burden in the world and disproportionately affects the socially disadvantaged, but studies on the longitudinal association of poverty with anxiety and stress are rare, especially in Asia. Using data from Hong Kong, we aimed to (1) assess the cross-sectional association of poverty with anxiety and stress at baseline, and (2) to examine whether baseline poverty and change in poverty status over time are associated with a subsequent change in anxiety and stress. METHODS Data were obtained from two waves of a territory-wide longitudinal survey in Hong Kong, with sample sizes of n=1970 and n=1224 for baseline and follow-up, respectively. Poverty was measured with a Deprivation Index and income-poverty. Anxiety and stress symptoms were assessed using Chinese Depression, Anxiety and Stress Scale-21 Items. We conducted cross-sectional and longitudinal analyses on the association of poverty with anxiety and stress. OUTCOMES Deprivation, but not income-poverty, was significantly associated with both outcomes at baseline. Increased deprivation over time was associated with greater score and increased risk of anxiety and stress. Persistent deprivation over time was associated with greater anxiety and stress, and increased risk of incident anxiety. INTERPRETATION Deprivation could have significant independent effects on anxiety and stress, even after adjusting for the effects of income-poverty. Greater attention should be paid to deprivation in policymaking to tackle the inequalities of mental health problems, especially since stress and anxiety are precursors to more severe forms of mental illness and other comorbidities.
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Affiliation(s)
- Roger Yat-Nork Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Jonathan Ka-Long Mak
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Gordon
- University of Bristol School for Policy Studies, Bristol, UK
| | - Dicken Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Gary Ka-Ki Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
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Petrović-van der Deen FS, Cunningham R, Manuel J, Gibb S, Porter RJ, Pitama S, Crowe M, Crengle S, Lacey C. Exploring indigenous ethnic inequities in first episode psychosis in New Zealand - A national cohort study. Schizophr Res 2020; 223:311-318. [PMID: 32948382 DOI: 10.1016/j.schres.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION First episode psychosis (FEP) disproportionately affects rangatahi (young) Māori, the Indigenous people of New Zealand, but little is known about factors contributing to this inequity. This study describes a cohort of rangatahi Māori and young non-Māori with FEP, and explores ethnic differences in incidence rates, and the contribution of deprivation, urbanicity and substance use. METHODS Māori and young non-Māori, aged 13-25 at the time of the first recorded psychosis-related diagnoses, were identified from within Statistics NZ's Integrated Data Infrastructure (IDI), between 2009 and 2012. To estimate age-standardised FEP incidence rates, the population-at-risk was estimated using IDI-based usual resident population estimates for 2009-2012, stratified by ethnicity and single year of age. Poisson regression models were used to estimate ethnic differences in FEP incidence adjusted for age, gender, deprivation, and urban-rural area classification. RESULTS A total of 2412 young people with FEP (40% Māori, 60% non-Māori) were identified. Māori were younger, and more likely to live in deprived and rural communities and be diagnosed with schizophrenia. Substance induced psychosis was uncommon. The unadjusted age-standardised FEP incidence rate ratio was 2.48 (95% CI: 2.29-2.69) for rangatahi Māori compared with young non-Māori. While adjusting for age, sex, deprivation and urban rural area classification reduced ethnic differences in incidence, rangatahi Māori were still more than twice as likely to have been diagnosed with FEP compared to young non-Māori. CONCLUSIONS This study confirms previous findings of elevated rates of psychosis among rangatahi Māori. The difference in rates between Māori and non-Māori were attenuated but remained after adjustment for deprivation and urbanicity.
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Affiliation(s)
- Frederieke S Petrović-van der Deen
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand; Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Jenni Manuel
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sheree Gibb
- Department of Public Health, University of Otago Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, PO Box 56, Dunedin 9054, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Department of Psychological Medicine, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand.
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Rotenberg M, Anderson KK, McKenzie K. Social capital and psychosis: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2020; 55:659-671. [PMID: 31802174 DOI: 10.1007/s00127-019-01812-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Social capital has been studied as a risk factor for psychotic disorders. The purpose of this scoping review was to scope the literature and synthesize findings on the association between social capital and psychosis. METHODS Three electronic databases were searched to identify relevant studies. Studies were included if they examined the association between social capital and either diagnosed psychotic disorders or symptoms of psychosis. RESULTS Of 191 studies reviewed, 12 met the inclusion criteria. Ten studies measured social capital at the ecological level. Seven studies focused on risk of psychotic disorders or symptoms of psychosis, three studies focused on course of psychotic illness, and two studies focused on both risk and course of illness. A variety of social capital measures were used including scales, surveys, and census-based measures. The association between social capital and both the incidence of psychosis and patterns of service use varied based on measures used and study population. There was no association between social capital and recovery or duration of untreated illness. CONCLUSIONS Prior literature has examined the impact of social capital on the incidence of psychotic disorders, as well as symptoms and course of illness. Based on the scant literature to date, it is difficult to make firm conclusions regarding the role of social capital in psychotic disorders. Heterogeneous measures of social capital make comparisons between studies challenging. Further specificity in measuring and defining dimensions of social capital is required for meaningful study of social capital and its association with psychotic disorders.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
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Lee SC, DelPozo-Banos M, Lloyd K, Jones I, Walters JTR, Owen MJ, O'Donovan M, John A. Area deprivation, urbanicity, severe mental illness and social drift - A population-based linkage study using routinely collected primary and secondary care data. Schizophr Res 2020; 220:130-140. [PMID: 32249120 DOI: 10.1016/j.schres.2020.03.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 01/20/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
We investigated whether associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs, including schizophrenia and bipolar disorder) is accounted for by social drift or social causation. We extracted primary and secondary care electronic health records from 2004 to 2015 from a population of 3.9 million. We identified prevalent and incident individuals with SMIs and their level of deprivation and urbanicity using the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator. The presence of social drift was determined by whether odds ratios (ORs) from logistic regression is greater than the incidence rate ratios (IRRs) from Poisson regression. Additionally, we performed longitudinal analysis to measure the proportion of change in deprivation level and rural/urban residence 10 years after an incident diagnosis of SMI and compared it to the general population using standardised rate ratios (SRRs). Prevalence and incidence of SMIs were significantly associated with deprivation and urbanicity (all ORs and IRRs significantly >1). ORs and IRRs were similar across all conditions and cohorts (ranging from 1.1 to 1.4). Results from the longitudinal analysis showed individuals with SMIs are more likely to move compared to the general population. However, they did not preferentially move to more deprived or urban areas. There was little evidence of downward social drift over a 10-year period. These findings have implications for the allocation of resources, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.
