22 results
Associations between disturbed sleep and attenuated psychotic experiences in people at clinical high risk for psychosis
- M. J. C. Formica, M. Fuller-Tyszkiewicz, U. Reininghaus, M. Kempton, P. Delespaul, L. de Haan, B. Nelson, A. Mikocka-Walus, L. Olive, S. Ruhrmann, B. Rutten, A. Riecher-Rössler, G. Sachs, L. Valmaggia, M. van der Gaag, P. McGuire, J. van Os, EU-GEI High-Risk Study, J. A. Hartmann
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- Journal:
- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 07 March 2024, pp. 1-10
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Background
Pre-diagnostic stages of psychotic illnesses, including ‘clinical high risk’ (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis.
MethodsSeventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population.
ResultsTwo of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa.
ConclusionIn this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population.
Variation of subclinical psychosis across 16 sites in Europe and Brazil: findings from the multi-national EU-GEI study
- Giuseppe D'Andrea, Diego Quattrone, Kathryn Malone, Giada Tripoli, Giulia Trotta, Edoardo Spinazzola, Charlotte Gayer-Anderson, Hannah E Jongsma, Lucia Sideli, Simona A Stilo, Caterina La Cascia, Laura Ferraro, Antonio Lasalvia, Sarah Tosato, Andrea Tortelli, Eva Velthorst, Lieuwe de Haan, Pierre-Michel Llorca, Paulo Rossi Menezes, Jose Luis Santos, Manuel Arrojo, Julio Bobes, Julio Sanjuán, Miguel Bernardo, Celso Arango, James B Kirkbride, Peter B Jones, Bart P Rutten, Jim Van Os, Jean-Paul Selten, Evangelos Vassos, Franck Schürhoff, Andrei Szöke, Baptiste Pignon, Michael O'Donovan, Alexander Richards, Craig Morgan, Marta Di Forti, Ilaria Tarricone, Robin M Murray
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- Journal:
- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 30 January 2024, pp. 1-14
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Background
Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP.
MethodsWe used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately.
ResultsSchizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia.
ConclusionsSchizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum.
Examining the association between exposome score for schizophrenia and cognition in schizophrenia, siblings, and healthy controls: Findings from the EUGEI study
- L. Fusar-Poli, E.-G.-W. 6. Investigators, G. Investigators, J. van Os, B. P. Rutten, S. Guloksuz
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S445
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Introduction
Schizophrenia spectrum disorders (SSD) are frequently associated with disturbances in both neurocognition and social cognition. The patoetiology of SSD derives from a complex interaction between genes and environment. Exposome score for schizophrenia (ES-SCZ) is a cumulative environmental exposure score for schizophrenia which have shown potential utility in risk stratification and outcome prediction.
ObjectivesTo investigate whether ES-SCZ is associated with cognition in patients with SSD, unaffected siblings, and healthy controls.
MethodsThe present cross-sectional study included 1141 patients with SSD, 1332 unaffected siblings, and 1495 healthy controls, recruited in the Netherlands, Spain, Serbia, and Turkey. The Wechsler Adult Intelligence Scale (WAIS) was used to evaluate neurocognition, while the Degraded Facial Emotion Recognition (DFAR) task was used to assess social cognition. ES-SCZ was calculated based on our previously validated method. Associations between ES-SCZ and cognitive domains were analyzed by applying regression models in each group (patients, siblings, and controls), adjusted by age, sex, and country.
ResultsAccording to our preliminary analyses, no significant associations were found between ES-SCZ and cognition in patients with SSD. ES-SCZ was negatively associated with WAIS in unaffected siblings (B=−0.40, p=0.03) and controls (B=-0.63, p=0.004) and positively associated with DFAR in siblings (B=0.83, p=0.004). No significant association between ES-SCZ and DFAR was found in healthy controls.
ConclusionsOur findings show that neurocognition and social cognition are oppositely associated with ES-SCZ. Longitudinal studies may clarify whether there is a cause-effect relationship between ES-SCZ and cognition. Further research should investigate whether ES-SCZ interacts with molecular genetic risk for schizophrenia to improve clinical chcracterization and outcome prediction in people with SSD.
Disclosure of InterestNone Declared
The association between autistic traits and quality of social interactions in the daily life of adolescents and young adults
- L. Fusar-Poli, T. Investigators, J. van Os, B. P. Rutten, S. Guloksuz
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S76
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Introduction
Autism spectrum disorder (ASD) is a heterogenous groups of neurodevelopmental conditions characterized by difficulties in social communication and the presence of restricted interests and repetitive behaviors. Autistic traits are distributed along a continuum in the general population and are negatively associated with social functioning also in non-autistic subjects. Several studies have evaluated the association between autistic traits and the quantity of social interaction; however, evidence on the relationship between autistic traits and quality of social interaction is still scarce.
ObjectivesTo evaluate the association between autistic traits and the quality of social interactions in daily life in youths from the general population using the experience samplic method (ESM).
MethodsDuring a six-day experience sampling period, 349 twins and 248 of their siblings aged between 15 and 34 reported the quality of their everyday social interactions. Autistic traits were assesed using the Autism Spectrum Quotient (AQ). The association between autistic traits and quality of social interaction was tested in separate multilevel linear and logistic regression models.
