The impact of social deprivation on paranoia, hallucinations, mania and depression: the role of discrimination social support, stress and trust

Ultra-high risk for psychosis stigma: an updated Systematic Review

OBJECTIVE

To clarify if stigma associated with schizophrenia has also been directed towards the ultra-high risk for psychosis (UHR) population, the present review aimed at synthetizing the existing literature to update and extend our understanding on the topic.

METHODS

A systematic PRISMA-compliant review was performed in PubMed, Embase, Cochrane and Web of Science for articles published until 30/04/2023, using a combination of search terms describing the at-risk mental states for psychosis and stigma and correlated terms.

RESULTS

Thirty-eight studies were included. Twenty-nine addressed UHR individuals directly, and 9 conducted interviews with non-patients regarding UHR. A total of 2560 UHR individuals were assessed; mean sample size was of 88.3 participants. Most of the studies were quantitative non-randomized/observational with young adults, 71.4% used SIPS (Structured Interview for Psychosis-risk Syndromes) and 25.0% used CAARMS (Comprehensive Assessment of At-Risk Mental States). Overall, the summarized studies have mainly involved individuals already attending UHR clinics from Western and high income countries. Studies can be grouped into five forms of stigma, among which the most frequently explored was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress and associative stigma. The main study design was quantitative nonrandomized, with only one interventional study. Most of the results confirmed the presence of stigma toward UHR individuals and findings provide additional support to the fact that stigma seems to be present since the very early stages of the disease.

CONCLUSION

There is still a paucity of research and knowledge gaps about UHR-related stigma. Nevertheless, results suggest the presence of stigma toward UHR individuals, supporting the fact that stigma is present since the early stages of psychosis.

Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas

The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.

Paranoid Thinking as a Function of Minority Group Status and Intersectionality: An International Examination of the Role of Negative Beliefs

BACKGROUND

Paranoia is higher in minority group individuals, especially those reporting intersecting aspects of difference. High negative and low positive self and other beliefs, and low social rank, are predictive of paranoia overtime; however, data are typically from majority group participants. This study examined whether social defeat or healthy cultural mistrust best characterizes paranoia in minority groups.

STUDY DESIGN

Using cross-sectional, survey design, with a large (n = 2510) international sample, moderation analyses (PROCESS) examined whether self and other beliefs, and perceived social rank, operate similarly or differently in minority vs majority group participants. Specifically, we tested whether beliefs moderated the influence of minority group, and intersecting aspects of difference, on paranoia.

STUDY RESULTS

Paranoia was consistently higher in participants from minority vs majority groups and level of paranoid thinking was significantly higher at each level of the intersectionality index. Negative self/other beliefs were associated with elevated paranoia in all participants. However, in support of the notion of healthy cultural mistrust, low social rank, and low positive self/other beliefs were significantly associated with paranoia in majority group participants but unrelated to paranoia in respective minority group members.

CONCLUSIONS

Although mixed, our findings signal the need to consider healthy cultural mistrust when examining paranoia in minority groups and bring into question whether "paranoia" accurately describes the experiences of marginalized individuals, at least at low levels of severity. Further research on paranoia in minority groups is crucial to developing culturally appropriate ways of understanding people's experiences in the context of victimization, discrimination, and difference.

Conceptualization of moral injury: A socio-cognitive perspective

LAY SUMMARY

This article looks at how moral injury (MI) may develop by considering what event features may be especially salient and cause MI and what experiences an individual may have after an event that might lead to the occurrence of a MI. It proposes that the beliefs someone has about themselves, others, and the world can be shaped by experiences in childhood and early life. Once an individual has experienced a potentially morally injurious event (PMIE) — for example, witnessing something that violates deeply held moral or ethical codes but being unable to stop it, doing something that violates these ethical codes, or experiencing a significant betrayal — they may try to make sense of it by changing the way they see the world, themselves, and others. This can lead to problems in the individual’s relationship with themselves and others, leading to feelings of shame and guilt and withdrawal from other people. More important, for an event to be a PMIE, it must significantly challenge strongly held moral beliefs and a sense of right and wrong.

The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe

AIMS

Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association.

METHODS

We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome.

RESULTS

High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results.

CONCLUSIONS

Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.

The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare

There is a notable disparity between the observed prevalence of schizophrenia-spectrum disorders in racialized persons in the United States and Canada and White individuals in these same countries, with Black people being diagnosed at higher rates than other groups. The consequences thereof bring a progression of lifelong punitive societal implications, including reduced opportunities, substandard care, increased contact with the legal system, and criminalization. Other psychological conditions do not show such a wide racial gap as a schizophrenia-spectrum disorder diagnosis. New data show that the differences are not likely to be genetic, but rather societal in origin. Using real-life examples, we discuss how overdiagnoses are largely rooted in the racial biases of clinicians and compounded by higher rates of traumatizing stressors among Black people due to racism. The forgotten history of psychosis in psychology is highlighted to help explain disparities in light of the relevant historical context. We demonstrate how misunderstanding race confounds attempts to diagnose and treat schizophrenia-spectrum disorders in Black individuals. A lack of culturally informed clinicians exacerbates problems, and implicit biases prevent Black patients from receiving proper treatment from mainly White mental healthcare professionals, which can be observed as a lack of empathy. Finally, we consider the role of law enforcement as stereotypes combined with psychotic symptoms may put these patients in danger of police violence and premature mortality. Improving treatment outcomes requires an understanding of the role of psychology in perpetuating racism in healthcare and pathological stereotypes. Increased awareness and training can improve the plight of Black people with severe mental health disorders. Essential steps necessary at multiple levels to address these issues are discussed.

Of precarity and conspiracy: Introducing a socio-functional model of conspiracy beliefs

Conspiracy Beliefs (CB) are a key vector of violent extremism, radicalism and unconventional political events. So far, social-psychological research has extensively documented how cognitive, emotional and intergroup factors can promote CB. Evidence also suggests that adherence to CB moves along social class lines: low-income and low-education are among the most robust predictors of CB. Yet, the potential role of precarity-the subjective experience of permanent insecurity stemming from objective material strain-in shaping CB remains largely unexplored. In this paper, we propose for the first time a socio-functional model of CB. We test the hypothesis that precarity could foster increased CB because it undermines trust in government and the broader political 'elites'. Data from the World Value Survey (n = 21,650; Study 1, electoral CB) and from representative samples from polls conducted in France (n = 1760, Study 2a, conspiracy mentality) and Italy (n = 2196, Study 2b, COVID-19 CB), corroborate a mediation model whereby precarity is directly and indirectly associated with lower trust in authorities and higher CB. In addition, these links are robust to adjustment on income, self-reported SES and education. Considering precarity allows for a truly social-psychological understanding of CB as the by-product of structural issues (e.g. growing inequalities). Results from our socio-functional model suggest that implementing solutions at the socio-economic level could prove efficient in fighting CB.

