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Chew QH, Sim K. Bane or boon regarding urbanicity and psychotic spectrum disorders: a scoping review of current evidence. Curr Opin Psychiatry 2024; 37:212-224. [PMID: 38415716 DOI: 10.1097/yco.0000000000000928] [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] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide an update on the association between urbanization and psychotic spectrum disorders, focusing on specific aspects of the urban environment that could be a bane or boon for the risk of psychosis. RECENT FINDINGS Majority of the included studies support previous evidence suggesting that urbanization is linked to a higher risk of psychotic experiences and psychotic spectrum disorders. A small minority, however, have also found specific factors in the urban environment that could give rise to positive outcomes, such as better social functioning and lower mortality rates in psychotic spectrum disorders, or mitigate the risks associated with urbanization. The perception of the urban environment was also an important factor that increased or mitigated stress levels in patients with psychosis, which in turn affected their susceptibility to psychotic symptoms. SUMMARY Specific aspects of the urban environment such as the availability and density of greenspaces are crucial for mitigating the effect of urbanization on risk of psychotic spectrum disorders, and should be incorporated into urban planning. At the same time, there is a need to further explore how modifiable risk factors of the urban environment such as air and noise pollution can be minimized to allow for more liveable cities in the context of psychotic spectrum conditions.
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Affiliation(s)
| | - Kang Sim
- West Region, Institute of Mental Health
- Yong Yoo Lin School of Medicine, National University of Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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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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Wang Y, Ding R, Luo Y, He P, Zheng X. Does college education reduce the risk of schizophrenia? Evidence from a college enrollment expansion policy in China. Schizophr Res 2024; 264:519-525. [PMID: 38295748 DOI: 10.1016/j.schres.2024.01.034] [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: 08/29/2022] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Schizophrenia occurs worldwide, and the health, and economic burden is substantial. As one of the common proxies of socioeconomic status (SES), education was reported to be associated with the risk of developing schizophrenia. However, there is no causal evidence about the relationship. This paper explores the health benefits of college education for schizophrenia. METHOD Based on exogenous variation in college enrollment across regions and cohorts induced by college enrollment expansion policy, we use instrument variable (IV) estimate strategy to estimate impacts of college education on the risk of schizophrenia with the data from Second National Sample Survey on Disability. RESULTS We find that college education reduces the risk of developing schizophrenia by 4.2 percentage points. Some further analyses suggest the causal protective effect is only found among men, rural, and low-income individuals. CONCLUSIONS These findings provide new evidence for the causal relationship between college education and schizophrenia, and add to the literature on the health benefits of education.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China; China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
| | - Ruoxi Ding
- Peking University Sixth Hospital, 38 Huayuan North Road, Haidian District, Beijing 100191, China.
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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Naughton S, Brady A, Geary E, Counihan E, Clarke M. An exploratory study of psychosis risk factors in individuals who are referred but do not meet criteria for an early intervention in psychosis service. BJPsych Open 2024; 10:e21. [PMID: 38179675 PMCID: PMC10790220 DOI: 10.1192/bjo.2023.640] [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: 10/20/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The 'at-risk mental state' (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk. AIMS To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria. METHOD A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period. RESULTS From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort. CONCLUSIONS This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.
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Affiliation(s)
- Sean Naughton
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland; and School of Medicine, University College Dublin, Ireland
| | - Aoife Brady
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Eoin Geary
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Eimear Counihan
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland; and School of Medicine, University College Dublin, Ireland
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Pignon B, Szöke A, Ku B, Melchior M, Schürhoff F. Urbanicity and psychotic disorders: Facts and hypotheses. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:122-138. [PMID: 37994794 PMCID: PMC10986450 DOI: 10.1080/19585969.2023.2272824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
In the present qualitative literature review, we summarise data on psychotic disorders and urbanicity, focusing particularly on recent findings. Longitudinal studies of the impact of urbanicity on the risk for psychotic disorders have consistently shown a significant association, with a relative risk between 2 and 2.5. However, most of the original studies were conducted in Western Europe, and no incidence studies were conducted in low- and middle-income countries. European studies suggest that neighbourhood-level social fragmentation and social capital may partly explain this association. Exposure to air pollution (positive association) and green space (negative association) may also be part of the explanation, but to date, available data do not make it possible to conclude if they act independently from urbanicity, or as part of the effect of urbanicity on psychotic disorders. Finally, several studies have consistently shown significant associations between the polygenic risk score for schizophrenia and urbanicity, with several possible explanations (pleiotropic effects, results of prodromic symptoms, or selection/intergenerational hypothesis). Thus, more studies are needed to understand the factors that explain the association between urbanicity and the risk of psychotic disorders. Further studies should account for the interdependence and/or interactions of different psychosocial and physical exposures (as well as gene-environment interactions), and explore this association in low- and middle-income countries.
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Affiliation(s)
- Baptiste Pignon
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Andrei Szöke
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Benson Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d‘Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Franck Schürhoff
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Druss BG, Gülöksüz S, Mathalon DH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Carrión RE. Associations Between Childhood Area-Level Social Fragmentation, Maladaptation to School, and Social Functioning Among Healthy Youth and Those at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:1437-1446. [PMID: 37358832 PMCID: PMC10686327 DOI: 10.1093/schbul/sbad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although studies have identified social fragmentation as an important risk factor for schizophrenia and other psychotic disorders, it is unknown whether it may impact social functioning. This study investigates whether social fragmentation during childhood predicts maladaptation to school as well as social functioning during childhood and adulthood. STUDY DESIGN Data were collected from the North American Prodrome Longitudinal Study. Participants included adults at clinical high risk for psychosis (CHR-P) and healthy comparisons (HC). Maladaptation to school and social functioning during childhood were assessed retrospectively and social functioning in adulthood was assessed at baseline. STUDY RESULTS Greater social fragmentation during childhood was associated with greater maladaptation to school (adjusted β = 0.21; 95% CI: 0.02 to 0.40). Social fragmentation was not associated with social functioning during childhood (unadjusted β = -0.08; 95% CI: -0.31 to 0.15). However, greater social fragmentation during childhood predicted poorer social functioning in adulthood (adjusted β = -0.43; 95% CI: -0.79 to -0.07). Maladaptation to school mediated 15.7% of the association between social fragmentation and social functioning. The association between social fragmentation and social functioning was stronger among adults at CHR-P compared to HC (adjusted β = -0.42; 95% CI: -0.82 to -0.02). CONCLUSIONS This study finds that social fragmentation during childhood is associated with greater maladaptation to school during childhood, which in turn predicts poorer social functioning in adulthood. Further research is needed to disentangle aspects of social fragmentation that may contribute to social deficits, which would have implications for the development of effective interventions at the individual and community levels.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sinan Gülöksüz
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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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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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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Jacinto RP, Ding T, Stafford J, Baio G, Kirkbride JB. The incidence of psychotic disorders in the Republic of Ireland: a systematic review. Ir J Psychol Med 2023:1-13. [PMID: 37522189 DOI: 10.1017/ipm.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Despite a substantial epidemiological literature on the incidence of psychotic disorders in Ireland, no systematic review has previously been undertaken. Such evidence can help inform understanding of need for psychosis care. METHODS We conducted a prospectively registered systematic review (PROSPERO: CRD42021245891) following PRISMA guidelines. We searched four databases (Medline, PsycInfo, Web of Science, Embase) for papers containing incidence data on non-organic psychotic disorders, in people 16-64 years, published between 1950 and 2021 in the general adult population. We conducted duplicate screening, risk of bias assessments, and extracted data to a standardised template. We undertook a narrative synthesis for each major diagnostic outcome. Random effects meta-analyses were conducted for comparisons with ≥5 incidence rates. RESULTS Our search yielded 1975 non-duplicate citations, of which 23 met inclusion criteria, containing incidence data ascertained between 1974 and 2016 (median study quality: 5/8; interquartile range: 4-6). Incidence of all psychotic disorders (N = 4 studies) varied from 22.0 (95%CI: 17.3-28.0) in Dublin to 34.1 per 100,000 person-years (95%CI: 31.0-37.5) in Cavan and Monaghan. The pooled incidence of schizophrenia (N = 6 studies, N = 8 settings) was 20.0 per 100,000 person-years, though with imprecision around this estimate (95%CI: 10.6-37.5; I2: 97.6%). Higher rates of most outcomes were observed in men. There was consistent evidence of raised rates in more deprived and fragmented social environments, but no clear pattern by rural-urban status. CONCLUSIONS Patterns of incidence of psychotic disorders in Ireland are broadly consistent with the wider literature from the Global North. Findings could help identify populations at higher risk of psychosis in Ireland.