ResultsWhen participants were alone, higher autistic traits were associated with a sense of being less safe (B=-0.02, p=0.02). When participants were in company, higher autistic traits were associated with a higher preference for being alone (B=0.02, p<0.001) and higher sense of being judged (B=0.03, p=0.001). Moreover, while in company, higher autistic traits were associated with a decreased pleasure of being in company (B=-0.03, p<0.001), a lower sense of being safe in company (B=-0.03, p<0.001), and a lower sense of belonging to a group (B=-0.02, p<0.001).
ConclusionsThe preliminary results of the present study showed that autistic traits may influence the quality of social interactions in daily life. Future studies may clarify the mechanisms underlying this association. Assessing autistic traits in youth may help improve the outcome of psychosocial interventions of youths presenting difficulties in social interactions.
Disclosure of InterestNone Declared
Affective wellbeing moderates the association between polygenic risk score for neuroticism and change in neuroticism
- J. Bahbouhová, M. V. Cade, A. T. De Sadeleer, C. Dibbets, L.-Q. Herrmann, P. O. F. Hovens, B. M. Jakson, R. C. Reising, C. Menne-Lothmann, J. Decoster, R. van Winkel, D. Collip, P. Delespaul, M. De Hert, C. Derom, E. Thiery, N. Jacobs, M. Wichers, J. van Os, B. P. F. Rutten, S. Gülöksüz, B. Klingenberg
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S175
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Introduction
Neuroticism has societal, mental and physical health relevance, with an etiology involving genetic predisposition, psychological influence, and their interaction.
ObjectivesTo understand whether the association between polygenic risk score for neuroticism (PRS-N) and neuroticism is moderated by affective well-being.
MethodsData were derived from TwinssCan, a general population twin cohort (age range=15-35 years, 478 monozygotic twins). Self-report questionnaires were used to measure well-being and neuroticism. PRS-N was trained from the Genetics of Personality Consortium (GPC) and United Kingdom Biobank (UKB). Multilevel mixed-effects models were used to test baseline and changes in well-being and neuroticism.
ResultsBaseline wellbeing and neuroticism were associated (β=-1.35, p<0.001). PRSs-N were associated with baseline neuroticism (lowest p-value: 0.008 in GPC, 0.01 in UKB). In interaction models (PRS x wellbeing), GPC PRS-N (β=0.38, p=0.04) and UKB PRS-N (β=0.81, p<0.001) had significant interactions.
PRSs-N were associated with changes in neuroticism (lowest p-value: 0.03 in GPC, 0.3 in UKB). Furthermore, changes in wellbeing and neuroticism were associated (β =-0.66, p<0.001). In interaction models (PRS x change in wellbeing), only UKB PRS-N had a significant interaction (β=0.80, p<0.001).
ConclusionsInteraction between polygenic risk, wellbeing and neuroticism, were observed regarding baselines measures and change over time. Depending on the analysis step, the direction of the effect changed.
Disclosure of InterestNone Declared
Differential associations of childhood adversity subtypes and psychopathology in men and women
- T. Prachason, I. Mutlu, L. Fusar-Poli, C. Menne-Lothmann, J. Decoster, R. van Winkel, D. Collip, P. Delespaul, M. De Hert, C. Derom, E. Thiery, N. Jacobs, M. Wichers, J. van Os, B. P. F. Rutten, L.-K. Pries, S. Gülöksüz
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S80-S81
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Introduction
Prior evidence suggests that men and women might be differentially susceptible to distinct types of childhood adversity (CA), but research on gender-specific associations between CA subtypes and psychiatric symptoms is limited.
ObjectivesTo test the gender-specific associations of CA subtypes and psychiatric symptoms in the general population.
MethodsData from 791 twins and siblings from the TwinssCan project were used. Psychopathology and CA exposure were assessed using the Symptom Checklist-90 Revised (SCL-90) and the Childhood Trauma Questionnaire (CTQ), respectively. The associations between the total CTQ scores and SCL-90 scores (i.e. total SCL-90, psychoticism, paranoid ideation, anxiety, depression, somatization, obsessive-compulsive, interpersonal sensitivity, hostility, and phobic anxiety) were tested in men and women separately. The associations between the five CA subtypes (i.e. physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect) and total SCL-90 were tested in a mutually adjusted model. As exploratory analyses, the associations between all CA subtypes and the nine SCL-90 subdomain scores were similarly tested. The regression coefficients between men and women were compared using Chow’s test. All models were adjusted for age and family structure.