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Affiliation(s)
- Sze Chim Lee
- HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Keith Lloyd
- HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - James T R Walters
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael O'Donovan
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Ann John
- HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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49
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Solmi F, Lewis G, Zammit S, Kirkbride JB. Neighborhood Characteristics at Birth and Positive and Negative Psychotic Symptoms in Adolescence: Findings From the ALSPAC Birth Cohort. Schizophr Bull 2020; 46:581-591. [PMID: 31167032 PMCID: PMC7147568 DOI: 10.1093/schbul/sbz049] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Urban birth is associated with risk of non-affective psychoses, but the association with subclinical positive and negative symptoms is less clear, despite emerging evidence. Further the extent to which these findings are confounded by polygenic risk scores (PRS) for schizophrenia is also unknown. METHODS Using data from the Avon Longitudinal Study of Parents and Children, linked to census geographical indicators, we examined whether various indices of urbanicity at birth were associated with negative and positive psychotic symptoms at age 16 and 18 years, respectively. We used logistic regression models, controlling for child's ethnicity, maternal age, education, marital status, social class, depressive symptoms, other neighborhood exposures, and, in a subsample of children of white ethnicity (N = 10 283), PRS for schizophrenia. RESULTS Amongst 11 879 adolescents, those born in the most densely populated tertile had greater odds of reporting positive psychotic experiences, after multivariable adjustment (odds ratio [OR]: 1.57, 95% confidence intervals (CIs): 1.14-2.17). Adolescents born in the most socially fragmented neighborhoods had greater odds of negative symptoms, after multivariable adjustment (OR: 1.43, 95% CI: 1.06-1.85). Although we found that greater schizophrenia PRS were associated with an increased risk of being born in more deprived and fragmented (bot not more densely populated areas), these associations were not confounded by PRS. INTERPRETATION Birth into more densely populated and socially fragmented environments increased risk of positive and negative psychotic phenomena in adolescence, respectively, suggesting that different forms of neighborhood social adversity may impinge on different psychopathophysiologies associated with the clinical expression of psychosis.
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, UCL, London, UK,To whom correspondence should be addressed; 6th Floor, Maple House 149 Tottenham Court Road, London W1T 7NF, UK; tel: +44(0)20-7679-9643; e-mail:
| | | | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK,Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
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50
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Veru-Lesmes F, Rho A, Joober R, Iyer S, Malla A. Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk. Schizophr Res 2020; 216:111-117. [PMID: 31899097 DOI: 10.1016/j.schres.2019.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/16/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The influence of socioeconomic deprivation on the cardiovascular health of patients with psychosis-spectrum disorders (PSD) has not been investigated despite the growing recognition of social factors as determinants of health, and the disproportionate rates of cardiovascular mortality observed in PSD. Discordant results have been documented when studying dyslipidemia -a core cardiovascular risk factor- in first-episode psychosis (FEP), before chronic exposure to antipsychotic medications. The objective of the present study is to determine the extent to which socioeconomic deprivation affects blood lipids in patients with FEP, and examine its implications for cardiovascular risk in PSD. METHODS Linear regression models, controlling for age, sex, exposure to pharmacotherapy, and physical anergia, were used to test the association between area-based measures of material and social deprivation and blood lipid levels in a sample of FEP patients (n = 208). RESULTS Social, but not material deprivation, was associated with lower levels of total and HDL cholesterol. This effect was statistically significant in patients with affective psychoses, but not in schizophrenia-spectrum disorders. CONCLUSIONS Contrary to other reports from the literature, the relationship between socioeconomic disadvantage and blood lipid levels was contingent on the social rather than the material aspects of deprivation. Furthermore, this association also depended on the main diagnostic category of psychosis, suggesting a complex interaction between the environment, psychopathology, and physical health. Future studies exploring health issues in psychosis might benefit from taking these associations into consideration. A better understanding of the biology of blood lipids in this context is necessary.
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Affiliation(s)
- Franz Veru-Lesmes
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aldanie Rho
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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