The association of physical multimorbidity with suicidal ideation and suicide attempts in England: A mediation analysis of influential factors

BACKGROUND

Suicide is one of the most important causes of deaths in the United Kingdom, and the numbers are currently increasing.

AIM

There are numerous identified determinants of suicidality, and physical multimorbidity is potentially important but is currently understudied. Thus, this study aims to investigate the association of physical multimorbidity with suicidality.

METHODS

Cross-sectional data from the Adult Psychiatric Morbidity Survey 2007, which was conducted in England between October 2006 and December 2007 by the National Center for Social Research and Leicester University were analyzed. Respondents were asked about 20 physical health conditions, and suicidal ideation and suicide attempts were assessed.

RESULTS

Out of 7,403 individuals aged 16 years or over, the prevalence of physical multimorbidity, suicidal ideation, and suicide attempts were 35.1%, 4.3%, and 0.7%, respectively. After adjustment for potential confounders, compared to no physical conditions, 1, 2, 3, and ⩾4 conditions were associated with significant 1.79 (95% CI [1.25, 2.57]), 2.39 (95% CI [1.63, 3.51]), 2.88 (95% CI [1.83, 4.55]), and 6.29 (95% CI [4.12, 9.61]) times higher odds for suicidal ideation. Mediation analysis showed that cognitive problems (mediated percentage 39.2%) and disability (37.5%) explained the largest proportion between multimorbidity and suicidal ideation. Pain (38.0%) and cognitive problems (30.7%) explained the largest proportion between multimorbidity and suicide attempts.

CONCLUSION

In this large sample of UK adults, physical multimorbidity was associated with significantly higher odds for suicidal ideation and suicide attempts. Moreover, several potential mediators were identified, and these may serve as future targets for interventions that aim to prevent suicidality among people with physical multimorbidity.

Progressive and degenerative journals: on the growth and appraisal of knowledge in scholarly publishing

Despite continued attention, finding adequate criteria for distinguishing "good" from "bad" scholarly journals remains an elusive goal. In this essay, I propose a solution informed by the work of Imre Lakatos and his methodology of scientific research programmes (MSRP). I begin by reviewing several notable attempts at appraising journal quality - focusing primarily on the impact factor and development of journal blacklists and whitelists. In doing so, I note their limitations and link their overarching goals to those found within the philosophy of science. I argue that Lakatos's MSRP and specifically his classifications of "progressive" and "degenerative" research programmes can be analogized and repurposed for the evaluation of scholarly journals. I argue that this alternative framework resolves some of the limitations discussed above and offers a more considered evaluation of journal quality - one that helps account for the historical evolution of journal-level publication practices and attendant contributions to the growth (or stunting) of scholarly knowledge. By doing so, the seeming problem of journal demarcation is diminished. In the process I utilize two novel tools (the mistake index and scite index) to further illustrate and operationalize aspects of the MSRP.

Symptoms of Paranoia Experienced by Students of Pakistani Heritage in England: The Role of Explicit and Implicit Identities and Perceived Discrimination

ABSTRACT

Individuals belonging to ethnic minority groups are less likely to experience symptoms of psychosis, such as paranoia, if they live in areas with high proportions of people from the same ethnic background. This effect may be due to processes associated with group belonging (social identification). We examined whether the relationship between perceived discrimination and paranoia was moderated by explicit and implicit Pakistani/English identification among students of Pakistani heritage (N = 119). Participants completed measures of explicit and implicit Pakistani and English identity, a measure of perceived discrimination, and a measure of paranoia. Perceived discrimination was the strongest predictor of paranoia (0.31). Implicit identities moderated the relationship between perceived discrimination and paranoia (-0.17). The findings suggest that higher levels of implicit Pakistani identity were most protective against high levels of paranoia (0.26, with low implicit English identity; 0.78, with medium English identity; 1.46, with high English identity). Overall, a complex relationship between identity and paranoia was apparent.

Index of multiple deprivation contributed to common psychiatric disorders: A systematic review and comprehensive analysis

BACKGROUND

Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders.

METHODS

56,613-106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0.

RESULT

Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education.

CONCLUSION

Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism.

Paranoia and Suicidality: A Cross-Sectional Study in the General Population

Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green's Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7-7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta²: .065); 0.5% (95% CI: 0.32-0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.

Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis

Importance

Depression is the leading cause of mental health-related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain.

Objective

To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults.

Data Sources

PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020.

Study Selection

We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up.

Data Extraction and Synthesis

Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood.

Main Outcomes and Measures

The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument.

Results

Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P < .001). Relative to adults not reporting any activity, those accumulating half the recommended volume of physical activity (4.4 marginal metabolic equivalent task hours per week [mMET-h/wk]) had 18% (95% CI, 13%-23%) lower risk of depression. Adults accumulating the recommended volume of 8.8 mMET hours per week had 25% (95% CI, 18%-32%) lower risk with diminishing potential benefits and higher uncertainty observed beyond that exposure level. There were diminishing additional potential benefits and greater uncertainty at higher volumes of physical activity. Based on an estimate of exposure prevalences among included cohorts, if less active adults had achieved the current physical activity recommendations, 11.5% (95% CI, 7.7%-15.4%) of depression cases could have been prevented.

Conclusions and Relevance

This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

The journey of adolescent paranoia: A qualitative study with patients attending child and adolescent mental health services

OBJECTIVES

Paranoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen outcomes. However, little is known about clinical presentations of paranoia at this age. We therefore explored the development, experience, and impact of paranoia in adolescent patients.

DESIGN

A qualitative interview design with interpretative phenomenological analysis was used.

METHOD

Twelve adolescents (11-17 years) with paranoia attending child and adolescent mental health services were interviewed.

RESULTS

Adolescents described a journey starting with their awareness of paranoia beginning to a paranoid experience of mistrust and fear of others, and, subsequently, their adjustment to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experiences. The paranoia experience included a struggle to trust friends, anticipating threat with intense fear, and using defensive strategies to keep safe. Adolescents described how the paranoia experience was confusing, negatively impacted self-concept, held them back from teenage life, and caused disconnection from friends. Longer-term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact.

CONCLUSIONS

The journey of paranoia in adolescence involves navigating multiple tensions, with young people balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Decisions about how to respond to paranoia are likely to determine the next stage of their journey.