ResultsTotal CTQ was significantly associated with total SCL-90 in men (B = 0.013, SE = 0.003, P < .001) and women (B = 0.011, SE = 0.002, P < .001). The associations with the nine symptom domains were also significant in both genders (P < .001). No significant gender differences in the regression coefficients of total CTQ were detected. The analyses of CA subtypes showed a significant association between emotional abuse and total SCL-90 in women (B = 0.173, SE = 0.030, P < .001) and men (B = 0.080, SE = 0.035, P = .023), but the association was significantly stronger in women (ꭓ2(1) = 4.10, P = .043). The association of sexual abuse and total SCL-90 was only significant in women (B = 0.217, SE = 0.053, P < .001). The associations of emotional neglect (B = 0.061, SE = 0.027, P = .026) and physical neglect (B = 0.167, SE = 0.043, P < .001) with total SCL-90 were only significant in men. The explorative analyses of SCL-90 subdomains revealed significant associations of emotional abuse with all nine symptom domains and of sexual abuse with seven symptom domains in women. Significant associations of physical neglect with six symptom domains and of emotional neglect with depression were also detected in men. No other significant associations between CT subtypes and total SCL-90 or symptom domain scores were observed in men and women.
ConclusionsCA exposure was associated with diverse psychopathology similarly in both genders. However, women are more sensitive to abuse, but men are more sensitive to neglect. Gender-specific influences of CA subtypes on psychopathology should be considered in future studies.
Disclosure of InterestNone Declared
Cannabis use as a potential mediator between childhood adversity and first-episode psychosis: results from the EU-GEI case–control study
- Giulia Trotta, Victoria Rodriguez, Diego Quattrone, Edoardo Spinazzola, Giada Tripoli, Charlotte Gayer-Anderson, Tom P Freeman, Hannah E Jongsma, Lucia Sideli, Monica Aas, Simona A Stilo, Caterina La Cascia, Laura Ferraro, Daniele La Barbera, Antonio Lasalvia, Sarah Tosato, Ilaria Tarricone, Giuseppe D'Andrea, Andrea Tortelli, Franck Schürhoff, Andrei Szöke, Baptiste Pignon, Jean-Paul Selten, Eva Velthorst, Lieuwe de Haan, Pierre-Michel Llorca, Paulo Rossi Menezes, Cristina M Del Ben, Jose Luis Santos, Manuel Arrojo, Julio Bobes, Julio Sanjuán, Miquel Bernardo, Celso Arango, James B Kirkbride, Peter B Jones, Alexander Richards, Bart P Rutten, Jim Van Os, Isabelle Austin-Zimmerman, Zhikun Li, Craig Morgan, Pak C Sham, Evangelos Vassos, Chloe Wong, Richard Bentall, Helen L Fisher, Robin M Murray, Luis Alameda, Marta Di Forti, EU-GEI WP2 Group
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- Journal:
- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 04 May 2023, pp. 7375-7384
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Background
Childhood adversity and cannabis use are considered independent risk factors for psychosis, but whether different patterns of cannabis use may be acting as mediator between adversity and psychotic disorders has not yet been explored. The aim of this study is to examine whether cannabis use mediates the relationship between childhood adversity and psychosis.
MethodsData were utilised on 881 first-episode psychosis patients and 1231 controls from the European network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Detailed history of cannabis use was collected with the Cannabis Experience Questionnaire. The Childhood Experience of Care and Abuse Questionnaire was used to assess exposure to household discord, sexual, physical or emotional abuse and bullying in two periods: early (0–11 years), and late (12–17 years). A path decomposition method was used to analyse whether the association between childhood adversity and psychosis was mediated by (1) lifetime cannabis use, (2) cannabis potency and (3) frequency of use.
ResultsThe association between household discord and psychosis was partially mediated by lifetime use of cannabis (indirect effect coef. 0.078, s.e. 0.022, 17%), its potency (indirect effect coef. 0.059, s.e. 0.018, 14%) and by frequency (indirect effect coef. 0.117, s.e. 0.038, 29%). Similar findings were obtained when analyses were restricted to early exposure to household discord.
ConclusionsHarmful patterns of cannabis use mediated the association between specific childhood adversities, like household discord, with later psychosis. Children exposed to particularly challenging environments in their household could benefit from psychosocial interventions aimed at preventing cannabis misuse.
The association between reasons for first using cannabis, later pattern of use, and risk of first-episode psychosis: the EU-GEI case–control study
- Edoardo Spinazzola, Diego Quattrone, Victoria Rodriguez, Giulia Trotta, Luis Alameda, Giada Tripoli, Charlotte Gayer-Anderson, Tom P Freeman, Emma C Johnson, Hannah E Jongsma, Simona Stilo, Caterina La Cascia, Laura Ferraro, Daniele La Barbera, Antonio Lasalvia, Sarah Tosato, Ilaria Tarricone, Giuseppe D'Andrea, Michela Galatolo, Andrea Tortelli, Ilaria Tagliabue, Marco Turco, Maurizio Pompili, Jean-Paul Selten, Lieuwe de Haan, Paulo Rossi Menezes, Cristina M Del Ben, Jose Luis Santos, Manuel Arrojo, Julio Bobes, Julio Sanjuán, Miguel Bernardo, Celso Arango, James B Kirkbride, Peter B Jones, Michael O'Donovan, Bart P Rutten, Jim Van Os, Craig Morgan, Pak C Sham, Isabelle Austin-Zimmerman, Zhikun Li, Evangelos Vassos, EU-GEI WP2 Group, Robin M Murray, Marta Di Forti
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- Journal:
- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 02 May 2023, pp. 7418-7427
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Background
While cannabis use is a well-established risk factor for psychosis, little is known about any association between reasons for first using cannabis (RFUC) and later patterns of use and risk of psychosis.
