Aberrant salience and fatigue as mediators between early life experiences and ideas of reference

Induced ideas of reference during social unrest and pandemic in Hong Kong

Ideas of reference (IOR) are often implicated in predicting psychosis onset. They have been conceptualized to present on a continuum, from oversensitive psychological reactions to delusional thoughts. It is however unknown to what extent IOR may be triggered by collective environmental stress. We obtained timely data from 9873 individuals to assess IOR in relation to trauma exposure in the 2019-2020 social unrest in Hong Kong. Two levels of IOR are distinguished: attenuated IOR (IOR-A), being the experience of feeling particularly referred to within a group; and exclusive IOR (IOR-E), the experience of feeling exclusively referred to while others are not. Logistic regressions showed that event-based rumination was a shared predictor for IOR-A (OR = 1.07, CI = 1.03-1.10) and IOR-E (OR = 1.09, CI = 1.02-1.17). For IOR-A, three categories of social unrest-related traumatic events (TEs) were significant predictors, including being attacked or having experienced sexual violence (OR = 4.14, CI = 1.93-8.85), being arrested (OR = 4.48, CI = 1.99-10.10), and being verbally abused (OR = 2.66, CI = 1.28-5.53). Being arrested was significant for IOR-E (OR = 3.87, CI = 1.03-14.52), though not when rumination was included. Education level also significantly predicted IOR-E (OR = 0.72, CI = 0.52-0.99). Further analysis revealed that rumination significantly mediated between TEs and IOR severity (β = 0.26, SE = 0.01, CI = 0.24-0.28). The findings are consistent with the hypothesis that IOR-A and IOR-E occur as levels on a continuum, but each has some distinctive correlates. Extrinsic events may play a more prominent role in IOR-A, while intrinsic factors, such as cognitive capacity, may play a more prominent role in IOR-E. The involvement of rumination across the IOR spectrum suggests an opportunity for intervention.

Interpersonal Violence and Psychotic-Like Experiences: The Mediation of Ideas of Reference, Childhood Memories, and Dissociation

Previous studies have demonstrated the relationship between the accumulation of situations involving interpersonal violence (IV) and psychotic-like experiences. This study explored whether IV is related to aberrant salience (AS), using a sequential mediation model that included memories of relationship with parents (submission, devaluation, and threat; Early Life Experiences Scale (ELES)), ideas of reference (IR), and dissociative symptoms (absorption and depersonalization), and whether the patient/nonpatient condition moderated this effect. The sample was made of 401 participants (including 43 patients with psychotic disorders) aged 18 to 71 years (Mage = 30.43; SD = 11.19). Analysis of a serial multiple mediator model revealed that IR, ELES, absorption, and depersonalization fully mediated the effect of IV on AS, explaining 39% of the variance, regardless of the patient/nonpatient condition. The indirect paths, which place IR and dissociation (especially absorption, the variable to which the IR and ELES lead) in a primordial position for being related to AS, are discussed. This continuum model could be useful for understanding processes related to the onset of psychosis unmoderated by the patient/nonpatient condition.