Empathy, Emotion Recognition, and Paranoia in the General Population

Background

Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia.

Methods

Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults (n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition.

Results

Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia (p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear (p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition (p = 0.002). All indirect paths through emotion recognition were non-significant.

Discussion

These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations.

Testing whether implicit emotion regulation mediates the association between discrimination and symptoms of psychopathology in late childhood: An RDoC perspective

Discrimination has been associated with adverse mental health outcomes, though it is unclear how early in life this association becomes apparent. Implicit emotion regulation, developing during childhood, is a foundational skill tied to a range of outcomes. Implicit emotion regulation has yet to be tested as an associated process for mental illness symptoms that can often emerge during this sensitive developmental period. Youth aged 9-11 were recruited for the Adolescent Brain Cognitive Development (ABCD) study. Associations between psychotic-like experiences, depressive symptoms, and total discrimination (due to race, ethnicity, nationality, weight, or sexual minority status) were tested, as well as associations with implicit emotion regulation measures (emotional updating working memory and inhibitory control). Analyses examined whether associations with symptoms were mediated by implicit emotion regulation. Discrimination related to decreased implicit emotion regulation performance, and increased endorsement of depressive symptoms and psychotic-like experiences. Emotional updating working memory performance partially mediated the association between discrimination and psychotic-like experiences, while emotional inhibitory control did not. Discrimination and implicit emotion regulation could serve as putative transdiagnostic markers of vulnerability. Results support the utility of using multiple units of analysis to improve understanding of complex emerging neurocognitive functions and developmentally sensitive periods.

Robust association between autistic traits and psychotic-like experiences in the adult general population: epidemiological study from the 2007 Adult Psychiatric Morbidity Survey and replication with the 2014 APMS

BACKGROUND

Studies have shown that there are overlapping traits and symptoms between autism and psychosis but no study to date has addressed this association from an epidemiological approach in the adult general population. Furthermore, it is not clear whether autistic traits are associated with specific symptoms of psychosis or with psychosis in general. We assess these associations for the first time by using the Adult Psychiatric Morbidity Survey (APMS) 2007 and the APMS 2014, predicting an association between autistic traits and probable psychosis, and specific associations between autistic traits and paranoia and strange experiences.

METHODS

Participants (N = 7353 in 2007 and 7500 in 2014) completed the Psychosis Screening Questionnaire (PSQ) and a 20-item version of the Autism Quotient (AQ-20). Binomial logistic regressions were performed using AQ-20 as the independent variable and probable psychosis and specific symptoms as dependent variables.

RESULTS

In the APMS 2007 dataset, significant associations were found between autism traits and probable psychosis, paranoia, thought insertion, and strange experiences. These results were replicated in APMS 2014 but with the additional significant association between autistic traits and hallucinations. Participants in the highest quartile of the AQ-20, compared with the lowest quartile, had an increased risk of probable psychosis of odds ratio (OR) = 15.5 [95% confidence interval (CI) 4.57-52.6] in APMS 2007 and OR = 22.5 (95% CI 7.64-66.3) in APMS 2014.

CONCLUSIONS

Autistic traits are strongly associated with probable psychosis and psychotic experiences with the exception of mania. Limitations such as the cross-sectional nature of the study are discussed.

The roles of coalitional threat and safety in paranoia: A network approach

OBJECTIVE

Paranoia is known to vary with levels of coalitional threat and safety present in the social environment. However, it remains underexplored whether threat and safety are differentially associated with paranoia, if these relationships vary with the source of threat and safety, and whether such effects hold across the continuum of severity of paranoid thoughts.

METHODS

We employed a network analysis approach with community analysis on a large dataset (n = 6,337), the UK Adult Psychiatric Morbidity Survey 2007, to explore these questions. We included one node to capture paranoia typical in the general population, and one pertaining to thought interference common in persecutory delusions in psychosis.

RESULTS

Nodes reflecting paranoia in the general population as well as persecution-related concerns in psychosis shared the strongest positive edges with nodes representing threat stemming from close social relationships. Paranoia common in the general population was negatively associated with both safety stemming from the wider social environment, and safety in close relationships, where the former association was strongest.

CONCLUSIONS

Our results suggest that threat from within one's immediate social group is more closely linked to paranoid thoughts than is safety from either one's social group or the wider social environment. Further, our results imply that coalitional threat may be a particularly associated with concerns common in psychosis, whereas paranoid ideation more common in the general population is also associated with reduced coalitional safety. Overall, this network analysis offers a broad view of how paranoia relates to multiple aspects of our coalitional environment and provides some testable predictions for future research in this area.

PRACTITIONER POINTS

Individuals with paranoia more typical of delusions may find threat in close social relationships most challenging Variation in paranoia in the general population may be attributed to feeling safe in the wider social environment more than in close social relationships.

Adverse Social Relationships in Childhood: Are there Links with Depression, Obsessive-Compulsive Disorder and Suicidality in Adulthood?

This study aimed to (i) explore the association between perceptions of negative social relationships in childhood with significant others, including peers, guardians and teachers, symptoms of depression and OCD, and suicide behaviors, and (ii) examine whether depression and OCD severity meditated the association between these perceptions and suicide experiences. In total, 783 individuals from the community were invited to complete self-report measures. There were strong associations between perceptions of adverse social relationships in childhood, severity of depression and OCD, and suicide behaviors. Furthermore, depression and OCD partially mediated the association between perceptions of adverse social relationships, especially with peers, and suicide behaviors. These results provide strong evidence for the importance of developing clinical interventions that directly target negative experiences of social relationships in childhood, and for raising public and scientific awareness that everyday adverse social interactions with significant others can impact negatively on mental health including suicide behaviors.

Work Stress Hampering Employee Performance During COVID-19: Is Safety Culture Needed?

During uncertain situations, such as the COVID-19 partial lockdown, maintaining satisfactory levels of employee performance (EP) is an important area of concern for many organizations. The current study examines the relationship of work stress due to COVID-19 (COVID-19 STR) and EP. Using social exchange theory (SET), safety culture (SC) is presented as a moderator for stress and performance relationships. A sample of 213 bank employees was collected using a convenient sampling method. Data were analyzed using stepwise linear regression and PROCESS Macro by Hayes (2013). Results revealed that COVID-19 STR has a negative impact on task and contextual performance (CP) and a positive impact on adaptive performance (AP). Similarly, the prevalence of SC significantly moderates the stress and performance relationships.