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Affiliation(s)
| | - T Ding
- Department of Statistical Sciences, UCL, London, UK
| | - J Stafford
- Division of Psychiatry, UCL, London, UK
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - G Baio
- Department of Statistical Sciences, UCL, London, UK
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10
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Ergül C, Drukker M, Binbay T, Kırlı U, Elbi H, Alptekin K, van Os J. A 6-year follow-up study in a community-based population: Is neighbourhood-level social capital associated with the risk of emergence and persistence of psychotic experiences and transition to psychotic disorder? Psychol Med 2023; 53:3974-3986. [PMID: 35301975 PMCID: PMC10317792 DOI: 10.1017/s0033291722000642] [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: 08/09/2021] [Revised: 01/30/2022] [Accepted: 02/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association between neighbourhood-level social capital and clinical transitions within the spectrum of psychosis. METHODS In total, 2175 participants, representative of a community-based population, were assessed twice (6 years apart) to determine their position within an extended psychosis spectrum: no symptoms, subclinical psychotic experiences (PE), clinical PE, PD. A variable representing change between baseline (T1) and follow-up (T2) assessment was constructed. Four dimensions of social capital (informal social control, social disorganisation, social cohesion and trust, cognitive social capital) were assessed at baseline in an independent sample, and the measures were aggregated to the neighbourhood level. Associations between the variable representing psychosis spectrum change from T1 to T2 and the social capital variables were investigated. RESULTS Lower levels of neighbourhood-level social disorganisation, meaning higher levels of social capital, reduced the risk of clinical PE onset (OR 0.300; z = -2.75; p = 0.006), persistence of clinical PE (OR 0.314; z = -2.36; p = 0.018) and also the transition to PD (OR 0.136; z = -2.12; p = 0.034). The other social capital variables were not associated with changes from T1 to T2. CONCLUSIONS Neighbourhood-level social disorganisation may be associated with the risk of psychosis expression. Whilst replication of this finding is required, it may point to level of social disorganisation as a public health target moderating population psychosis risk.
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Affiliation(s)
- Ceylan Ergül
- Department of Psychiatry, Faculty of Medicine, Üsküdar University, Istanbul, Turkey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Umut Kırlı
- Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Ege University, Izmir, Turkey
| | - Hayriye Elbi
- Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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11
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Belvederi Murri M, Ferrara M, Imbesi M, Leuci E, Marchi M, Musella V, Natali A, Neri A, Ragni S, Saponaro A, Tarricone I, Tullini A, Starace F. A public early intervention approach to first-episode psychosis: Treated incidence over 7 years in the Emilia-Romagna region. Early Interv Psychiatry 2023. [PMID: 37221039 DOI: 10.1111/eip.13437] [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: 11/18/2022] [Revised: 03/28/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
AIM To estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. METHODS We computed the raw treated incidence in 2013-2019, based on FEP users aged 18-35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. RESULTS Thousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39-43.86; Imola: 3.07; 95% CrI: 1.61-4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = -0.09, p < .001), duration of untreated psychosis (R = -0.12, p < .001) and referral type. CONCLUSIONS The Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Massimiliano Imbesi
- Department of Mental Health and Substance Abuse, AUSL Piacenza, Piacenza, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, AUSL Parma, Parma, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Musella
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
| | - Alba Natali
- Department of Mental Health and Pathological Addiction, AUSL Imola, Imola, Italy
| | - Anastasia Neri
- Department of Mental Health and Pathological Addiction, AUSL Ravenna, Ravenna, Italy
| | - Sabrina Ragni
- Department of Mental Health and Pathological Addiction, AUSL Cesena, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Bologna, Italy
| | - Andrea Tullini
- Department of Mental Health and Pathological Addiction, AUSL Rimini, Rimini, Italy
| | - Fabrizio Starace
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL, Modena, Italy
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12
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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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13
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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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14
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O'Donoghue B, Lyne J, Roche E, Mifsud N, Renwick L, Behan C, Clarke M. Risk of first-episode psychosis in migrants to the Republic of Ireland. Psychol Med 2023; 53:468-475. [PMID: 34030746 DOI: 10.1017/s003329172100177x] [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: 11/07/2022]
Abstract
BACKGROUND Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. METHODS We included all presentations of first-episode psychosis over 8.5 years to the DETECT Early Intervention for psychosis service in the Republic of Ireland (573 individuals aged 18-65, of whom 22% were first-generation migrants). Psychotic disorder diagnosis relied on SCID. The at-risk population was calculated using census data, and negative binomial regression was used to estimate incidence rate ratios. RESULTS The annual crude incidence rate for a first-episode psychotic disorder in the total cohort was 25.62 per 100000 population at risk. Migrants from Africa had a nearly twofold increased risk for developing a psychotic disorder compared to those born in the Republic of Ireland (IRR = 1.83, 95% CI 1.11-3.02, p = 0.02). In contrast, migrants from certain Asian countries had a reduced risk, specifically those from China, India, Philippines, Pakistan, Malaysia, Bangladesh and Hong Kong (aIRR = 0.36, 95% CI 0.16-0.81, p = 0.01). CONCLUSIONS Further research into the reasons for this inflated risk in specific migrant groups could produce insights into the aetiology of psychotic disorders. This information should also be used, alongside other data on environmental risk factors that can be determined from census data, to predict the incidence of psychotic disorders and thereby resource services appropriately.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John Lyne
- Wicklow Mental Health Services, Newcastle Hospital, Greystones, Co Wicklow, Ireland
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Eric Roche
- Cluain Mhuire Mental Health Services, Newtownpark Avenue, Blackrock, Co Dublin, Ireland
| | - Nathan Mifsud
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Laoise Renwick
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England
| | - Caragh Behan
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention for Psychosis Service, Blackrock, Co Dublin, Ireland
- Department of Psychiatry, University College Dublin, Dublin, Ireland
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15
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Valladares A, Bornstein L, Botero N, Gold I, Sayanvala F, Weinstock D. From scary places to therapeutic landscapes: Voices from the community of people living with schizophrenia. Health Place 2022; 78:102903. [PMID: 36174464 DOI: 10.1016/j.healthplace.2022.102903] [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: 05/23/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.
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Affiliation(s)
| | | | - Nicolás Botero
- McGill University, Department of Cognitive Science, Canada
| | - Ian Gold
- McGill University, Department of Philosophy, Canada
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16
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Millman ZB, West ML, Thibeau H, Sanders AS, Guyer M, Keshavan M, Lilly M, Friedman-Yakoobian M, Woodberry KA, Johnson KA, Kline ER. Changes in community providers' screening behaviours, referral practices, and clinical confidence following participation in an early psychosis educational campaign. Early Interv Psychiatry 2022; 16:744-751. [PMID: 34532946 PMCID: PMC10591393 DOI: 10.1111/eip.13215] [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: 02/17/2021] [Revised: 06/07/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Successful delivery of care to individuals with early psychosis depends on the ability of community providers to identify and refer appropriate candidates for services. Although specialty centres commonly rely upon education and outreach campaigns to building bridges with community providers, few studies have examined the effectiveness of these campaigns or the mechanisms by which they may achieve their intended effects. METHODS We surveyed community clinicians (N = 39) about their screening behaviours, referral practices, and confidence in managing early psychosis just before and 3-6 months after attending an educational event designed to promote recognition and quality treatment of early psychosis. RESULTS Three to six months following attendance, providers reported screening a greater proportion of clients for early psychosis, referring a greater number of clients to specialty services, and feeling more confident in their ability to respond to clients with early psychosis. Increases in confidence following attendance were associated with corresponding increases in screening behaviour. CONCLUSIONS The results suggest that outreach campaigns designed to enhance community providers' knowledge about early psychosis assessment and resources may be effective in promoting screening, referrals, and confidence in managing psychosis. Gains in provider confidence may contribute to increases in screening. Given the lack of control group and relatively short follow-up period, more research is needed to determine the effects of early psychosis educational events and the mechanisms by which they may promote successful treatment delivery for young people in need.
