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Evidence that the wider social environment moderates the association between familial liability and psychosis spectrum outcome

Published online by Cambridge University Press:  16 April 2012

T. Binbay
Affiliation:
Department of Psychiatry, Atatürk State Hospital, Sinop, Turkey Maastricht University Medical Center, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Vijverdal, Maastricht, The Netherlands
M. Drukker
Affiliation:
Maastricht University Medical Center, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Vijverdal, Maastricht, The Netherlands
K. Alptekin
Affiliation:
Department of Psychiatry, School of Medicine, Dokuz Eylül University, Izmir, Turkey
H. Elbi
Affiliation:
Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
F. Aksu Tanık
Affiliation:
Department of Public Health, School of Medicine, Ege University, Izmir, Turkey
F. Özkınay
Affiliation:
Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
H. Onay
Affiliation:
Department of Medical Genetics, School of Medicine, Ege University, Izmir, Turkey
N. Zağlı
Affiliation:
Veritas Psychiatry and Neuroscience, Istanbul, Turkey
J. van Os*
Affiliation:
Maastricht University Medical Center, School of Mental Health and Neuroscience, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Vijverdal, Maastricht, The Netherlands Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College, De Crespigny Park, Denmark Hill, London, UK
*
*Address for correspondence: J. van Os, Ph.D., Department of Psychiatry and Psychology, Maastricht University Medical Center, PO Box 616 (DRT12), 6200MD Maastricht, The Netherlands. (Email: J.vanos@MaastrichtUniversity.nl)

Abstract

Background

Familial liability to both severe and common mental disorder predicts psychotic disorder and psychotic symptoms, and may be used as a proxy in models examining interaction between genetic risk and the environment at individual and contextual levels.

Method

In a representative general population sample (n=4011) in Izmir, Turkey, the full spectrum of expression of psychosis representing (0) no symptoms, (1) subclinical psychotic experiences, (2) low-impact psychotic symptoms, (3) high-impact psychotic symptoms and (4) full-blown clinical psychotic disorder was assessed in relation to mental health problems in the family (proxy for familial liability) and the wider social environment. Quality of the wider social environment was assessed in an independent sample using contextual measures of informal social control, social disorganization, unemployment and low income, aggregated to the neighbourhood level.

Results

The association between familial liability to severe mental illness and expression of psychosis spectrum was stronger in more deprived neighbourhoods [e.g. this association increased from β=0.33 (p=0.01) in low-unemployment neighbourhoods to β=0.92 (p<0.001) in high-unemployment neighbourhoods] and in neighbourhoods high in social control, while neighbourhood variables did not modify the association between familial liability to common mental disorder and the psychosis outcome. Neighbourhood variables mediated urbanicity effects.

Conclusions

Contextual effects may be important in moderating the expression of psychosis liability in populations, representing a specific pathway independent of the link between common mental disorder and psychosis.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

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