Association of Self-Perceived Psychological Stress with the Periodontal Health of Socially Deprived Women in Shelter Homes

The present study aimed to assess the effect of self-perceived psychological stress on the periodontal health of socially deprived women. The study included three hundred and eighty-five socially deprived women residing in shelter homes. The presence of stress and its severity was assessed by using Sheldon Cohen's 10-item perceived stress scale (PSS), and periodontal health status was assessed utilizing the community periodontal index. Statistical analyses were performed using an independent sample t-test, a one-way ANOVA, the Pearson chi-Square test, and binary logistic regression. Results: A total of 385 samples were included, the majority of whom (n = 297; 72.5%) belonged to the age group of 15-30 years. There were 34 (8.8%) participants who were educated up to graduate level. A total of 47.8% of the women were found with healthy periodontal status, and 52.5% of the samples were diagnosed with major psychological stress. Half of the samples (201-52.2%) had a periodontal problem. The mean PSS was found statistically significant concerning age group, education, and psychological stress level. In the univariate logistic regression analysis, a significant association of periodontal status was observed with the age group 31-45 years [(OR = 1.76; 95% C.I (1.11-2.78)] and with a major psychological stress level [(OR = 2.60; 95% C.I (1.72-3.93)]. Psychosocial stress among socially deprived women was found to be a risk factor for periodontal disease.

Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study

Background

People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.

Objectives

The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.

Design

Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews.

Setting

The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber).

Participants

The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff.

Data sources

The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation.

Results

People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’).

Limitations

Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices.

Conclusions

People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone.

Future work

These findings can inform the development of targeted interventions aimed at addressing inequalities in this population.

Study registration

National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921.

Funding

This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.

The relationship between ingroup identity and Paranoid ideation among people from African and African Caribbean backgrounds

OBJECTIVES

People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self-esteem and locus of control) and moderating (contact with White British people) factors.

DESIGN

Cross-sectional quantitative survey design.

METHODS

We recruited 335 people from African and African Caribbean backgrounds who completed online self-report measures of identification with Great Britain, self-esteem, locus of control, positive and negative contact with White British people, and paranoia.

RESULTS

A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self-esteem was not implicated in either pathway.

CONCLUSIONS

Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations.

PRACTITIONER POINTS

People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences. Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative. It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control. Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology.

Inégalités sociales de santé et médecine d’urgence

En France, le système de santé est basé sur un principe d’universalité et les indicateurs macroscopiques y sont satisfaisants. Toutefois, des inégalités de santé persistent touchant particulièrement les populations vulnérables. Celles-ci peuvent voir s’ériger des barrières financières, institutionnelles ou cognitives qui entravent leur accès aux soins et participent à l’altération de leur état de santé. L’exercice de la médecine d’urgence n’est pas exempté des problématiques soulevées par ces inégalités sociales de santé qu’il s’agisse : du rôle des services d’urgence dans la sanctuarisation de l’accès aux soins ; des pathologies urgentes plus fréquentes ou plus graves observées parmi les populations les plus vulnérables ; de la qualité des soins administrés qui est parfois suboptimale. La première partie de cet article indique ce qui définit la vulnérabilité d’une population puis il présente les spécificités des prises en charge aux urgences. Il détaille ensuite les barrières à l’accès aux soins qui persistent ainsi que les répercussions du renoncement sur le recours aux services d’urgence. Enfin, l’exemple du contexte actuel de la pandémie du Sars-Cov2 permet de mettre en lumière les nombreuses interactions qui existent entre vulnérabilité et état de santé. Les questions de l’organisation de l’offre de soins en amont des urgences et des conditions réelles de son accessibilité pour tous sont des éléments fondamentaux qui impactent la pratique de la médecine d’urgence. Il appartient aussi aux professionnels de s’en saisir et de mobiliser avec force les décideurs publics sur ces sujets.

Social reward, punishment, and prosociality in paranoia

Paranoia is the exaggerated belief that harm will occur and is intended by others. Although commonly framed in terms of attributing malicious intent to others, recent work has explored how paranoia also affects social decision-making, using economic games. Previous work found that paranoia is associated with decreased cooperation and increased punishment in the Dictator Game (where cooperating and punishing involve paying a cost to respectively increase or decrease a partner's income). These findings suggest that paranoia might be associated with variation in subjective reward from positive and/or negative social decision-making, a possibility we explore using a preregistered experiment with U.S.-based participants (n = 2,004). Paranoia was associated with increased self-reported enjoyment of negative social interactions and decreased self-reported enjoyment of prosocial interactions. More paranoid participants attributed stronger harmful intent to a partner. Harmful intent attributions and the enjoyment of negative social interactions positively predicted the tendency to pay to punish the partner. Cooperation was positively associated with the tendency to enjoy prosocial interactions and increased with participant age. There was no main effect of paranoia on tendency to cooperate in this setting. We discuss these findings in light of previous research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses : A systematic literature review

PURPOSE

Suicide deaths are a major concern in people with schizophrenia diagnoses. However, many people with such diagnoses do not attempt suicide, nor die by suicide, suggesting that some individuals are resilient to the impact of suicide triggers. This systematic literature review aimed to (1) appraise the evidence for psychological factors which confer resilience to suicidal thoughts and behaviours, and (2) categorize these psychological factors into broader psychological constructs which characterize resilience.

METHODS

The review was conducted in accordance with the PRISMA guidelines for the reporting of systematic reviews. A literature search of four electronic databases (Web of Science, PubMed, PsycINFO, and MEDLINE) was conducted. A quality evaluation of the included studies was carried out by two independent researchers using a quality assessment tool.

RESULTS

Psychological factors from 27 studies were categorized into four constructs: (1) perceived social support, (2) holding religious and spiritual beliefs, (3) identifying reasons for living, and (4) perceived positive personal skills and attributes.

CONCLUSIONS

The limited literature showed that resilience is important in understanding suicidal thoughts and behaviours in people with schizophrenia diagnoses. There is a need for prospective research that investigates moderating effects of psychological resilience in the pathways to suicidal thoughts and behaviours in people with schizophrenia diagnoses.

PRACTITIONER POINTS

Novel evidence for four psychological constructs which may confer resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses. Strong evidence for the impact of perceived social support and appraisals of personal skills and attributes on the severity of suicidal experiences in people with schizophrenia diagnoses. There was equivocal evidence for the effect of holding religious and spiritual beliefs on suicide attempts. Clinical practice would benefit from assessing perceived personal attributes and levels of social support from significant others and health professionals.

