MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, Wales.
Epidemiology of Mental Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
JAMA Psychiatry. 2018 Nov 1;75(11):1128-1136. doi: 10.1001/jamapsychiatry.2018.2233.
Residential mobility (changing residence) during childhood and early adolescence is a possible risk factor for several adverse health outcomes, including psychotic disorders. However, it is unclear whether sensitive periods to residential mobility exist over the life course, including in adulthood, or if greater moving distances, which might disrupt social networks, are associated with a greater psychosis risk.
To examine the association between residential mobility over the life course and the risk of nonaffective psychosis.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included all people born in Sweden between January 1, 1982, and December 31, 1995, who were alive and resided in Sweden on their 16th birthday who were followed up until up to age 29 years (ending December 2011). Participants were followed until receiving a first diagnosis of an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) nonaffective psychotic disorder (F20-29), emigration, death, or the end of 2011, whichever was sooner. National register linkage provided exposure, outcome, and covariate data (complete data were available for 1 440 383 participants [97.8%]).
The exposures to distance moved and the number of residential moves were examined for participants at the following periods over the life course: 0 to 6 years, 7 to 15 years, 16 to 19 years, and 20 years and older.
This study included 1 440 383 participants, of whom 4537 (0.31%) had nonaffective psychotic disorder (median age, 20.9 [interquartile range, 19.0-23.3]). More frequent moves during childhood and adolescence were associated with an increased risk of nonaffective psychosis that showed dose-response associations independent of covariates. The most sensitive period of risk occurred during late adolescence; those who moved during each year between age 16 to 19 years had an increased adjusted hazard ratio (HR) of 1.99 (95% CI, 1.30-3.05) compared with those who never moved. One move during adulthood was not associated with psychosis risk (adjusted HR, 1.04; 95% CI, 0.94-1.14), but moving 4 or more times during adulthood was associated with increased risk (adjusted hazard ratio, 1.82; 95% CI, 1.51-2.23). Independently, moving greater distances before age 16 years was associated with an increased risk (adjusted HR, 1.11; 95% CI, 1.05-1.19), with evidence of a nonlinear threshold effect for moves longer than 30 km. The distance moved after age 20 years was associated with a decreased risk (adjusted HR, 0.67; 95% CI, 0.63-0.71).
Children and adolescents with less disruption in their residential environments are less likely to experience psychotic disorders in early adulthood. Moves that may necessitate changes in school and social networks were most strongly associated with future risk.
儿童期和青春期的居住地迁移（迁居）可能是多种不良健康结果（包括精神障碍）的风险因素。然而，目前尚不清楚一生中是否存在对居住地迁移敏感的时期，包括成年期，或者是否更大的迁移距离（可能会破坏社交网络）与更大的精神病风险相关。
研究一生中的居住地迁移与非情感性精神病风险之间的关系。
设计、地点和参与者：这项前瞻性队列研究包括 1982 年 1 月 1 日至 1995 年 12 月 31 日期间出生且在瑞典居住的所有人群，他们在 16 岁生日时活着且居住在瑞典，随访至 29 岁（截至 2011 年 12 月）。参与者接受了首次国际疾病分类第十版（ICD-10）非情感性精神病障碍（F20-29）诊断、移民、死亡或 2011 年底，以先发生者为准。国家登记处的链接提供了暴露、结局和协变量数据（1440383 名参与者中有 97.8%的数据完整）。
对于一生中以下时期的参与者，评估了距离迁移和居住地迁移次数的暴露情况：0-6 岁、7-15 岁、16-19 岁和 20 岁及以上。
这项研究包括 1440383 名参与者，其中 4537 名（0.31%）患有非情感性精神病（中位数年龄为 20.9[四分位数间距，19.0-23.3]）。儿童期和青春期更频繁的迁居与非情感性精神病风险增加有关，且与协变量无关，具有剂量-反应关系。风险最敏感的时期发生在青少年晚期；与从未迁居者相比，在 16 岁至 19 岁之间每年迁居的参与者，其校正后的危险比（HR）为 1.99（95%置信区间，1.30-3.05）。成年期一次迁居与精神病风险无关（校正 HR，1.04；95%置信区间，0.94-1.14），但成年期迁居 4 次或以上与风险增加相关（校正 HR，1.82；95%置信区间，1.51-2.23）。独立地，在 16 岁之前迁移的距离较大与风险增加有关（校正 HR，1.11；95%置信区间，1.05-1.19），而且距离大于 30 公里的迁居存在非线性阈值效应。20 岁以后迁移的距离与风险降低有关（校正 HR，0.67；95%置信区间，0.63-0.71）。
儿童和青少年的居住环境干扰较小，成年早期出现精神病的可能性较小。可能需要改变学校和社交网络的迁居与未来风险的关系最为密切。