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Affiliation(s)
- Zachary B. Millman
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle L. West
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- University of Colorado, Aurora, Colorado, USA
| | - Heather Thibeau
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - A. Simone Sanders
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Margaret Guyer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Megan Lilly
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michelle Friedman-Yakoobian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kristen A. Woodberry
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Psychiatric Research, Maine Medical Center, Portland, Maine, USA
- Department of Psychiatry, Tufts School of Medicine, Boston, Massachusetts, USA
| | - Kelsey A. Johnson
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily R. Kline
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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17
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Oh H, Nagendra A, Besecker M, Smith L, Koyanagi A, Wang JSH. Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020. Early Interv Psychiatry 2022; 16:770-781. [PMID: 34469041 DOI: 10.1111/eip.13221] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/15/2021] [Indexed: 01/14/2023]
Abstract
AIM Socioeconomic status (SES) is linked to psychosis, and much can be learned by examining how various indicators of SES-specifically economic strain and intergenerational transfer of resources-are related to sub-threshold psychotic experiences among college students. METHODS Using data from the Healthy Minds Survey (September 2020-December 2020), we used multivariable logistic regression models to examine the associations between five SES indicators and 12-month psychotic experiences, adjusting for age, gender and race/ethnicity. We also examined the count of predictors and psychotic experiences. RESULTS Each indicator of economic strain was associated with greater odds of psychotic experiences. In particular, increasing levels of financial stress (current, childhood and pandemic-related) were associated with greater odds of psychotic experiences in a dose-response fashion. Food insecurity was associated with double the odds of psychotic experiences. In terms of intergenerational transfer of resources, having either one or no parents who attended college was associated with significantly greater odds of having psychotic experiences, when compared with having both parents who attended college. Examining all predictors in the same model, only childhood and current financial stress and food insecurity were significantly associated with psychotic experiences. The count of predictors was significantly associated with greater odds of having psychotic experiences in a dose-dependent fashion. CONCLUSIONS Among college students, economic strain and intergenerational transfer of resources were associated with recent psychotic experiences, highlighting the importance of economic interventions targeting young adults to influence risk for psychosis.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Arundati Nagendra
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Julia Shu-Huah Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam Road, Hong Kong
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18
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González-Valderrama A, Jongsma HE, Mena C, Castañeda CP, Nachar R, Undurraga J, Crossley N, Aceituno D, Iruretagoyena B, Gallardo C, Mondaca P, Monje M, Irarrazaval M, Zavala C, Valmaggia L, Kirkbride JB. The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases. Psychol Med 2022; 52:914-923. [PMID: 32758314 PMCID: PMC9005445 DOI: 10.1017/s0033291720002664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. METHODS We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. RESULTS We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. CONCLUSION Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
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Affiliation(s)
- Alfonso González-Valderrama
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Hannah E. Jongsma
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Cristián Mena
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Carmen Paz Castañeda
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Rubén Nachar
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- School of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Juan Undurraga
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Nicolás Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Department of Psychosis Studies, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - David Aceituno
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
- Department of Health Service and Population Research, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - Barbara Iruretagoyena
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago Metropolitan Region, Chile
| | - Carlos Gallardo
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Pilar Mondaca
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Matías Monje
- Early Intervention Program, Instituto Psiquiátrico Dr J Horwitz Barak, Santiago, Chile
| | - Matías Irarrazaval
- Department of Mental Health, Ministry of Health, Santiago, Chile
- Millennium Institute for Research in Depression and Personality, Santiago, Chile
- Faculty of Medicine, Clínica Psiquiátrica Universitaria, University of Chile, Santiago, Chile
| | - Cynthia Zavala
- Department of Mental Health, Ministry of Health, Santiago, Chile
| | - Lucia Valmaggia
- Department of Psychology, King's College London, Institute of Psychology, Psychiatry, and Neuroscience, London, UK
| | - James B. Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
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19
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Veru F, MacDonald K, Malla A, Pruessner M, King S, Joober R, Shah J, Iyer SN. The effects of childhood adversity on treatment delays and its components in first-episode psychosis. Psychiatry Res 2022; 308:114341. [PMID: 34953203 DOI: 10.1016/j.psychres.2021.114341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022]
Abstract
Apart from increasing risk for psychotic disorders, childhood adversity has been associated with worse outcomes. One way in which childhood adversity may worsen outcomes is by lengthening treatment delays, which are associated with negative impacts. We tested the influence of childhood trauma on treatment delays, measured as the duration of untreated psychosis (DUP), and its help-seeking and referral components, in a first-episode psychosis cohort (N = 203). We accounted for pertinent social (e.g., migrant status) and other determinants (i.e., age at onset, diagnosis, symptoms) of treatment delays. Multiple linear regression analyses revealed that for a one-unit increase in Childhood Trauma Questionnaire (CTQ) scores, average overall DUP increased by 25%. Higher CTQ scores also significantly predicted help-seeking and referral DUPs. Patients with schizophrenia-spectrum psychosis had longer help-seeking and total DUPs than those with affective psychosis. More severe positive symptoms predicted longer help-seeking DUPs, while more severe negative symptoms predicted longer referral DUPs. Indicators of social disadvantage did not affect DUP. Our results show that childhood trauma increases DUP by prolonging the help-seeking process and delaying access to mental healthcare even after help is sought. Early identification of psychosis among populations with trauma histories seems warranted and can likely positively impact outcomes.
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Affiliation(s)
- Franz Veru
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Kathleen MacDonald
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Marita Pruessner
- Department of Psychiatry, McGill University, Montréal, Canada; Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Suzanne King
- Department of Psychiatry, McGill University, Montréal, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montréal, Canada; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Canada.
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20
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Terhune J, Dykxhoorn J, Mackay E, Hollander AC, Kirkbride JB, Dalman C. Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden. Psychol Med 2022; 52:362-371. [PMID: 32578529 PMCID: PMC8842197 DOI: 10.1017/s0033291720002068] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. METHODS By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. RESULTS Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26-1.73] or child of a migrant (OR 1.27; 95% CI 1.10-1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51-2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17-1.81), non-Nordic European (OR 1.27; 95% CI 1.01-1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03-1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06-1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02-1.24). CONCLUSIONS Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.
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Affiliation(s)
- J. Terhune
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - J. Dykxhoorn
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - E. Mackay
- CORE Group, Division of Psychology and Language Science, UCL, London, WC1E 7HB, UK
| | - A.-C. Hollander
- EPICSS, Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, SE-171 77Stockholm, UK
| | - J. B. Kirkbride
- PsyLife Group, Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - C. Dalman
- EPICSS, Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, SE-171 77Stockholm, UK
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21
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Mwesiga EK, Akena D, Koen N, Nakku J, Nakasujja N, Stein DJ. Comparison of antipsychotic naïve first-episode psychosis patients and healthy controls in Uganda. Early Interv Psychiatry 2021; 15:1713-1720. [PMID: 33445227 DOI: 10.1111/eip.13120] [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: 12/11/2019] [Revised: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The risk factors for a first episode of psychosis in low and middle-income countries (LMICs) are not well described. The study compared the association of different risk factors in patients with first-episode psychosis patients and healthy controls from an LMIC context. METHODS A comparative, descriptive, cross-sectional study was performed in antipsychotic naïve first-episode psychosis patients and healthy controls at the National referral hospital in Uganda. Standardized tools were used to assess sociodemographic (e.g., age, sex, socioeconomic status) and clinical (e.g., childhood trauma, quality of life) variables. First episode psychosis participants were compared to healthy controls in terms of sociodemographic and clinical variables, and logistic regression was used to determine predictors of FEP. RESULTS Our final sample included 198 antipsychotic naïve first-episode psychosis participants and 82 controls. Most participants were female (68.5%) with a mean age of 29.4 years. After adjusting for age and sex, FEP patients when compared to controls were less likely to be female [AOR 0.18 (95%CI 0.03-0.85; p = .031)], more likely to have experienced emotional abuse [AOR 1.30 (95%CI 1.02-1.65; p = .032)] and more likely to have a poor quality of life [AOR 0.93 (95%CI 0.89-0.97; p = .002)]. DISCUSSION The risk factors for a first episode of psychosis in this low and middle-income population were like those described in high-income countries. Further studies on interventions to prevent the transition to psychotic disorders in this sub-groups of patients are recommended. Also, the use of specialized early intervention services in improving the quality of life needs to be evaluated.
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Affiliation(s)
- Emmanuel K Mwesiga
- Department of Psychiatry, Makerere University, Kampala, Uganda.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Juliet Nakku
- National Psychiatric Referral and Teaching Hospital, Kampala, Uganda
| | | | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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22
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Walker EF, Woods SW, Druss BG. Association between residential instability at individual and area levels and future psychosis in adolescents at clinical high risk from the North American Prodrome Longitudinal Study (NAPLS) consortium. Schizophr Res 2021; 238:137-144. [PMID: 34673386 PMCID: PMC10800030 DOI: 10.1016/j.schres.2021.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Accumulating evidence supports an association between residential instability and increased risk for psychosis, but the association between residential instability and conversion to psychosis among adolescents at clinical high risk (CHR) is unclear. In this study, we determined whether individual-level and area-level residential instability and their interaction are associated with conversion to psychosis within two years. METHODS Data were collected as part of the North American Prodrome Longitudinal Study Phase 2. Individual-level residential instability, defined as having ever moved during lifetime, was derived from the Life Events Scale. Area-level residential instability, defined as the percentage of people who were not living in the same house five years ago, was derived from the U.S. Decennial Censuses. RESULTS This study included 285 adolescents at CHR (including 36 subjects who later converted to full psychosis). We found that individual-level residential instability was associated with conversion (adjusted OR = 2.769; 95% CI = 1.037-7.393). The interaction between individual-level and area-level residential instability was significant (p = 0.030). In a subgroup of CHR participants who have never moved (n = 91), area-level residential instability during childhood was associated with conversion (adjusted OR = 1.231; 95% CI = 1.029-1.473). Conversely, in a subgroup of CHR participants who resided in residentially stable areas during childhood (n = 142), the association between individual-level residential instability and conversion remained significant (adjusted OR = 15.171; 95% CI = 1.753-131.305). CONCLUSIONS These findings suggest that individual-level and area-level residential instability may be associated with conversion to psychosis.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Matcheri Keshavan
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - William S Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, MA, United States
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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23
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Pignon B, Lajnef M, Kirkbride JB, Peyre H, Ferchiou A, Richard JR, Baudin G, Tosato S, Jongsma H, de Haan L, Tarricone I, Bernardo M, Velthorst E, Braca M, Arango C, Arrojo M, Bobes J, Del-Ben CM, Di Forti M, Gayer-Anderson C, Jones PB, La Cascia C, Lasalvia A, Menezes PR, Quattrone D, Sanjuán J, Selten JP, Tortelli A, Llorca PM, van Os J, Rutten BPF, Murray RM, Morgan C, Leboyer M, Szöke A, Schürhoff F. The Independent Effects of Psychosocial Stressors on Subclinical Psychosis: Findings From the Multinational EU-GEI Study. Schizophr Bull 2021; 47:1674-1684. [PMID: 34009318 PMCID: PMC8562561 DOI: 10.1093/schbul/sbab060] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The influence of psychosocial stressors on psychosis risk has usually been studied in isolation and after the onset of the disorder, potentially ignoring important confounding relationships or the fact that some stressors that may be the consequence of the disorder rather than preexisting. The study of subclinical psychosis could help to address some of these issues. In this study, we investigated whether there was (i) an association between dimensions of subclinical psychosis and several psychosocial stressors including: childhood trauma, self-reported discrimination experiences, low social capital, and stressful life experiences, and (ii) any evidence of environment-environment (ExE) interactions between these factors. Data were drawn from the EUGEI study, in which healthy controls (N = 1497) and siblings of subjects with a psychotic disorder (N = 265) were included in six countries. The association between psychosocial stressors and subclinical psychosis dimensions (positive, negative and depressive dimension as measured by the Community Assessment of Psychic Experiences (CAPE) scale) and possible ExE interactions were assessed using linear regression models. After adjusting for sex, age, ethnicity, country, and control/sibling status, childhood trauma (β for positive dimension: 0.13, negative: 0.49, depressive: 0.26) and stressful life events (positive: 0.08, negative: 0.16, depressive: 0.17) were associated with the three dimensions. Lower social capital was associated with the negative and depression dimensions (negative: 0.26, depressive: 0.13), and self-reported discrimination experiences with the positive dimension (0.06). Our findings are in favor of independent, cumulative and non-specific influences of social adversities in subclinical psychosis in non-clinical populations, without arguments for E × E interactions.