Development and validation of the cancer symptoms discrimination scale: a cross-sectional survey of students in Yunnan, China

Background

This study aimed to devise a Cancer symptoms Discrimination Scale (CSDS) suitable for China based on a cross-sectional survey.

Methods

The CSDS was developed using the classical measurement theory. A total of 3610 students from Yunnan province, China, participated in the cross-sectional survey. The test version of the scale was modified by the item analysis method, and after the official version of CSDS was developed, its reliability and validity were verified. A univariate analysis of variance and a multiple linear regression model were used to analyze the influencing factors of cancer symptoms discrimination among the university/college students.

Results

There were 21 items in total for the CSDS, including 3 subscales --- common clinical manifestations (11 items), physical appearance defects (6 items), and drainage tube(s) wearing (4 items). This CSDS had good validity (GFI = 0.930, AGFI = 0.905, RMR = 0.013, I-CVIs> 0.80, and the Pearson correlation coefficient was satisfactory.) and reliability (Cronbach’s alpha = 0.862, spearman-brown coefficient = 0.875). The multiple linear regression showed that certain factors may affect the students’ discrimination level against cancer symptoms (P < 0.05), including gender, major, current education degree, guardian’s highest record of formal schooling, self-rated health status, history of care for cancer patients, family relationship, ways of cancer knowledge acquisition, good/poor understanding of cancer-related information, degree of cancer fear, and their perception of cancer infectiousness.

Conclusion

This CSDS, with good reliability and validity, can be used for the evaluation of the discrimination risk and levels against cancer symptoms among healthy students.

Sexual minority status and symptoms of psychosis: The role of bullying, discrimination, social support, and drug use - Findings from the Adult Psychiatric Morbidity Survey 2007

OBJECTIVE

Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk.

METHODS

The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson-Holm-Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio-demographic confounders were included in analyses.

RESULTS

Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia.

CONCLUSIONS

Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross-sectional nature of the study limits direct inference about causality of such symptoms.

PRACTITIONER POINTS

Sexual minority groups may be more likely to experience symptoms of paranoia. It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups.

The association of loneliness after sudden bereavement with risk of suicide attempt: a nationwide survey of bereaved adults

PURPOSE

We aimed to test the hypothesis that among people who experience sudden bereavement, loneliness is associated with post-bereavement suicide attempt and post-bereavement suicidal ideation, even when adjusting for network size.

METHODS

We analysed cross-sectional data collected in the 2010 UCL Bereavement Study, to identify 3193 respondents who had experienced sudden bereavement. We used multivariable logistic regression to test for an association between loneliness (using a newly-developed eight-item loneliness measure) and post-bereavement suicide attempt and suicidal ideation, adjusting for socio-demographic factors, pre-bereavement depression and self-harm, and network size.

RESULTS

Among bereaved adults, loneliness was significantly associated with probability of post-bereavement suicide attempt (AOR 1.19; 95% CI 1.14-1.25) and of post-bereavement suicidal ideation (AOR 1.24; 95% CI 1.20-1.28), with estimates unchanged by adding perceived stigma of the bereavement to adjusted models. There was no association between suicide bereavement and loneliness (adjusted coefficient 0.22; 95% CI - 0.12 to 0.45; p = 0.063). The association of loneliness and suicide attempt risk was similar whether participants were bereaved by suicide or not.

CONCLUSIONS

People who report feeling lonely after sudden bereavement are more likely to make a suicide attempt after their loss, even when taking into account their network size and the perceived stigma of the sudden bereavement. There is no evidence that the effects of loneliness on suicidality are specific to suicide bereavement. This work identifies loneliness as a potential target for suicide prevention interventions among bereaved people. It also fuels interest in longitudinal research investigating loneliness as a putative mediator of suicide risk.

Dopamine manipulations modulate paranoid social inferences in healthy people

Altered dopamine transmission is thought to influence the formation of persecutory delusions. However, despite extensive evidence from clinical studies there is little experimental evidence on how modulating the dopamine system changes social attributions related to paranoia, and the salience of beliefs more generally. Twenty seven healthy male participants received 150mg L-DOPA, 3 mg haloperidol, or placebo in a double-blind, randomised, placebo-controlled study, over three within-subject sessions. Participants completed a multi-round Dictator Game modified to measure social attributions, and a measure of belief salience spanning themes of politics, religion, science, morality, and the paranormal. We preregistered predictions that altering dopamine function would affect (i) attributions of harmful intent and (ii) salience of paranormal beliefs. As predicted, haloperidol reduced attributions of harmful intent across all conditions compared to placebo. L-DOPA reduced attributions of harmful intent in fair conditions compared to placebo. Unexpectedly, haloperidol increased attributions of self-interest about opponents' decisions. There was no change in belief salience within any theme. These results could not be explained by scepticism or subjective mood. Our findings demonstrate the selective involvement of dopamine in social inferences related to paranoia in healthy individuals.

Family support and adaptation mechanisms of adults outpatients with schizophrenia

Background: The presence of psychotic symptoms in adults’ with schizophrenia need an increase in family control and support to prevent the risk of aggressive behavior. However, the issue of whether psychotic symptoms hold any clinical relevance in relatively stable outpatient samples has not been established. The purpose of this study, therefore, was to identify the relationship between family supports and adaptation mechanisms of adults’ outpatients with schizophrenia.

Design and methods: The study design involves quantitative research and descriptive correlation, attained through purposive sampling approach. 101 samples were obtained from the population of schizophrenia outpatients. The questionnaires of House & Kahn were used as an instrument to evaluate family support, while Nursalam questionnaires were used to access adaptation skills.

Results: Findings from Spearman’s rho test showed P<0.005, indicating the provision of high family support, while patients were highly adaptive to the symptoms of schizophrenia.

Conclusions: This study indicates the positive influence of family support on the adaptability of schizophrenia outpatients, hence there is need for relatives to provide good level of support, in order to facilitate adaptability.

Shame, social deprivation, and the quality of the voice-hearing relationship

OBJECTIVES

Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice-hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them.

DESIGN

The study utilized a cross-sectional, Internet-based design.

METHODS

Eighty-seven adult voice-hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data.

RESULTS

Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice-hearing beliefs/relationships but not positive voice-hearing beliefs/relationships. Principal component analysis on the eight voice-hearing variables yielded two components related to positive and negative voice-hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice-hearing qualities.

CONCLUSIONS

The results suggest that therapies that target shame may be helpful when working with negative voice-hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship.

PRACTITIONER POINTS

The results contribute to the limited research evidence available regarding the relationship between shame and voice-hearing. The results suggest the utility of psychological therapies that focus on shame such as compassion-focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy. No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom. Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice-hearing experiences and to examine other factors that may predict shame.