MethodsWe used data from 11 sites of the multicentre European Gene-Environment Interaction (EU-GEI) case–control study. 558 first-episode psychosis patients (FEPp) and 567 population controls who had used cannabis and reported their RFUC.
We ran logistic regressions to examine whether RFUC were associated with first-episode psychosis (FEP) case–control status. Path analysis then examined the relationship between RFUC, subsequent patterns of cannabis use, and case–control status.
ResultsControls (86.1%) and FEPp (75.63%) were most likely to report ‘because of friends’ as their most common RFUC. However, 20.1% of FEPp compared to 5.8% of controls reported: ‘to feel better’ as their RFUC (χ2 = 50.97; p < 0.001). RFUC ‘to feel better’ was associated with being a FEPp (OR 1.74; 95% CI 1.03–2.95) while RFUC ‘with friends’ was associated with being a control (OR 0.56; 95% CI 0.37–0.83). The path model indicated an association between RFUC ‘to feel better’ with heavy cannabis use and with FEPp-control status.
ConclusionsBoth FEPp and controls usually started using cannabis with their friends, but more patients than controls had begun to use ‘to feel better’. People who reported their reason for first using cannabis to ‘feel better’ were more likely to progress to heavy use and develop a psychotic disorder than those reporting ‘because of friends’.
Tobacco use in first-episode psychosis, a multinational EU-GEI study
- T. Sánchez-Gutiérrez, E. Rodríguez-Toscano, L. Roldán, L. Ferraro, M. Parellada, A. Calvo, G. López, M. Rapado-Castro, D. La Barbera, C. La Cascia, G. Tripoli, M. Di Forti, R. M. Murray, D. Quattrone, C. Morgan, J. van Os, P. García-Portilla, S. Al-Halabí, J. Bobes, L. de Haan, M. Bernardo, J. L. Santos, J. Sanjuán, M. Arrojo, A. Ferchiou, A. Szoke, B. P. Rutten, S. Stilo, G. D'Andrea, I. Tarricone, EU-GEI WP2 Group, C. M. Díaz-Caneja, C. Arango
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- Journal:
- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 26 April 2023, pp. 7265-7276
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Background
Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis.
MethodsThe sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use.
ResultsAfter controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1–3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2–2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = −2.3; p ⩽ 0.001; 95% CI [−3.7 to −0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0–1.8]); however, these results were no longer significant after controlling for cannabis use.
ConclusionsTobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
Child maltreatment, migration and risk of first-episode psychosis: results from the multinational EU-GEI study
- Giuseppe D'Andrea, Jatin Lal, Sarah Tosato, Charlotte Gayer-Anderson, Hannah E. Jongsma, Simona A. Stilo, Els van der Ven, Diego Quattrone, Eva Velthorst, Domenico Berardi, Paulo Rossi Menezes, Celso Arango, Mara Parellada, Antonio Lasalvia, Caterina La Cascia, Laura Ferraro, Daniele La Barbera, Lucia Sideli, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Cristina Marta Del-Ben, Giada Tripoli, Pierre-Michel Llorca, Lieuwe de Haan, Jean-Paul Selten, Andrea Tortelli, Andrei Szöke, Roberto Muratori, Bart P. Rutten, Jim van Os, Peter B. Jones, James B. Kirkbride, Robin M. Murray, Marta di Forti, Ilaria Tarricone, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 53 / Issue 13 / October 2023
- Published online by Cambridge University Press:
- 28 October 2022, pp. 6150-6160
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Background
Child maltreatment (CM) and migrant status are independently associated with psychosis. We examined prevalence of CM by migrant status and tested whether migrant status moderated the association between CM and first-episode psychosis (FEP). We further explored whether differences in CM exposure contributed to variations in the incidence rates of FEP by migrant status.
MethodsWe included FEP patients aged 18–64 years in 14 European sites and recruited controls representative of the local populations. Migrant status was operationalized according to generation (first/further) and region of origin (Western/non-Western countries). The reference population was composed by individuals of host country's ethnicity. CM was assessed with Childhood Trauma Questionnaire. Prevalence ratios of CM were estimated using Poisson regression. We examined the moderation effect of migrant status on the odds of FEP by CM fitting adjusted logistic regressions with interaction terms. Finally, we calculated the population attributable fractions (PAFs) for CM by migrant status.
ResultsWe examined 849 FEP cases and 1142 controls. CM prevalence was higher among migrants, their descendants and migrants of non-Western heritage. Migrant status, classified by generation (likelihood test ratio:χ2 = 11.3, p = 0.004) or by region of origin (likelihood test ratio:χ2 = 11.4, p = 0.003), attenuated the association between CM and FEP. PAFs for CM were higher among all migrant groups compared with the reference populations.
ConclusionsThe higher exposure to CM, despite a smaller effect on the odds of FEP, accounted for a greater proportion of incident FEP cases among migrants. Policies aimed at reducing CM should consider the increased vulnerability of specific subpopulations.