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Affiliation(s)
- Baptiste Pignon
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France,To whom correspondence should be addressed; Hôpital Albert
Chenevier, Groupe hospitalier Henri-Mondor, CHU de Créteil, Assistance
Publique-Hôpitaux de Paris (AP-HP), 40 rue de Mesly, 94 000 Créteil,
France; tel: 33-1-49-81-31-31, fax:
+33-1-49-81-30-59, e-mail:
| | - Mohamed Lajnef
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
| | | | - Hugo Peyre
- AP-HP, Hôpital universitaire Robert Debré,
Service de pédopsychiatrie, Paris,
France
| | - Aziz Ferchiou
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
| | - Jean-Romain Richard
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
| | - Grégoire Baudin
- Université de Paris, Laboratoire de Psychopathologie
et Processus de Santé, Boulogne
Billancourt, France
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona, Italy
| | - Hannah Jongsma
- Centre for Transcultural Psychiatry
“Veldzicht.” Balkbrug, the Netherlands; VR Mental Health Group,
University Center for Psychiatry, Univerisity Medical Centre
Groningen, Groningen, The Netherlands,Centre for Longitudinal Studies, UCL,
London, UK
| | - Lieuwe de Haan
- Amsterdam UMC,
Amsterdam, The
Netherlands,Arkin, Amsterdam,
The Netherlands
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna
University, Bologna, Italy
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit, Hospital
Clínic of Barcelona, Institute of Neuroscience, University of Barcelona;
Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),
Barcelona; Centro de Investigación Biomédica en Red de Salud Mental
(CIBERSAM), Spain
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Mauro Braca
- Department of Mental Health and Pathological Addictions,
Local Health Authority, Bologna, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute
of Psychiatry and Mental Health, Hospital General.Universitario Gregorio
Marañón, Gregorio Marañón, (IiGSM), School of Medicine,
Universidad Complutense de Madrid; CIBERSAM,
Madrid, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group,
Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo
Hospitalario Universitario de Santiago de Compostela, Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences - Psychiatry,
Universidad de Oviedo; ISPA, INEUROPA CIBERSAM,
Oviedo, Spain
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behaviour, Ribeirão
Preto Medical School, University of São Paulo,
São Paulo, Brazil
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK,South London and Maudsley NHS Mental Health Foundation
Trust, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research,
Institute of Psychiatry, King’s College London, De Crespigny
Park, Denmark Hill, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of
Cambridge, Cambridge, UK,CAMEO, Cambridgeshire & Peterborough NHS Foundation
Trust, Cambridge, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced
Diagnostics, School of Medicine, University of Palermo,
Palermo, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona, Italy
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina,
Universidade of São Paulo, São
Paulo, Brazil
| | - Diego Quattrone
- Social, Genetic, and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Julio Sanjuán
- Biomedical Research Networking Centre in Mental Health
(CIBERSAM), Madrid, Spain,Department of Psychiatry, Hospital Clínico
Universitario de Valencia, School of Medicine, Universidad de
Valencia, Valencia, Spain,Biomedical Research Institute INCLIVA,
Valencia, Spain
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health,
Leiden, The
Netherlands,Maastricht University Medical Center, Departmentof
Psychiatry & Neuropsychology, School for Mental Health and
Neuroscience, Maastricht, The Netherlands
| | - Andrea Tortelli
- French National Institute of Health and Medical Research
(INSERM), Créteil, France,EPS Maison Blanche,
Paris, France
| | - Pierre-Michel Llorca
- CHU Clermont-Ferrand, Psychiatrie B,
Clermont-Ferrand, France,Université Clermont Auvergne,
Clermont-Ferrand, France
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, Maastricht University Medical
Centre, Maastricht, The Netherlands,Department of Psychiatry, UMC Utrecht Brain Centre,
University Medical Centre Utrecht, Utrecht University,
Utrecht, The
Netherlands,Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College London,
London, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, Maastricht University Medical
Centre, Maastricht, The Netherlands
| | - Robin M Murray
- The Institute of Psychiatry, Psychology and Neuroscience,
King’s College London, London,
UK
| | - Craig Morgan
- Department of Health Service and Population Research,
Institute of Psychiatry, King’s College London, De Crespigny
Park, Denmark Hill, London, UK
| | - Marion Leboyer
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
| | - Andrei Szöke
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
| | - Franck Schürhoff
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires « H. Mondor», DMU IMPACT, Fondation
FondaMental, Créteil, France
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24
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Okubo R, Yoshioka T, Nakaya T, Hanibuchi T, Okano H, Ikezawa S, Tsuno K, Murayama H, Tabuchi T. Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic. J Affect Disord 2021; 287:89-95. [PMID: 33774320 PMCID: PMC9754685 DOI: 10.1016/j.jad.2021.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. METHODS A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. RESULTS Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). CONCLUSION These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.
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Affiliation(s)
- Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Tomoya Hanibuchi
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroki Okano
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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25
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Ajnakina O, Rodriguez V, Quattrone D, di Forti M, Vassos E, Arango C, Berardi D, Bernardo M, Bobes J, de Haan L, Del-Ben CM, Gayer-Anderson C, Jongsma HE, Lasalvia A, Tosato S, Llorca PM, Menezes PR, Rutten BP, Santos JL, Sanjuán J, Selten JP, Szöke A, Tarricone I, D’Andrea G, Richards A, Tortelli A, Velthorst E, Jones PB, Arrojo Romero M, La Cascia C, Kirkbride JB, van Os J, O’Donovan M, Murray RM. Duration of Untreated Psychosis in First-Episode Psychosis is not Associated With Common Genetic Variants for Major Psychiatric Conditions: Results From the Multi-Center EU-GEI Study. Schizophr Bull 2021; 47:1653-1662. [PMID: 33963865 PMCID: PMC8562562 DOI: 10.1093/schbul/sbab055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Duration of untreated psychosis (DUP) is associated with clinical outcomes in people with a diagnosis of first-episode psychosis (FEP), but factors associated with length of DUP are still poorly understood. Aiming to obtain insights into the possible biological impact on DUP, we report genetic analyses of a large multi-center phenotypically well-defined sample encompassing individuals with a diagnosis of FEP recruited from 6 countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Genetic propensity was measured using polygenic scores for schizophrenia (SZ-PGS), bipolar disorder (BD-PGS), major depressive disorder (MDD-PGS), and intelligence (IQ-PGS), which were calculated based on the results from the most recent genome-wide association meta-analyses. Following imputation for missing data and log transformation of DUP to handle skewedness, the association between DUP and polygenic scores (PGS), adjusting for important confounders, was investigated with multivariable linear regression models. The sample comprised 619 individuals with a diagnosis of FEP disorders with a median age at first contact of 29.0 years (interquartile range [IQR] = 22.0-38.0). The median length of DUP in the sample was 10.1 weeks (IQR = 3.8-30.8). One SD increases in SZ-PGS, BD-PGS, MDD-PGS or IQ-PGS were not significantly associated with the length of DUP. Our results suggest that genetic variation does not contribute to the DUP in patients with a diagnosis of FEP disorders.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, University of London, London,
UK,Department of Behavioural Science and Health, Institute of
Epidemiology and Health Care, University College London,
London, UK,Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark,To whom correspondence should be addressed; Department of
Biostatistics and Health Informatics, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, PO20, 16 De Crespigny Park, London
SE5 8AF, UK; tel: +44(0)20 7848 0938, e-mail:
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Marta di Forti
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, London, UK
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of
Psychiatry and Mental Health, Hospital General Universitario Gregorio
Marañón, School of Medicine, Universidad Complutense,
Madrid, Spain
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Miguel Bernardo
- Department of Psychiatry, Barcelona Clinic Schizophrenia
Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of
Barcelona, IDIBAPS, CIBERSAM, Barcelona,
Spain
| | - Julio Bobes
- Faculty of Medicine and Health Sciences –
Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM,
Oviedo, Spain
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section,
Amsterdam UMC, University of Amsterdam,
Amsterdam, The
Netherlands
| | - Cristina Marta Del-Ben
- Neuroscience and Behavior Department, Ribeirão Preto
Medical School, University of São Paulo, São
Paulo, Brazil
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research,
Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, De Crespigny Park, Denmark Hill, London,
UK
| | - Hannah E Jongsma
- Centre for Longitudinal Studies, University College
London, London, UK,Centre for Transcultural Psychiatry
Veldzicht, Balkbrug, The Netherlands,University Centre for Psychiatry, University Medical
Centre Groningen, Groningen, The Netherlands
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona,
Verona,Italy
| | - Pierre-Michel Llorca
- Université Clermont Auvergne, CMP-B CHU, CNRS,
Clermont Auvergne INP, Institut Pascal,
Clermont-Ferrand, France
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina
FMUSP, University of São Paulo, São
Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherlands
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría
Hospital “Virgen de la Luz,”Cuenca, Spain
| | - Julio Sanjuán
- Department of Psychiatry, Hospital Clínico
Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de
Valencia, Valencia, Spain