Perceived ethnic discrimination as a risk factor for psychotic symptoms: a systematic review and meta-analysis

BACKGROUND

Previous studies have shown an elevated risk of psychotic symptoms (PS) and experiences (PEs) among ethnic minority groups, with significant variation between groups. This pattern may be partially attributable to the unfavorable socio-environmental conditions that surround ethnic minority groups. Perceived ethnic discrimination (PED) in particular has been a salient putative risk factor to explain the increased risk.

METHODS

We conducted a systematic literature review and meta-analysis to assess the impact of PED on reporting PS/PEs in ethnic minorities. This review abides by the guidelines set forth by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The included studies were obtained from the databases: Medline, PsycINFO, and Web Of Science. Sub-group analyses were performed assessing the effect of PED in different subtypes of PS, the influence of ethnicity and moderating/mediating factors.

RESULTS

Seventeen studies met the inclusion criteria, and nine were used to conduct the meta-analysis. We found a positive association between PED and the occurrence of PS/PEs among ethnic minorities. The combined odds ratio were 1.77 (95% CI 1.26-2.49) for PS and 1.94 (95% CI 1.42-2.67) for PEs. We found that the association was similar across ethnic groups and did not depend on the ethnic origin of individuals. Weak evidence supported the buffering effects of ethnic identity, collective self-esteem and social support; and no evidence supported the moderating effect of ethnic density. Sensitivity to race-based rejection significantly but only slightly mediated the association.

CONCLUSION

These findings suggest that PED is involved in the increased risk of PS/PEs in ethnic minority populations.

Investigating the role of hallucinatory experiences in the transition from suicidal thoughts to attempts

OBJECTIVE

Psychotic experiences, including auditory hallucinatory experiences (HEs), are strongly associated with both suicidal thoughts and behaviour. This study examined their role in the ideation-to-attempt transition in adolescents, including their direct and indirect effect via potential mediators.

METHOD

Participants were from an Australian prospective longitudinal cohort of 1669 adolescents (12-17 years); of which a subsample endorsing baseline suicidal ideation (n = 216) was the focus of most analyses. Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess auditory HEs. Potential mediators of interest were psychological distress and Interpersonal Theory of Suicide (IPTS) constructs.

RESULTS

Among adolescents reporting suicidal ideation at baseline (n = 216), 6.5% had attempted suicide during follow-up. The size of auditory HEs' univariate effect suggests a possible strong relationship with increased risk of incident suicide attempts (OR = 2.40; 95%CI = 0.76-7.56); however, there was inadequate statistical power to produce a precise estimate. When HEs were accompanied by distress there was a nine-fold increased risk of acting on suicidal thoughts. Distress was independently associated with risk of attempt transition (OR = 4.09), whereas IPTS constructs were poor explanatory variables in most models.

CONCLUSION

Adolescents with psychological distress and auditory HEs are at high risk of incident suicide attempts. Further investigations on the role of negative/distressing content of hallucinations in the ideation-to-attempt transition are warranted.

Evidence for Specific Associations Between Depressive Symptoms, Psychotic Experiences, and Suicidal Ideation in Chilean Adolescents From the General Population

Associations between psychotic experiences and suicidal ideation are not yet fully understood, and the potential role of depressive symptoms in this relationship remains unclear. The current study examined relationships between depressive symptoms (DS), psychotic experiences (PE) and suicidal ideation (SI) using two complementary approaches on cross-sectional data from a community sample of adolescents aged 13-19 years (N = 1,591). First, we investigated the association between the three domains using mediation analysis, showing that depressive symptoms partly mediate the relationship between psychotic experiences and suicidal ideation. Second, we looked at associations between the three domains at item level using network analysis. Specific associations between symptoms of the three domains were found, indicating depressive symptoms of sadness, avolition, pessimism, and self-criticalness/worthlessness as the most central symptoms in the network. Suicidal ideation was associated with the depressive symptoms pessimism and worthlessness, to social anxiety, and to perceptual anomalies. Our results show that the mediating effect of depressive symptoms between psychotic experiences and suicidal ideation may be due to associations between specific aspects of SI, depressive symptoms and psychotic experiences. These findings can contribute to the planning of health services and programs aimed at the timely detection of psychopathology and suicidal risk in young people.

Chronic stress, structural exposures and neurobiological mechanisms: A stimulation, discrepancy and deprivation model of psychosis

Chronic stress exposure has been established as a key vulnerability factor for developing psychotic disorders, including schizophrenia. A structural, or systems level perspective, has often been lacking in conceptualizations of chronic stress for psychotic disorders. The current review thus identified three subtypes of structural exposures. Stimulation exposures included urban environments, population density and crime exposure, with intermediary mechanisms of lack of safety and high attentional demands. Underlying neural mechanisms included threat neural circuits. Discrepancy exposures included environmental ethnic density, income inequality, and social fragmentation, with intermediary mechanisms of lack of belonging and social exclusion, and neural mechanisms including the oxytocin system. Deprivation exposures included environments lacking socioeconomic, educational, or material resources, with intermediary mechanisms of lack of needed environmental enrichment, and underlying neural mechanisms of over-pruning and protracted PFC development. Delineating stressor etiology at the systems level is a necessary step in reducing barriers to effective interventions and health policy.

Perceived Discrimination, Depression, and the Role of Perceived Social Support as an Effect Modifier in Korean Young Adults

OBJECTIVES

The relationships among discrimination, social support, and mental health have mostly been studied in minorities, and relevant studies in the general population are lacking. We aimed to investigate associations between discrimination and depressive symptoms in Korean non-minority young adults, considering the role of social support.

METHODS

In total, 372 participants who completed the psychological examinations conducted in the third wave of the Jangseong High School Cohort study were included. We used the Everyday Discrimination Scale to evaluate perceived discrimination and the Beck Depression Inventory-II to measure depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support. Multivariate linear regression was conducted to investigate associations between discrimination and depression, along with the effect modification of social support. We stratified the population by gender to investigate gender differences.

RESULTS

Perceived discrimination was significantly associated with depressive symptoms (β=0.736, p<0.001), and social support was negatively associated with depression (β=-0.245, p<0.001). In men, support from friends was the most influential factor (β=-0.631, p=0.011), but no significant effect modification was found. In women, support from family was the most influential factor (β=-0.440, p=0.010), and women with higher familial support showed a significantly diminished association between discrimination and depression, unlike those with lower family support.