Genetic and psychosocial stressors have independent effects on the level of subclinical psychosis: findings from the multinational EU-GEI study
- B. Pignon, H. Peyre, A. Ayrolles, J. B. Kirkbride, S. Jamain, A. Ferchiou, J. R. Richard, G. Baudin, S. Tosato, H. Jongsma, L. de Haan, I. Tarricone, M. Bernardo, E. Velthorst, M. Braca, C. Arango, M. Arrojo, J. Bobes, C. M. Del-Ben, M. Di Forti, C. Gayer-Anderson, P. B. Jones, C. La Cascia, A. Lasalvia, P. R. Menezes, D. Quattrone, J. Sanjuán, J. P. Selten, A. Tortelli, P. M. Llorca, J. van Os, B. P. F. Rutten, R. M. Murray, C. Morgan, M. Leboyer, A. Szöke, F. Schürhoff
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 31 / 2022
- Published online by Cambridge University Press:
- 27 September 2022, e68
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Aims
Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample.
MethodsData were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of ‘Genetic’ models (solely fitted with PRS-SZ), ‘Environmental’ models (solely fitted with each environmental stressor), ‘Independent’ models (with PRS-SZ and each environmental factor), and ‘Interaction’ models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models.
ResultsThere were no genes-environment associations. PRS-SZ was associated with positive dimensions (β = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension.
ConclusionsThis study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.
Use of multiple polygenic risk scores for distinguishing schizophrenia-spectrum disorder and affective psychosis categories in a first-episode sample; the EU-GEI study
- Victoria Rodriguez, Luis Alameda, Diego Quattrone, Giada Tripoli, Charlotte Gayer-Anderson, Edoardo Spinazzola, Giulia Trotta, Hannah E. Jongsma, Simona Stilo, Caterina La Cascia, Laura Ferraro, Daniele La Barbera, Antonio Lasalvia, Sarah Tosato, Ilaria Tarricone, Elena Bonora, Stéphane Jamain, Jean-Paul Selten, Eva Velthorst, Lieuwe de Haan, Pierre-Michel Llorca, Manuel Arrojo, Julio Bobes, Miguel Bernardo, Celso Arango, James Kirkbride, Peter B. Jones, Bart P. Rutten, Alexander Richards, Pak C. Sham, Michael O'Donovan, Jim Van Os, Craig Morgan, Marta Di Forti, Robin M. Murray, Evangelos Vassos
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- Journal:
- Psychological Medicine / Volume 53 / Issue 8 / June 2023
- Published online by Cambridge University Press:
- 25 January 2022, pp. 3396-3405
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Background
Schizophrenia (SZ), bipolar disorder (BD) and depression (D) run in families. This susceptibility is partly due to hundreds or thousands of common genetic variants, each conferring a fractional risk. The cumulative effects of the associated variants can be summarised as a polygenic risk score (PRS). Using data from the EUropean Network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) first episode case–control study, we aimed to test whether PRSs for three major psychiatric disorders (SZ, BD, D) and for intelligent quotient (IQ) as a neurodevelopmental proxy, can discriminate affective psychosis (AP) from schizophrenia-spectrum disorder (SSD).
MethodsParticipants (842 cases, 1284 controls) from 16 European EU-GEI sites were successfully genotyped following standard quality control procedures. The sample was stratified based on genomic ancestry and analyses were done only on the subsample representing the European population (573 cases, 1005 controls). Using PRS for SZ, BD, D, and IQ built from the latest available summary statistics, we performed simple or multinomial logistic regression models adjusted for 10 principal components for the different clinical comparisons.
ResultsIn case–control comparisons PRS-SZ, PRS-BD and PRS-D distributed differentially across psychotic subcategories. In case–case comparisons, both PRS-SZ [odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.54–0.92] and PRS-D (OR = 1.31, 95% CI 1.06–1.61) differentiated AP from SSD; and within AP categories, only PRS-SZ differentiated BD from psychotic depression (OR = 2.14, 95% CI 1.23–3.74).
ConclusionsCombining PRS for severe psychiatric disorders in prediction models for psychosis phenotypes can increase discriminative ability and improve our understanding of these phenotypes. Our results point towards the potential usefulness of PRSs in specific populations such as high-risk or early psychosis phases.
Synergistic effects of childhood adversity and polygenic risk in first-episode psychosis: the EU-GEI study
- Monica Aas, Luis Alameda, Marta Di Forti, Diego Quattrone, Paola Dazzan, Antonella Trotta, Laura Ferraro, Victoria Rodriguez, Evangelos Vassos, Pak Sham, Giada Tripoli, Caterina La Cascia, Daniele La Barbera, Ilaria Tarricone, Roberto Muratori, Domenico Berardi, Antonio Lasalvia, Sarah Tosato, Andrei Szöke, Pierre-Michel Llorca, Celso Arango, Andrea Tortelli, Lieuwe de Haan, Eva Velthorst, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Cristina Marta Del-Ben, Paulo Rossi Menezes, Jean-Paul Selten, Peter B. Jones, Hannah E. Jongsma, James B. Kirkbride, Bart P. F. Rutten, Jim van Os, Charlotte Gayer-Anderson, Robin M. Murray, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 53 / Issue 5 / April 2023
- Published online by Cambridge University Press:
- 29 September 2021, pp. 1970-1978
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Background
A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to the number of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing polygenic vulnerability. Here, we investigated, in the largest sample of first-episode psychosis (FEP) cases to date, whether childhood adversity and high polygenic risk scores for schizophrenia (SZ-PRS) combine synergistically to increase the risk of psychosis, over and above the effect of each alone.
