NIHR Biomedical Research Centre, and Section of Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK.
Trinity College, Dublin, Ireland.
Psychol Med. 2014 Jan;44(2):407-19. doi: 10.1017/S0033291713000767. Epub 2013 Apr 16.
There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects.
All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls.
There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample.
Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.
有证据表明，一系列社会环境因素与精神分裂症风险增加有关。然而，尽管这些因素可能以复杂的方式共同作用增加风险，但大多数研究往往分别考虑每种暴露因素。有鉴于此，我们试图扩展 AESOP（精神分裂症和其他精神病的病因和种族）研究中关于儿童和成年劣势指标的数据分析，以检验它们如何共同增加精神病风险，同时测试中介（路径）模型和协同效应。
所有在英国伦敦和诺丁汉特定服务范围内首次出现精神病症状的患者（n=390）和一系列社区对照者（n=391）都被纳入 AESOP 研究。从病例和对照者那里收集了与临床和社会变量有关的数据，包括父母离异和丧亲、教育和成年劣势。
有证据表明，童年时期与父母离异（而非死亡）对精神病风险的影响部分通过随后的教育程度低（无学历）、成年社会劣势以及在较小程度上通过自尊心低来介导。此外，有强有力的证据表明，父母离异（而非死亡）与随后的劣势相结合，具有协同作用，增加了风险。这些效应在样本中的所有种族群体中都存在。
暴露于儿童和成年劣势可能以复杂的方式共同作用，使一些人沿着主要的社会发展途径发展为精神病。