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health
Care, Sandifortdreef 19, 2333 ZZ Leiden,
The Netherlands
| | - Andrei Szöke
- Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux
Universitaires “ H. Mondor ,” DMU IMPACT, Fondation
FondaMental, Creteil, France
| | - Ilaria Tarricone
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | - Giuseppe D’Andrea
- Department of Biomedical and Neuromotor Sciences,
Psychiatry Unit, Alma Mater Studiorum Università di Bologna,
Bologna, Italy
| | - Alexander Richards
- Division of Psychological Medicine and Clinical
Neurosciences, Cardiff, UK
| | | | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section,
Academic Medical Centre, University of Amsterdam,
Amsterdam, The
Netherlands,Department of Psychiatry, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel
Smith Building for Brain & Mind Sciences,
Cambridge, UK,CAMEO Early Intervention Service, Cambridgeshire &
Peterborough NHS Foundation Trust,
Cambridge, UK
| | - Manuel Arrojo Romero
- Department of Psychiatry, Psychiatric Genetic Group,
Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo
Hospitalario Universitario de Santiago de Compostela,
Santiago de Compostela, Spain
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical
Neuroscience, University of Palermo,
Palermo, Italy
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College
London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK,Department of Psychiatry and Neuropsychology, School for
Mental Health and Neuroscience, South Limburg Mental Health Research and
Teaching Network, Maastricht University Medical Centre,
Maastricht, The
Netherland,UMC Utrecht Brain Centre, Utrecht University Medical
Centre, Utrecht, The
Netherlands
| | - Mick O’Donovan
- Division of Psychological Medicine and Clinical
Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff
University, Cardiff, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London,
London, UK,Department of Psychiatry, Experimental Biomedicine and
Clinical Neuroscience, University of Palermo,
Palermo, Italy
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26
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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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27
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Krabbendam L, van Vugt M, Conus P, Söderström O, Abrahamyan Empson L, van Os J, Fett AKJ. Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health. Psychol Med 2021; 51:1099-1110. [PMID: 32156322 DOI: 10.1017/s0033291720000355] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.
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Affiliation(s)
- Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
| | - Mark van Vugt
- Department of Experimental and Applied Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Ola Söderström
- Institut de Géographie, Université de Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Lilith Abrahamyan Empson
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Jim van Os
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne-Kathrin J Fett
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BTAmsterdam, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, LondonSE5 8AF, UK
- Department of Psychology, City, University of London, Northampton Square, LondonEC1V 0HB, UK
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28
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Oluwoye O, Amiri S, Kordas G, Fraser E, Stokes B, Daughtry R, Langton J, McDonell MG. Geographic Disparities in Access to Specialty Care Programs for Early Psychosis in Washington State. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:5-12. [PMID: 33877475 DOI: 10.1007/s10488-021-01137-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Supported by the 10% set-aside funds in the Community Mental Health Block grant, distributed at the state level, coordinated specialty care (CSC) have been widely disseminated throughout the U.S. This study explores variations in the geographical accessibility of CSC programs by neighborhood level characteristics in Washington State. CSC locations were geocoded. Socioeconomic neighborhood deprivation (i.e., Area deprivation index) and rurality (i.e., Rural-Urban Commuting Area codes) were neighborhood level characteristics extracted from the 2018 American Community Survey. Geographic accessibility of CSC was assessed using a two-step floating catchment area technique and multilevel linear models were used to examine the association between specific neighborhood characteristics and geographic accessibility. The association between access and socioeconomically deprived neighborhoods varied differentially by neighborhood rurality (an interaction effect). Model estimates indicated that the least deprived, metropolitan neighborhoods had the best access (M = 0.38; CI: 0.34, 0.42) and rural neighborhoods in the second most deprived quartile had the worst access (M = 0.16; CI: 0.11, 0.21) to CSC. There was a clear decrease in accessibility for more rural neighborhoods, regardless of other neighborhood characteristics. In conclusions, findings provide important insight into how resource distribution contributes to geographic disparities in access to CSC. The use of spatial analytic techniques has the potential to identify specific neighborhoods and populations where there is a need to expand and increase availability of CSC to ensure access to rural and socioeconomically deprived neighborhoods.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA. .,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.
| | - Solmaz Amiri
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Institute for Research and Education To Advance Community Health (IREACH), Seattle, USA
| | - Gordon Kordas
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
| | - Rebecca Daughtry
- Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.,Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia, WA, USA
| | - Jared Langton
- Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.,Youth and Family Behavioral Health Section, Washington State Health Care Authority, Olympia, WA, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.,Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA
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29
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Menculini G, Bernardini F, Attademo L, Balducci PM, Sciarma T, Moretti P, Tortorella A. The Influence of the Urban Environment on Mental Health during the COVID-19 Pandemic: Focus on Air Pollution and Migration-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3920. [PMID: 33917942 PMCID: PMC8068323 DOI: 10.3390/ijerph18083920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused a crisis worldwide, due to both its public health impact and socio-economic consequences. Mental health was consistently affected by the pandemic, with the emergence of newly diagnosed psychiatric disorders and the exacerbation of pre-existing ones. Urban areas were particularly affected by the virus spread. In this review, we analyze how the urban environment may influence mental health during the COVID-19 pandemic, considering two factors that profoundly characterize urbanization: air pollution and migration. Air pollution serves as a possibly risk factor for higher viral spread and infection severity in the context of urban areas and it has also been demonstrated to play a role in the development of serious mental illnesses and their relapses. The urban environment also represents a complex social context where minorities such as migrants may live in poor hygienic conditions and lack access to adequate mental health care. A global rethinking of the urban environment is thus required to reduce the impact of these factors on mental health. This should include actions aimed at reducing air pollution and combating climate change, promoting at the same time a more inclusive society in a sustainable development perspective.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Francesco Bernardini
- CSM 24 ore Area delle Dolomiti Friulane, Department of Mental Health, AsFO Friuli Occidentale, 33170 Pordenone, Italy;
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Luigi Attademo
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
- SPDC Potenza, Department of Mental Health, ASP Basilicata, Italian National Health Service, 85100 Potenza, Italy
| | - Pierfrancesco Maria Balducci
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
- CSM Terni, Department of Mental Health, 05100 Terni, Italy
| | - Tiziana Sciarma
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Patrizia Moretti
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
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30
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Abrahamyan Empson L, Baumann PS, Söderström O, Codeluppi Z, Söderström D, Conus P. Urbanicity: The need for new avenues to explore the link between urban living and psychosis. Early Interv Psychiatry 2020; 14:398-409. [PMID: 31389169 DOI: 10.1111/eip.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/25/2018] [Accepted: 07/14/2019] [Indexed: 12/26/2022]
Abstract
AIM A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies. METHOD A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted. RESULTS The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress." The latter may link urban upbringing to the development of psychosis through overlapping neuro- and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce. CONCLUSIONS Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental well-being.
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Affiliation(s)
- Lilith Abrahamyan Empson
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Philipp S Baumann
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | - Zoé Codeluppi
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Philippe Conus
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
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31
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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: 11] [Impact Index Per Article: 2.8] [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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Ku BS, Pauselli L, Manseau M, Compton MT. Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophr Res 2020; 218:247-254. [PMID: 31948900 PMCID: PMC7299734 DOI: 10.1016/j.schres.2019.12.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). METHODS Data were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. RESULTS 143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. CONCLUSIONS This study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.