MethodsWe assigned a schizophrenia-polygenic risk score (SZ-PRS), calculated from the Psychiatric Genomics Consortium (PGC2), to all participants in a sample of 384 FEP patients and 690 controls from the case–control component of the EU-GEI study. Only participants of European ancestry were included in the study. A history of childhood adversity was collected using the Childhood Trauma Questionnaire (CTQ). Synergistic effects were estimated using the interaction contrast ratio (ICR) [odds ratio (OR)exposure and PRS − ORexposure − ORPRS + 1] with adjustment for potential confounders.
ResultsThere was some evidence that the combined effect of childhood adversities and polygenic risk was greater than the sum of each alone, as indicated by an ICR greater than zero [i.e. ICR 1.28, 95% confidence interval (CI) −1.29 to 3.85]. Examining subtypes of childhood adversities, the strongest synergetic effect was observed for physical abuse (ICR 6.25, 95% CI −6.25 to 20.88).
ConclusionsOur findings suggest possible synergistic effects of genetic liability and childhood adversity experiences in the onset of FEP, but larger samples are needed to increase precision of estimates.
Migration history and risk of psychosis: results from the multinational EU-GEI study
- Ilaria Tarricone, Giuseppe D'Andrea, Hannah E. Jongsma, Sarah Tosato, Charlotte Gayer-Anderson, Simona A. Stilo, Federico Suprani, Conrad Iyegbe, Els van der Ven, Diego Quattrone, Marta di Forti, Eva Velthorst, Paulo Rossi Menezes, Celso Arango, Mara Parellada, Antonio Lasalvia, Caterina La Cascia, Laura Ferraro, Julio Bobes, Miguel Bernardo, Iulio Sanjuán, Jose Luis Santos, Manuel Arrojo, Cristina Marta Del-Ben, Giada Tripoli, Pierre-Michel Llorca, Lieuwe de Haan, Jean-Paul Selten, Andrea Tortelli, Andrei Szöke, Roberto Muratori, Bart P. Rutten, Jim van Os, Peter B. Jones, James B. Kirkbride, Domenico Berardi, Robin M. Murray, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 52 / Issue 14 / October 2022
- Published online by Cambridge University Press:
- 10 February 2021, pp. 2972-2984
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Background
Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration.
MethodsWe used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case–control study. We defined a set of three indicators of social disadvantage for each phase: pre-migration, migration and post-migration. We examined whether social disadvantage in the pre- and post-migration phases, migration adversities, and mismatch between achievements and expectations differed between first-generation migrants with first-episode psychosis and healthy first-generation migrants, and tested whether this accounted for differences in odds of psychosis in multivariable logistic regression models.
ResultsIn total, 249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95% CI 1.06–2.44, p = 0.027) and post-migration social disadvantages (OR 1.89, 95% CI 1.02–3.51, p = 0.044), along with expectations/achievements mismatch (OR 1.14, 95% CI 1.03–1.26, p = 0.014) were all significantly associated with psychosis. Migration adversities (OR 1.18, 95% CI 0.672–2.06, p = 0.568) were not significantly related to the outcome. Finally, we found a dose–response effect between the number of adversities across all phases and odds of psychosis (⩾6: OR 14.09, 95% CI 2.06–96.47, p = 0.007).
ConclusionsThe cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may reduce the excess of psychosis in migrants.
Examining the independent and joint effects of genomic and exposomic liabilities for schizophrenia across the psychosis spectrum
- L.-K. Pries, G. A. Dal Ferro, J. van Os, P. Delespaul, G. Kenis, B. D. Lin, J. J. Luykx, A. L. Richards, B. Akdede, T. Binbay, V. Altınyazar, B. Yalınçetin, G. Gümüş-Akay, B. Cihan, H. Soygür, H. Ulaş, E. Şahin Cankurtaran, S. Ulusoy Kaymak, M. M. Mihaljevic, S. Andric Petrovic, T. Mirjanic, M. Bernardo, G. Mezquida, S. Amoretti, J. Bobes, P. A. Saiz, M. Paz García-Portilla, J. Sanjuan, E. J. Aguilar, J. L. Santos, E. Jiménez-López, M. Arrojo, A. Carracedo, G. López, J. González-Peñas, M. Parellada, N. P. Maric, C. Atbaşoğlu, A. Ucok, K. Alptekin, M. Can Saka, Genetic Risk and Outcome of Psychosis (GROUP) investigators, C. Arango, M. O'Donovan, S. Tosato, B. P. F. Rutten, S. Guloksuz
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 29 / 2020
- Published online by Cambridge University Press:
- 17 November 2020, e182
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Aims
Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene–environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum.
MethodsThe sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components).