CONCLUSIONS

Discrimination perceived by individuals can lead to depressive symptoms in Korean young adults, and this relationship can may differ by gender and social support status.

Does your neighborhood protect you from being depressed? A study on social trust and depression in Indonesia

BACKGROUND

Prevalence of depression in Indonesia is estimated at about 3.7% of the total population, although the actual may be higher. Studies worldwide have linked the environment where people live to their mental health status. However, little research is found in Indonesia regarding this link. We examined the association between individuals' perception towards their neighborhood and their depression symptoms.

METHODS

Social trust was measured at the individual (level 1) and community (level 2) levels based on the Indonesian Family Life Survey 5 (IFLS5) in 2014. Depression was measured using the 10-item Center for Epidemiologic Studies-Depression Scale Revised (CESD-R-10) and the scores were transformed into logit form using the Rasch model. Multilevel regression was used to determine correlations.

RESULTS

Of the total sample of 14,227 respondents in this study, about 19.4% had experienced severe depression symptoms in the past week. Social trust was found to be significantly associated with severe depression symptoms. The weaker the individuals' social trust towards their neighbourhood, the higher the probability of experiencing severe depression symptoms would be.

CONCLUSIONS

This study shows that social trust is associated with the severity of depression symptoms: the higher the social trust, the lower the probability of having severe depression symptoms is. Depression symptoms may also be attributed to significant differences between communities.

Physical activity and depression: Towards understanding the antidepressant mechanisms of physical activity

Physical activity can treat and prevent depressive symptoms, but its antidepressant mechanisms are yet to be established. In this review, we comprehensively assess key biological and psychosocial mechanisms through which physical activity exerts antidepressant effects, with a particular focus on exercise. Exercise, a subset of physical activity, influences a range of biological and psychosocial processes also implicated in the pathophysiology of depression. We focus on the capacity for exercise to elicit changes in neuroplasticity, inflammation, oxidative stress, the endocrine system, self-esteem, social support and self-efficacy. We also discuss how a better understanding of these mechanisms can inform the way we design and implement exercise-based interventions to maximise their antidepressant effects on an individual basis. We conclude by presenting a conceptual framework of the key biological and psychosocial mechanisms underlying the relationship between physical activity and depressive symptoms, and the moderators and confounders that may influence it.

Perceived discrimination and psychotic experiences in the English general population

BACKGROUND

Perceived discrimination has been linked to psychotic experiences (PEs). However, as yet, information is lacking on the relationship between different forms of discrimination and PEs. This study examined this association in the English general population.

METHODS

Nationally representative, cross-sectional data were analyzed from 7363 adults aged 16 and above that came from the Adult Psychiatric Morbidity Survey, 2007. Self-reported information was obtained on six forms of discrimination (ethnicity, sex, religious beliefs, age, physical health problems/disability, sexual orientation), while PEs were assessed with the Psychosis Screening Questionnaire (PSQ). Multivariable logistic regression analysis was used to assess associations.

RESULTS

In a fully adjusted logistic regression analysis, any discrimination was significantly associated with PEs (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.75-3.48). All individual forms of discrimination were significantly associated with PEs except sexual orientation. Multiple forms of discrimination were associated with higher odds for PEs in a monotonic fashion with those experiencing ≥ 3 forms of discrimination having over 5 times higher odds for any PE. In addition, experiencing any discrimination was associated with significantly increased odds for all individual forms of PE with ORs ranging from 2.16 (95%CI: 1.40-3.35) for strange experience to 3.36 (95%CI: 1.47-7.76) for auditory hallucination.

CONCLUSION

Different forms of discrimination are associated with PEs in the general population. As discrimination is common at the societal level, this highlights the importance of public policy and evidence-based interventions to reduce discrimination and improve population mental health.

Are socioenvironmental factors associated with psychotic symptoms in people with first-episode psychosis? A cross-sectional study of a West London clinical sample

OBJECTIVES

To determine whether neighbourhood-level socioenvironmental factors including deprivation and inequality predict variance in psychotic symptoms after controlling for individual-level demographics.

DESIGN

A cross-sectional design was employed.

SETTING

Data were originally collected from secondary care services within the UK boroughs of Ealing, Hammersmith and Fulham, Wandsworth, Kingston, Richmond, Merton, Sutton and Hounslow as part of the West London First-Episode Psychosis study.

PARTICIPANTS

Complete case analyses were undertaken on 319 participants who met the following inclusion criteria: aged 16 years or over, resident in the study's catchment area, experiencing a first psychotic episode, with fewer than 12 weeks' exposure to antipsychotic medication and sufficient command of English to facilitate assessment.

OUTCOME MEASURES

Symptom dimension scores, derived from principal component analyses of the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms, were regressed on neighbourhood-level predictors, including population density, income deprivation, income inequality, social fragmentation, social cohesion, ethnic density and ethnic fragmentation, using multilevel regression. While age, gender and socioeconomic status were included as individual-level covariates, data on participant ethnicity were not available.

RESULTS

Higher income inequality was associated with lower negative symptom scores (coefficient=-1.66, 95% CI -2.86 to -0.46, p<0.01) and higher levels of ethnic segregation were associated with lower positive symptom scores (coefficient=-2.32, 95% CI -4.17 to -0.48, p=0.01) after adjustment for covariates.

CONCLUSIONS

These findings provide further evidence that particular characteristics of the environment may be linked to specific symptom clusters in psychosis. Longitudinal studies are required to begin to tease apart the underlying mechanisms involved as well as the causal direction of such associations.

Perceived discrimination and psychosis: a systematic review of the literature

PURPOSE

Higher rates of psychosis have been reported in minority groups. Since individuals belonging to such groups are vulnerable to the experiences of discrimination, and in line with models proposing that social and life adversity may play a causal role in development and maintenance of psychotic experiences, it has been proposed that perceived discrimination may represent an important determinant of psychotic experiences. This paper reviews the literature examining the relationship between perceived discrimination and psychosis, examining whether discrimination is associated with an increased risk of psychosis, the severity of psychotic symptoms and whether there is an association with specific psychotic symptoms.

METHODS

A systematic database search of PsycINFO, Embase and PubMed was conducted to identify quantitative cross-sectional and prospective studies that examined the association between discrimination and psychosis.

RESULTS

Twenty-four studies met the inclusion criteria, four of which used prospective designs and twenty used cross-sectional designs. The main findings indicated that discrimination may be associated with an increased risk of psychosis (too few studies to determine whether discrimination is associated with severity). Some studies found associations between discrimination and positive psychotic experiences and/or specific psychotic experiences such as paranoia. A small number of studies found that greater exposure to discrimination was associated with a greater likelihood of reporting psychotic experiences, tentatively indicating a dose-response relationship.