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Affiliation(s)
- Benson S. Ku
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA,Corresponding author: Benson Ku, M.D., , 100 Woodruff Circle Suite 327, Atlanta, GA 30322, (404) 727-8381, Fax: 289-802-1992
| | - Luca Pauselli
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA,Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, Department of Psychiatry, New York, NY, USA
| | - Marc Manseau
- New York University School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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33
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Lemmers-Jansen IL, Fett AKJ, van Os J, Veltman DJ, Krabbendam L. Trust and the city: Linking urban upbringing to neural mechanisms of trust in psychosis. Aust N Z J Psychiatry 2020; 54:138-149. [PMID: 31409094 DOI: 10.1177/0004867419865939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Elevated prevalence of non-affective psychotic disorders is often found in densely populated areas. This functional magnetic resonance imaging study investigates if reduced trust, a component of impaired social functioning in patients with psychotic disorder, is associated with urban upbringing. METHODS In total, 39 patients (22 first episode and 17 clinical high risk) and 30 healthy controls, aged 16-29, performed two multi-round trust games, with a cooperative and unfair partner during functional magnetic resonance imaging scanning. Baseline trust was operationalized as the first investment made, and changes of trust as changes in investments made over the 20 trials during the games. Urban exposure during upbringing (0-15 years) was defined as higher urban (≥2500 inhabitants/km2) or lower urban (<2500 inhabitants/km2). RESULTS Patients displayed lower baseline trust (first investment) than controls, regardless of urbanicity exposure. During cooperative interactions, lower-urban patients showed increasing investments. In addition, during cooperative interactions, group-by-developmental urbanicity interactions were found in the right and left amygdalae, although for the latter only at trend level. Higher urbanicity was associated with decreased activation of the left amygdala in patients and controls during investments and with increased activation of the right and left amygdalae in patients only, during repayments. During unfair interactions, no associations of urbanicity with behavior or brain activation were found. CONCLUSION Urban upbringing was unrelated to baseline trust. Associations with urbanicity were stronger for patients compared to controls, suggesting greater susceptibility to urbanicity effects during the developmental period. Higher-urban patients failed to compensate for the initial distrust specifically during repeated cooperative interactions. This finding highlights potential implications for social functioning. Urban upbringing was linked to differential amygdala activation, suggesting altered mechanisms of feedback learning, but this was not associated with trust game behavior.
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Affiliation(s)
- Imke Lj Lemmers-Jansen
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Kathrin J Fett
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, City, University of London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU Medical Center, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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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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Kaminga AC, Dai W, Liu A, Myaba J, Banda R, Wen SW. Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi. Early Interv Psychiatry 2019; 13:1455-1464. [PMID: 30706661 PMCID: PMC6900171 DOI: 10.1111/eip.12794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/24/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.
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Affiliation(s)
- Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- Department of Mathematics and StatisticsMzuzu UniversityMzuzuMalawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Shi W. Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaOntarioCanada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
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O’Keeffe D, Hannigan A, Doyle R, Kinsella A, Sheridan A, Kelly A, Madigan K, Lawlor E, Clarke M. The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis. Aust N Z J Psychiatry 2019; 53:1080-1092. [PMID: 30722671 PMCID: PMC6826887 DOI: 10.1177/0004867419827648] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. METHOD iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort (N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. RESULTS At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5-11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. CONCLUSION Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.
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Affiliation(s)
- Donal O’Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland,School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin, Ireland,Donal O’Keeffe, DETECT Early Intervention in Psychosis Service, Avila House, Block 5, Blackrock Business Park, Blackrock, Co. Dublin A94 Y030, Ireland.
| | - Ailish Hannigan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Roisin Doyle
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Anthony Kinsella
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aine Kelly
- Research Department, Saint John of God Hospitaller Services, Dublin, Ireland
| | - Kevin Madigan
- St. John of God Community Services, Dublin, Ireland,School of Postgraduate Studies, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Reynolds S, Brown E, Kim DJ, Geros H, Sizer H, Eaton S, Tindall R, McGorry P, O'Donoghue B. The association between community and service level factors and rates of disengagement in individuals with first episode psychosis. Schizophr Res 2019; 210:122-127. [PMID: 31176534 DOI: 10.1016/j.schres.2019.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Individuals who experience a first episode of psychosis require early intervention and regular follow-up in order to improve their prognosis and avoid long-term negative outcomes. However, approximately 30% of individuals accessing support will end up disengaging from early intervention (EI) services. Although we know that individual factors can impact rates of disengagement, less is known about potential service and community level factors. METHODS Data were gathered from a cohort of individuals attending a specialist youth mental health service in Melbourne, Australia between 1st January 2011 and 7th September 2014. Data were collected from clinical files and electronic medical records using a standardised audit instrument. Cox regression analysis was used to identify whether community level factors were predictors of disengagement. RESULTS Data were available for 707 young people experiencing a first episode of psychosis. Individuals residing in neighbourhoods of higher social deprivation were at a higher relative risk of disengaging, with 4.7% increase in engagement for each increase in decile of deprivation. The introduction of a new clinic was not significantly associated with a difference in the proportion of individuals disengaging from the service and distance to service was not significantly associated with disengagement rates. DISCUSSION Developing strategies focused on engaging young people with first episode psychosis who reside in more deprived areas may address the higher rates of disengagement these individuals experience. These finding suggest that location may not be a barrier to engagement, however services should be resourced in-line with the population demographic in their specific location.
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Affiliation(s)
- Siobhan Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Ellie Brown
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong 3220, Australia
| | - Da Jung Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Hellen Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Holly Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Rachel Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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Eaton S, Harrap B, Downey L, Thien K, Bowtell M, Bardell-Williams M, Ratheesh A, McGorry P, O'Donoghue B. Incidence of treated first episode psychosis from an Australian early intervention service and its association with neighbourhood characteristics. Schizophr Res 2019; 209:206-211. [PMID: 31130401 DOI: 10.1016/j.schres.2019.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 03/26/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Psychotic disorder incidence varies geographically and is associated with neighbourhood characteristics, including social deprivation, population density, unemployment, social capital or social fragmentation. Yet it is not known whether these findings are applicable to Australia's unique geography. This study aimed to determine whether the incidence of first episode psychosis (FEP) varies according to neighbourhood characteristics in an Australian cohort. METHOD This study included all young people, aged 15 to 24, with an FEP who attended Orygen Youth Health in Melbourne, from a geographically defined catchment area encompassing Northern and Western Melbourne, over a 44-month period. Neighbourhood demographic data was collected from the 2011 Australian National Census. Negative binomial regression was used to determine incidence rate ratios controlled for age, sex and migrant status. RESULTS A total of 747 young people had an FEP during the 44-month study period and 722 were included in this study. Of these, 58.0% were males and 67.9% had a non-affective psychotic disorder; the mean age of the cohort was 19.1 years. The incidence of FEP in young people aged 15 to 24 in the catchment area was 123.2 per 100,000 person-years. There was a higher incidence of FEP in neighbourhoods of greatest social deprivation (IRR = 1.65, CI = 1.06-2.51, p = .02), highest unemployment (IRR = 1.56, CI = 1.04-2.35, p = .03) and above average social fragmentation (IRR = 1.42, CI = 1.02-1.97, p = .04), when controlled for age, sex and migrant status. CONCLUSIONS This study highlights variation in psychotic disorder incidence and the need for this disparity to be reflected in appropriate resource allocation.
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Affiliation(s)
- Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Benjamin Harrap
- Melbourne Epicentre, Melbourne Health and The University of Melbourne, 300 Grattan Street, Royal Melbourne Hospital, Victoria 3052, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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Abstract
PURPOSE OF REVIEW Epidemiological studies associate city living with an elevated psychosis risk. Urban (social/economic) stress and exposure to environmental toxins, pollution or disease agents have been proposed to underlie this association. This review provides an update on the recent evidence (May 2017 - November 2018). RECENT FINDINGS Of 647 screened studies, 17 on: urbanicity-psychosis associations in worldwide high, middle and low-income countries; explanatory mechanisms, including nature exposure, social and economic stressors and genetic risk; urbanicity effects on the brain and coping; and urbanicity and resources, were included. The reviewed evidence revealed complex patterns of urbanicity-psychosis associations with considerable international variation within Europe and between low, middle and high-income countries worldwide. Social and economic stressors (e.g. migration, ethnic density and economic deprivation), nature exposure and access to resources could only explain part of the urbanicity effects. Risk factors differed between countries and between affective and non-affective psychosis. SUMMARY Urbanicity-psychosis associations are heterogeneous and driven by multiple risk and protective factors that seem to act differently in different ethnic groups and countries. Interdisciplinary research combining approaches, for example from experimental neuroscience and epidemiology, are needed to unravel specific urban mechanisms that increase or decrease psychosis risk.
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Renwick L, Drennan J, Sheridan A, Lyne J, Kinsella A, O' Callaghan E, Clarke M. Disagreement between service-users and clinicians assessment of physical health during early psychosis. Early Interv Psychiatry 2019; 13:314-317. [PMID: 29707910 DOI: 10.1111/eip.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 02/04/2023]
Abstract
AIMS Physical illnesses account for the majority of excess deaths following psychosis; access to care and treatment is inequitable and schizophrenia has now been dubbed the life-shortening disease. We compared service-users and clinician's perspectives of their physical health assuming that one of the fundamental issues in prompting screening and treatment is the view that health is poor. METHODS Data comprising sample characteristics, diagnosis, symptoms, insight, antecedents to psychosis and physical health perspectives were obtained prospectively as part of a larger epidemiological study of first-episode psychosis. We compared physical health perspectives between service-users and clinicians and examined clinical correlates. RESULTS Contrary to our expectations, we found that service-users reported poorer physical health over time than clinicians did. CONCLUSION Reconciling service-users and clinician's views of physical health may be an important step towards collaborative care and improving access to better quality healthcare for serious mental illness.