ResultsBoth genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene–environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions.
ConclusionsThe interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.
The incidence of psychotic disorders among migrants and minority ethnic groups in Europe: findings from the multinational EU-GEI study
- Fabian Termorshuizen, Els van der Ven, Ilaria Tarricone, Hannah E. Jongsma, Charlotte Gayer-Anderson, Antonio Lasalvia, Sarah Tosato, Diego Quattrone, Caterina La Cascia, Andrei Szöke, Domenico Berardi, Pierre-Michel Llorca, Lieuwe de Haan, Eva Velthorst, Miguel Bernardo, Julio Sanjuán, Manuel Arrojo, Robin M. Murray, Bart P. Rutten, Peter B. Jones, Jim van Os, James B. Kirkbride, Craig Morgan, Jean-Paul Selten
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- Journal:
- Psychological Medicine / Volume 52 / Issue 7 / May 2022
- Published online by Cambridge University Press:
- 22 September 2020, pp. 1376-1385
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Background
In Europe, the incidence of psychotic disorder is high in certain migrant and minority ethnic groups (hence: ‘minorities’). However, it is unknown how the incidence pattern for these groups varies within this continent. Our objective was to compare, across sites in France, Italy, Spain, the UK and the Netherlands, the incidence rates for minorities and the incidence rate ratios (IRRs, minorities v. the local reference population).
MethodsThe European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study was conducted between 2010 and 2015. We analyzed data on incident cases of non-organic psychosis (International Classification of Diseases, 10th edition, codes F20–F33) from 13 sites.
ResultsThe standardized incidence rates for minorities, combined into one category, varied from 12.2 in Valencia to 82.5 per 100 000 in Paris. These rates were generally high at sites with high rates for the reference population, and low at sites with low rates for the reference population. IRRs for minorities (combined into one category) varied from 0.70 (95% CI 0.32–1.53) in Valencia to 2.47 (95% CI 1.66–3.69) in Paris (test for interaction: p = 0.031). At most sites, IRRs were higher for persons from non-Western countries than for those from Western countries, with the highest IRRs for individuals from sub-Saharan Africa (adjusted IRR = 3.23, 95% CI 2.66–3.93).
ConclusionsIncidence rates vary by region of origin, region of destination and their combination. This suggests that they are strongly influenced by the social context.
Association of extent of cannabis use and psychotic like intoxication experiences in a multi-national sample of first episode psychosis patients and controls
- Musa Sami, Diego Quattrone, Laura Ferraro, Giada Tripoli, Erika La Cascia, Charlotte Gayer-Anderson, Jean-Paul Selten, Celso Arango, Miguel Bernardo, Ilaria Tarricone, Andrea Tortelli, Giusy Gatto, Simona del Peschio, Cristina Marta Del-Ben, Bart P. Rutten, Peter B. Jones, Jim van Os, Lieuwe de Haan, Craig Morgan, Cathryn Lewis, Sagnik Bhattacharyya, Tom P. Freeman, Michael Lynskey, Robin M. Murray, Marta Di Forti
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- Journal:
- Psychological Medicine / Volume 51 / Issue 12 / September 2021
- Published online by Cambridge University Press:
- 28 April 2020, pp. 2074-2082
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Background
First episode psychosis (FEP) patients who use cannabis experience more frequent psychotic and euphoric intoxication experiences compared to controls. It is not clear whether this is consequent to patients being more vulnerable to the effects of cannabis use or to their heavier pattern of use. We aimed to determine whether extent of use predicted psychotic-like and euphoric intoxication experiences in patients and controls and whether this differs between groups.
MethodsWe analysed data on patients who had ever used cannabis (n = 655) and controls who had ever used cannabis (n = 654) across 15 sites from six countries in the EU-GEI study (2010–2015). We used multiple regression to model predictors of cannabis-induced experiences and to determine if there was an interaction between caseness and extent of use.
ResultsCaseness, frequency of cannabis use and money spent on cannabis predicted psychotic-like and euphoric experiences (p ⩽ 0.001). For psychotic-like experiences (PEs) there was a significant interaction for caseness × frequency of use (p < 0.001) and caseness × money spent on cannabis (p = 0.001) such that FEP patients had increased experiences at increased levels of use compared to controls. There was no significant interaction for euphoric experiences (p > 0.5).
ConclusionsFEP patients are particularly sensitive to increased psychotic-like, but not euphoric experiences, at higher levels of cannabis use compared to controls. This suggests a specific psychotomimetic response in FEP patients related to heavy cannabis use. Clinicians should enquire regarding cannabis related PEs and advise that lower levels of cannabis use are associated with less frequent PEs.
Is sensitivity to daily stress predictive of onset or persistence of psychopathology?
- T. Vaessen, M. van Nierop, J. Decoster, P. Delespaul, C. Derom, M. de Hert, N. Jacobs, C. Menne-Lothmann, B. Rutten, E. Thiery, J. van Os, R. van Winkel, M. Wichers, I. Myin-Germeys
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- Journal:
- European Psychiatry / Volume 45 / September 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. 167-173
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Purpose:
The aim of the current study was to replicate findings in adults indicating that higher sensitivity to stressful events is predictive of both onset and persistence of psychopathological symptoms in a sample of adolescents and young adults. In addition, we tested the hypothesis that sensitivity to mild stressors in particular is predictive of the developmental course of psychopathology.