CONCLUSIONS

This review indicates that discrimination plays an important role in the experience of psychosis; however, future research is required to clarify the nature of this relationship. Avenues for further research and clinical implications are proposed.

Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study

Our goal was to examine the association between physical multimorbidity and subjective cognitive complaints (SCC) using UK nationally representative cross-sectional community-based data, and to quantify the extent to which a broad range of mainly psychological and behavioral factors explain this relationship. Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed [N = 7399 adults, mean (SD) age 46.3 (18.6) years, 48.6% men]. Multimorbidity was defined as ≥2 physical diseases. SCC included two different cognitive constructs: subjective concentration and memory complaints. Multivariable logistic regression and mediation analyses were conducted. Multimorbidity was associated with higher prevalence of subjective concentration (30.7% vs. 17.3%) and memory complaints (42.8% vs. 22.9%) compared to no multimorbidity. In the regression model adjusted for sociodemographics, multimorbidity was associated with subjective concentration (OR = 2.58; 95% CI = 2.25–2.96) and memory complaints (OR = 2.34; 95% CI = 2.08–2.62). Sleep problems, stressful life events and any anxiety disorder explained 21–23%, 20–22% and 14–15% of the multimorbidity-SCC association, respectively. Multimorbidity and SCC are highly co-morbid. The utility of SCC screening in identifying individuals at high risk for future cognitive decline among individuals with multimorbidity should be assessed.

Social exclusion in schizophrenia: Psychological and cognitive consequences

Social exclusion is associated with reduced self-esteem and cognitive impairments in healthy samples. Individuals with schizophrenia experience social exclusion at a higher rate than the general population, but the specific psychological and cognitive consequences for this group are unknown. We manipulated social exclusion in 35 participants with schizophrenia and 34 demographically-matched healthy controls using Cyberball, a virtual ball-tossing game in which participants believed that they were either being included or excluded by peers. All participants completed both versions of the task (inclusion, exclusion) on separate visits, as well as measures of psychological need security, working memory, and social cognition. Following social exclusion, individuals with schizophrenia showed decreased psychological need security and working memory. Contrary to expectations, they showed an improved ability to detect lies on the social cognitive task. Controls showed a decrease in psychological security after exclusion that was larger than that seen in the schizophrenia group. The results suggest that social support and interventions targeting social integration may benefit community functioning by reducing cognitive impairments and psychological stress.

Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents

PURPOSE

The association between psychotic experiences (PEs) and non-accidental self-injury (NASI; including self-harm and suicide attempts) is well established, although variables influencing this relationship have not been comprehensively examined. This study aimed to investigate (1) the cross-sectional PE-NASI association before and after adjustment for confounders, and (2) the individual contribution of each confounding and potentially mediating variable to the association.

METHODS

A random sample of Australian adolescents aged 14-17 years (n = 1998) completed self-report questions regarding any self-harm, suicidality or PEs experienced in the past 12 months in 2013-2014 as part of the Young Minds Matter Survey, a national household survey. We conducted logistic regression analyses to investigate the association between NASI and PEs, after controlling for confounders (sociodemographics, substance use, and parental mental illness) as well as the influence of potential mediators (major depression, bullying, psychological distress, sleep, self-esteem, disordered eating behaviour, social isolation, and intervention factors).

RESULTS

Except for special messages, all PE subtypes (auditory and visual hallucinatory experiences [HEs], and two of the three delusional experiences [DEs]) were associated with NASI after adjustment for confounders (OR range: 2.60-5.21). Depression and psychological distress significantly influenced all PE-NASI associations, where depression appeared to fully explain the DE-NASI association, and partially attenuate the HE-NASI association. Variables such as parental mental illness, disordered eating behaviour, and social isolation had negligible effects in nearly all self-harm and attempted suicide models.

CONCLUSIONS

Adolescents reporting any PE in the past 12 months reported increased likelihood of NASI in the same time period and, auditory HEs in particular, were strongly and independently associated with self-harm and suicide attempts. These results highlight the importance of PEs as indicators of risk of self-injurious behaviour among Australian youth.

Positive and negative symptoms in schizophrenia: A longitudinal analysis using latent variable structural equation modelling

BACKGROUND

Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identification of possible causal relationships. The European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose.

METHODS

EuroSC includes 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures were repeated after 12 and 24 months. Latent variable structural equation modelling was used to investigate the direction of effect between positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, controlling for the effects of depressed mood and antipsychotic medication.

RESULTS

The structural model provided acceptable overall fit [χ² (953) = 2444.32, P < 0.001; CFI = 0.909; RMSEA = 0.046 (90% CI: 0.043, 0.048); SRMR = 0.052]. Both positive and negative symptoms were persistent, and strongly auto-correlated. There were also persistent cross-sectional associations between positive and negative symptoms. While the path from latent positive to negative symptoms from T1 to T2 approached conventional levels of statistical significance (P = 0.051), that from T2 to T3 did not (P = 0.546). Pathways in the reverse direction were uniformly non-significant.

CONCLUSIONS

There was no evidence that negative symptoms predict later positive symptoms. The prediction of negative symptoms by positive symptoms was ambiguous. We discuss implications for conceptualization of schizophrenic processes.

The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom

OBJECTIVE

The goal was to analyze the association of religiosity with suicidal ideation and suicide attempts in a UK nationally representative sample.

METHODS

This study used cross-sectional data from 7403 people who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). Religion was assessed with the question 'Do you have a specific religion?' with 'yes' and 'no' answer options. Lifetime and past 12-month suicidal ideation and suicide attempts were assessed. The association between religiosity and suicidality was studied in multivariable logistic regression models adjusted for sociodemographic, behavioural, and psychopathological factors.

RESULTS

Compared to those without a religion, the prevalence of past 12-month suicidal ideation (3.2% vs. 5.4%), past 12-month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion. In the fully adjusted model, having a religion was significantly associated with lower odds for all types of suicidality except past 12-month suicide attempts: suicidal ideation (past 12-month: OR = 0.71, 95% CI = 0.51-0.99; lifetime: OR = 0.83, 95% CI = 0.69-0.99) and suicide attempts (past 12-month: OR = 0.71, 95% CI = 0.35-1.45; lifetime: OR = 0.69, 95% CI = 0.53-0.90).

CONCLUSION

There is a negative association between religiosity and suicidality in the UK. Future studies should focus on the underlying mechanisms.