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Affiliation(s)
- Laoise Renwick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - John Lyne
- DETECT Early Psychosis Service, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
| | | | - Eadbhard O' Callaghan
- DETECT Early Psychosis Service, Dublin, Ireland.,School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Psychosis Service, Dublin, Ireland.,School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
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Silva AHSD, Vedana KGG, Tressoldi LDS, Martin IDS, Corradi-Webster CM, Gherardi-Donato ECDS, Zanetti ACG. First-Episode Psychosis from the Perspective of Family Members. J Psychosoc Nurs Ment Health Serv 2019; 57:34-42. [PMID: 30130380 DOI: 10.3928/02793695-20180817-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to explore family members' perceptions of the causes of first-episode psychosis (FEP). A qualitative study with 68 family members of patients with FEP was performed. Data were collected through semi-structured interviews and submitted for thematic analysis. The attributions for FEP were: use of psychoactive substances as a trigger; influence of genetic and personal factors; exposure to stressful life events; and lack of previous health care and knowledge about psychotic symptoms. Knowledge of possible attributions for the onset of psychosis may be valuable in optimizing early identification of individuals with FEP. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 34-42.].
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Castillejos MC, Martín-Pérez C, Moreno-Küstner B. A systematic review and meta-analysis of the incidence of psychotic disorders: the distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level. Psychol Med 2018; 48:2101-2115. [PMID: 29467052 DOI: 10.1017/s0033291718000235] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Considering existing knowledge on the relationship between certain environmental factors and incidence rates of psychosis, we carried out a systematic review to provide a broad and updated picture of the incidences of different psychotic disorder subgroups worldwide and how some environmental factors influence these rates. METHODS Studies with original data related to the incidence of psychosis (published between 2000 and 2015) were identified via searching electronic databases (CINAHL, MEDLINE, PSYCINFO, PUBMED, and SCOPUS). Data on the following risk factors were extracted: gender, urbanicity, immigration and socio-economic level. Descriptive appraisals of variation in incidence rates (IR) and incidence rate ratios (IRR), with a 95% confidence interval were calculated. In addition, a meta-analysis was performed to calculate IR pooled by diagnosis group and IRR pooled by diagnosis and gender, urbanity, immigration and socio-economic level, using a random effects model. RESULTS We identified 33 reports to analyse. Overall IR per 100 000 persons for non-affective psychoses (IR pooled = 22.53 (16.51-28.54)) were higher than affective psychoses (IR pooled = 7.12 (5.03-9.22)). There was an increase in rates of psychosis in men v. women (IRR pooled = 1.54 (1.37-1.72)), in urban v. rural areas (IRR pooled = 1.64 (1.38-1.95)), in immigrants v. natives (IRR pooled = 3.09 (2.74-3.49)), and in lower socio-economic level areas (IRR pooled = 1.78 (1.43-2.22)). CONCLUSIONS IR among different psychotic disorders was found to vary depending on gender, urbanicity, and immigration (as most of the previous literature focuses on non-affective psychosis or schizophrenia).
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Affiliation(s)
- M C Castillejos
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain
- Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain
| | - C Martín-Pérez
- Andalusian Health Service, North East Granada Sanitary District, Clinical Management Unit at Marquesado, Alquife, Granada, Spain
| | - B Moreno-Küstner
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain
- Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain
- Biomedical Research Institute of Malaga (IBIMA)
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Veru-Lesmes F, Rho A, King S, Joober R, Pruessner M, Malla A, Iyer SN. Social Determinants of Health and Preclinical Glycemic Control in Newly Diagnosed First-Episode Psychosis Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:547-556. [PMID: 29661027 PMCID: PMC6099748 DOI: 10.1177/0706743718762097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The abnormally high incidence of disorders of glucose metabolism (DGM) in psychotic-spectrum disorders (PSD) has often been attributed to the side effects of antipsychotics and unhealthy lifestyles. The influence of social determinants of health has been largely ignored, despite ample evidence linking social adversity with both PSD and DGM. The aim of this study is to examine the influence of well-established social determinants of health on preclinical levels of glycated hemoglobin (HbA1c) in a sample of first-episode psychosis (FEP) patients. METHODS In a sample of newly admitted FEP patients, univariate analyses were used to select the main predictors of HbA1c levels from the following social determinants of health: childhood trauma, immigrant background, visible minority status, and indices of social and material deprivation. The predictors identified in the univariate analyses were tested in multivariate linear regression models including age, sex, BMI, depression, and physical anergia (proxy of sedentary behaviour) as covariates. RESULTS Univariate analyses identified visible minority status and childhood physical abuse as predictors of HbA1c. After controlling for covariates, minority status significantly predicted higher levels of glycated hemoglobin (β = 0.23; P = 0.01), and physical abuse had a marginally significant effect (β = 0.23; P = 0.06). Other predictors were not significantly associated. CONCLUSION FEP patients from a visible minority or who were victims of childhood physical abuse have higher levels of HbA1c at admission compared with other patients. This might suggest an increase in risk for the development of future DGM. If confirmed, preventive strategies could be tailored for these groups.
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Affiliation(s)
- Franz Veru-Lesmes
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Aldanie Rho
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec
| | - Suzanne King
- 2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Ridha Joober
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec
| | - Marita Pruessner
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec.,4 Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Ashok Malla
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec.,Authors contributed equally to the work
| | - Srividya N Iyer
- 1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec.,3 Department of Psychiatry, McGill University, Montreal, Quebec.,Authors contributed equally to the work
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Reichert A, Jacobs R. Socioeconomic inequalities in duration of untreated psychosis: evidence from administrative data in England. Psychol Med 2018; 48:822-833. [PMID: 28805178 DOI: 10.1017/s0033291717002197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Duration of untreated psychosis (DUP) is an important measure of access to care as it predicts prognosis and treatment outcomes. Little is known about potential socioeconomic inequalities in DUP. The aim of this study was to investigate inequalities in DUP associated with socioeconomic deprivation in a national cohort in England. METHOD We analysed a cohort of 887 patients with a first-episode in psychosis using the administrative Mental Health Services Dataset in England for 2012/13-2014/15. We used a Generalised Linear Model to account for non-linearity in DUP and looked at inequalities across the whole distribution of DUP using quantile regression. RESULTS The median DUP was 22 days (mean = 74 days) with considerable variations between and within the 31 hospital providers. We found evidence of significant inequalities regarding the level of socioeconomic deprivation. Patients living in the second, third and fourth deprived neighbourhood quintiles faced a 36, 24 and 31 day longer DUP than patients from the least deprived neighbourhoods. Inequalities were more prevalent in higher quantiles of the DUP distribution. Unemployment prolonged DUP by 40 days. Having been in contact with mental health care services prior to the psychosis start significantly reduced the DUP by up to 53 days. CONCLUSIONS Socioeconomic deprivation is an important factor in explaining inequalities in DUP. Policies to improve equitable access to care should particularly focus on preventing very long delays in treatment and target unemployed patients as well as people that have not been in contact with any mental health professional in the past.
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Affiliation(s)
- A Reichert
- Centre for Health Economics,University of York,York YO105DD,UK
| | - R Jacobs
- Centre for Health Economics,University of York,York YO105DD,UK
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Richardson L, Hameed Y, Perez J, Jones PB, Kirkbride JB. Association of Environment With the Risk of Developing Psychotic Disorders in Rural Populations: Findings from the Social Epidemiology of Psychoses in East Anglia Study. JAMA Psychiatry 2018; 75:75-83. [PMID: 29188295 PMCID: PMC5833554 DOI: 10.1001/jamapsychiatry.2017.3582] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
IMPORTANCE Social determinants are important risk factors for the development of first-episode psychosis (FEP); their effects in rural areas are largely unknown. OBJECTIVE To investigate neighborhood-level factors associated with FEP in a large, predominantly rural population-based cohort. DESIGN, SETTING, AND PARTICIPANTS This study extracted data on referrals for treatment of potential FEP at 6 Early-Intervention Psychosis services from the Social Epidemiology of Psychoses in East Anglia naturalistic cohort study data set, which covered a population of more than 2 million people in a rural area in the East of England for a period of 3.5 years. All individuals aged 16 to 35 years who presented to Early-Intervention Psychosis services and met diagnostic criteria for first episodes of nonaffective psychoses and affective psychoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes F20-33) were included (n = 631). Persons whose disorders had an organic basis (diagnostic codes F06.X) and those meeting the criteria for substance-induced psychosis (diagnostic codes F1X.5) were excluded. We derived 4 neighborhood-level exposures from a routine population data set using exploratory factor analysis (racial/ethnic diversity, deprivation, urbanicity, and social isolation) and investigated intragroup racial/ethnic density and fragmentation. MAIN OUTCOMES AND MEASURES Multilevel Poisson regression was performed to determine associations between incidence rates and neighborhood-level factors, after adjustment for individual factors. Results were reported as incidence rate ratios (IRRs). RESULTS The study included 631 participants who met criteria for FEP and whose median age at first contact was 23.8 years (interquartile range, 19.6-27.6 years); 416 of 631 (65.9%) were male. Crude incidence of FEP was calculated as 31.2 per 100 000 person-years (95% CI, 28.9-33.7). Incidence varied significantly between neighborhoods after adjustment for age, sex, race/ethnicity, and socioeconomic status. For nonaffective psychoses, incidence was higher in neighborhoods that were more economically deprived (IRR, 1.13; 95% CI, 1.06-1.20) and socially isolated (IRR, 1.11; 95% CI, 1.04-1.19). It was lower in more racially/ethnically diverse neighborhoods (IRR, 0.94; 95% CI, 0.87-1.00). Higher intragroup racial/ethnic density (IRR, 0.97; 95% CI, 0.94-1.00) and lower intragroup racial/ethnic fragmentation (IRR, 0.98; 95% CI, 0.96-1.00) were associated with a reduced risk of affective psychosis. CONCLUSIONS AND RELEVANCE Spatial variation in the incidence of nonaffective and affective psychotic disorders exists in rural areas. This suggests that the social environment contributes to psychosis risk across the rural-urban gradient.