Methods:We analyzed experience sampling and questionnaire data collected at baseline and one-year follow-up of 445 adolescent and young adult twins and non-twin siblings (age range: 15–34). Linear multilevel regression was used for the replication analyses. To test if affective sensitivity to mild stressors in particular was associated with follow-up symptoms, we used a categorical approach adding variables on affective sensitivity to mild, moderate and severe daily stressors to the model.
Results:Linear analyses showed that emotional stress reactivity was not associated with onset (ß = .02; P = .56) or persistence (ß = -.01; P = .78) of symptoms. There was a significant effect of baseline symptom score (ß = .53; P < .001) and average negative affect (NA: ß = .19; P < .001) on follow-up symptoms. Using the categorical approach, we found that affective sensitivity to mild (ß = .25; P < .001), but not moderate (ß = -.03; P = .65) or severe (ß = -.06; P = .42), stressors was associated with symptom persistence one year later.
Discussion:We were unable to replicate previous findings relating stress sensitivity linearly to symptom onset or persistence in a younger sample. Whereas sensitivity to more severe stressors may reflect adaptive coping, high sensitivity to the mildest of daily stressors may indicate an increased risk for psychopathology.
Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case–control study
- Diego Quattrone, Laura Ferraro, Giada Tripoli, Caterina La Cascia, Harriet Quigley, Andrea Quattrone, Hannah E. Jongsma, Simona Del Peschio, Giusy Gatto, EU-GEI group, Charlotte Gayer-Anderson, Peter B. Jones, James B. Kirkbride, Daniele La Barbera, Ilaria Tarricone, Domenico Berardi, Sarah Tosato, Antonio Lasalvia, Andrei Szöke, Celso Arango, Miquel Bernardo, Julio Bobes, Cristina Marta Del Ben, Paulo Rossi Menezes, Pierre-Michel Llorca, Jose Luis Santos, Julio Sanjuán, Andrea Tortelli, Eva Velthorst, Lieuwe de Haan, Bart P. F. Rutten, Michael T. Lynskey, Tom P. Freeman, Pak C. Sham, Alastair G. Cardno, Evangelos Vassos, Jim van Os, Craig Morgan, Ulrich Reininghaus, Cathryn M. Lewis, Robin M. Murray, Marta Di Forti
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- Journal:
- Psychological Medicine / Volume 51 / Issue 8 / June 2021
- Published online by Cambridge University Press:
- 18 March 2020, pp. 1329-1337
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Background
Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.
MethodWe analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.
ResultsIn patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14–0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = −0.22; 95% CI −0.37 to −0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.
ConclusionsOur findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.
Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: results from the EU-GEI case–control study
- Hannah E. Jongsma, Charlotte Gayer-Anderson, Ilaria Tarricone, Eva Velthorst, Els van der Ven, Diego Quattrone, Marta di Forti, EU-GEI WP2 Group, Paulo Rossi Menezes, Christina Marta Del-Ben, Celso Arango, Antonio Lasalvia, Domenico Berardi, Caterina La Cascia, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Lieuwe de Haan, Andrea Tortelli, Andrei Szöke, Robin M. Murray, Bart P. Rutten, Jim van Os, Craig Morgan, Peter B. Jones, James B. Kirkbride
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- Journal:
- Psychological Medicine / Volume 51 / Issue 9 / July 2021
- Published online by Cambridge University Press:
- 03 March 2020, pp. 1536-1548
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Background
Ethnic minority groups in Western countries face an increased risk of psychotic disorders. Causes of this long-standing public health inequality remain poorly understood. We investigated whether social disadvantage, linguistic distance and discrimination contributed to these patterns.
MethodsWe used case–control data from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, carried out in 16 centres in six countries. We recruited 1130 cases and 1497 population-based controls. Our main outcome measure was first-episode ICD-10 psychotic disorder (F20–F33), and exposures were ethnicity (white majority, black, mixed, Asian, North-African, white minority and other), generational status, social disadvantage, linguistic distance and discrimination. Age, sex, paternal age, cannabis use, childhood trauma and parental history of psychosis were included as a priori confounders. Exposures and confounders were added sequentially to multivariable logistic models, following multiple imputation for missing data.
ResultsParticipants from any ethnic minority background had crude excess odds of psychosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.69–2.43], which remained after adjustment for confounders (OR 1.61, 95% CI 1.31–1.98). This was progressively attenuated following further adjustment for social disadvantage (OR 1.52, 95% CI 1.22–1.89) and linguistic distance (OR 1.22, 95% CI 0.95–1.57), a pattern mirrored in several specific ethnic groups. Linguistic distance and social disadvantage had stronger effects for first- and later-generation groups, respectively.
ConclusionSocial disadvantage and linguistic distance, two potential markers of sociocultural exclusion, were associated with increased odds of psychotic disorder, and adjusting for these led to equivocal risk between several ethnic minority groups and the white majority.