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Affiliation(s)
- Lucy Richardson
- PsyLife Group, Division of Psychiatry, University College London, London, England
| | - Yasir Hameed
- Norfolk and Suffolk National Health Service Foundation Trust, Hellesdon Hospital, Norwich, Norfolk, England
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, England
| | - James B. Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, England
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Poverty, low education, and the expression of psychotic-like experiences in the general population of São Paulo, Brazil. Psychiatry Res 2017; 253:182-188. [PMID: 28388455 DOI: 10.1016/j.psychres.2017.03.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/21/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
The aim of our study was to assess psychotic-like experiences in the general population aged 18-30 years old of the city of São Paulo, Brazil. A household survey was conducted with 1950 young-adults randomly drawn from the city's general population. The validated 92-item Portuguese version of the Prodromal Questionnaire (PQ) was used for face-to-face interviews. Latent class analysis was conducted. Mean age was of 24 years; 51.1% of the sample was of women. Mean total score on the PQ was 22.06 (SD=17.16). Considering a suggested cut-off of 14 in the positive subscale, 30.8% of individuals were above the threshold for ultra-high risk for psychosis detection. Latent class analysis resulted in a three classes clusterization. Class 1 (20%; n=390) had the highest overall PQ scores (mean=49.31,SD=10.783), class 2 (43%; n=835) had intermediate scores (mean=23.37,SD=6.56), and class 3 (37%; n=721) had the lowest scores (mean=5.81,SD=3.74). Class 1 had significantly more individuals with less education and significantly more individuals with lower socioeconomic class. Poverty and low education might be associated with the psychotic expression in the general population, amplifying their actions on the psychosis gradient in developing countries. The psychosis continuum might be constituted by three distinct quantitatively different classes.
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Solmi F, Colman I, Weeks M, Lewis G, Kirkbride JB. Trajectories of Neighborhood Cohesion in Childhood, and Psychotic and Depressive Symptoms at Age 13 and 18 Years. J Am Acad Child Adolesc Psychiatry 2017; 56:570-577. [PMID: 28647008 PMCID: PMC5493518 DOI: 10.1016/j.jaac.2017.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/09/2017] [Accepted: 04/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Exposure to adverse social environments has been associated with psychotic and depressive symptoms in adolescence in cross-sectional studies, but the longitudinal relation is unclear. This study examined whether longitudinal trajectories of exposure to adverse social environments across childhood are associated with psychotic experiences and depressive symptoms in adolescence. METHOD Data on participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) were used to estimate longitudinal trajectories of childhood exposure to neighborhood cohesion (NC), discord (ND), and stress (NS) using latent class growth modeling. Logistic regression was used to examine the association between these trajectories and psychotic experiences and depressive symptoms at 13 and 18 years of age, adjusting for maternal psychopathology, participant sociodemographic and socioeconomic characteristics, and area-level deprivation. RESULTS A dose-response association was observed between higher NS and the odds of psychotic experiences at 13 years (medium NS, adjusted odds ratio [aOR] 1.25, 95% CI 1.05-1.49; high NS, aOR 1.77, 95% CI 1.30-2.40), whereas high levels of ND predicted psychotic experiences at 18 years (aOR 1.50, 95% CI 1.10-2.07). High levels of NC (aOR 1.43, 95% CI 1.02-1.71) and NS (aOR 1.55, 95% CI 1.07-2.26) were associated with increased odds of high depressive symptoms at 18 years in a dose-response fashion. CONCLUSION Prolonged and more severe exposure to adverse social environments is associated with greater odds of developing psychotic and depressive symptoms in late adolescence.
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Affiliation(s)
- Francesca Solmi
- Division of Psychiatry, University College London, London, UK.
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Murray Weeks
- Directorate of Force Health Protection, Canadian Forces Health Services Group, Ottawa
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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O'Donoghue B, Roche E, Lane A. Neighbourhood level social deprivation and the risk of psychotic disorders: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2016; 51:941-50. [PMID: 27178430 DOI: 10.1007/s00127-016-1233-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The incidence of psychotic disorders varies according to the geographical area, and it has been investigated whether neighbourhood level factors may be associated with this variation. The aim of this systematic review is to collate and appraise the literature on the association between social deprivation and the incidence or risk for psychotic disorders. METHOD A systematic review was conducted, and studies were included if they were in English, provided a measure of social deprivation for more than one geographically defined area and examined either the correlation, rate ratio or risk of psychotic disorder. A defined search strategy was undertaken with Medline, CINAHL Plus and PsychInfo databases. RESULTS A total of 409 studies were identified in the search, of which 28 fulfilled the inclusion criteria. Of these, four examined the association between social deprivation at the time of birth, three examined the putative prodrome of psychosis or those at ultra-high risk (UHR) for psychosis, and 23 examined the time at presentation with a first episode of psychosis (FEP) (one study examined two time points and one study included both UHR and FEP). Three of the studies that examined the level of social deprivation at birth found an association with a higher risk for psychotic disorders and increased social deprivation. Seventeen of the 23 studies found that there was a higher risk or rate of psychotic disorders in more deprived neighbourhoods at the time of presentation; however, adjusting for individual factors tended to weaken this association. Limited research has been conducted in the putative prodromal stage and has resulted in conflicting findings. CONCLUSIONS Research conducted to date has not definitively identified whether the association is a result of social causation or social drift; however, the findings do have significant implications for service provision, such as the location and access of services.
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Affiliation(s)
- Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar rd, Parkville, VIC, 3052, Australia.
- University College Dublin, Belfield, Dublin 4, Ireland.
| | - Eric Roche
- University College Dublin, Belfield, Dublin 4, Ireland
- DETECT Early Intervention for Psychosis Service, Dublin, Ireland
| | - Abbie Lane
- University College Dublin, Belfield, Dublin 4, Ireland
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Legge SE, Hamshere M, Hayes RD, Downs J, O'Donovan MC, Owen MJ, Walters JT, MacCabe JH. Reasons for discontinuing clozapine: A cohort study of patients commencing treatment. Schizophr Res 2016; 174:113-119. [PMID: 27211516 PMCID: PMC5756540 DOI: 10.1016/j.schres.2016.05.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clozapine is uniquely effective in the management of treatment-resistant schizophrenia (TRS). However, a substantial proportion of patients discontinue treatment and this carries a poor prognosis. METHODS We investigated the risk factors, reasons and timing of clozapine discontinuation in a two-year retrospective cohort study of 316 patients with TRS receiving their first course of clozapine. Reasons for discontinuation of clozapine and duration of treatment were obtained from case notes and Cox regression was employed to test the association of baseline clinical factors with clozapine discontinuation. RESULTS A total of 142 (45%) patients discontinued clozapine within two years. By studying the reasons for discontinuations due to a patient decision, we found that adverse drug reactions (ADRs) accounted for over half of clozapine discontinuations. Sedation was the most common ADR cited as a reason for discontinuation and the risk of discontinuation due to ADRs was highest in the first few months of clozapine treatment. High levels of deprivation in the neighbourhood where the patient lived were associated with increased risk of clozapine discontinuation (HR=2.12, 95% CI 1.30-3.47). CONCLUSIONS Living in a deprived neighbourhood was strongly associated with clozapine discontinuation. Clinical management to reduce the burden of ADRs in the first few months of treatment may have a significant impact and help more patients experience the benefits of clozapine treatment.
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Affiliation(s)
- Sophie E. Legge
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Marian Hamshere
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard D. Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Johnny Downs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Michael C. O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J. Owen
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - James T.R. Walters
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK,Corresponding author at: Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK.Division of Psychological Medicine and Clinical NeurosciencesSchool of MedicineCardiff UniversityHadyn Ellis BuildingMaindy RoadCathaysCardiffCF24 4HQUK
| | - James H. MacCabe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Spatial distribution of psychotic disorders in an urban area of France: an ecological study. Sci Rep 2016; 6:26190. [PMID: 27189529 PMCID: PMC4870636 DOI: 10.1038/srep26190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/27/2016] [Indexed: 11/08/2022] Open
Abstract
Previous analyses of neighbourhood variations of non-affective psychotic disorders (NAPD) have focused mainly on incidence. However, prevalence studies provide important insights on factors associated with disease evolution as well as for healthcare resource allocation. This study aimed to investigate the distribution of prevalent NAPD cases in an urban area in France. The number of cases in each neighbourhood was modelled as a function of potential confounders and ecological variables, namely: migrant density, economic deprivation and social fragmentation. This was modelled using statistical models of increasing complexity: frequentist models (using Poisson and negative binomial regressions), and several Bayesian models. For each model, assumptions validity were checked and compared as to how this fitted to the data, in order to test for possible spatial variation in prevalence. Data showed significant overdispersion (invalidating the Poisson regression model) and residual autocorrelation (suggesting the need to use Bayesian models). The best Bayesian model was Leroux's model (i.e. a model with both strong correlation between neighbouring areas and weaker correlation between areas further apart), with economic deprivation as an explanatory variable (OR = 1.13, 95% CI [1.02-1.25]). In comparison with frequentist methods, the Bayesian model showed a better fit. The number of cases showed non-random spatial distribution and was linked to economic deprivation.
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