Queensland Centre for Mental Health Research, Queensland Health, Wacol, QLD, Australia.
School of Public Health, The University of Queensland, Herston, QLD, Australia.
Aust N Z J Psychiatry. 2021 Sep;55(9):892-902. doi: 10.1177/0004867420984832. Epub 2021 Jan 28.
Previous research has found an alarmingly high rate of psychosis in Indigenous patients from remote communities of Cape York and the Torres Strait with the treated prevalence of psychosis four times higher than that found for the Australian population. This study assesses comorbid illness and risk factors among this same cohort of psychosis patients.
Data were collated from a clinical database that contains complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients who received treatment for a psychotic disorder from the Remote Area Mental Health Service. Descriptive analysis and logistic regression models explored differences across subgroups of ethnicity and sex, and relationships between co-morbid disorders and risk factors. All multivariate models included variables of age, year of birth, sex and ethnicity.
Sixty per cent of participants ( = 256) experienced a comorbid mental or substance use disorder. Forty-five per cent ( = 192) of participants experienced a physical comorbidity. The most frequent physical health outcomes were injury (29%, = 93), diabetes (18%, = 58) and cardiovascular disease (21%, = 68). Risk factors considered to play a potential biological or neurodevelopmental role in the development of psychosis were approximately three times more likely in Aboriginal (odds ratio = 3.2; 95% confidence interval = [2.0, 4.9]) versus Torres Strait Islander patients, and those born after 1980 (odds ratio = 2.5; 95% confidence interval = [1.6, 3.9]) versus those born prior to 1980. Environmental or contextual factors were associated with significantly greater risk among Aboriginal (odds ratio = 3.8; 95% confidence interval = [2.4, 6.0]) compared with Torres Strait Islander patients.
Our data expose the perinatal and early environment of Indigenous children who later developed a psychotic disorder. As risk factors for schizophrenia may be cumulative and interactive, both with each other and with critical periods of neurodevelopmental vulnerability, our results suggest possible causes for the increasing prevalence of psychotic disorders between 1992 and 2015.
先前的研究发现，约克角和托雷斯海峡偏远社区的土著患者中精神病的发病率高得惊人，接受治疗的精神病患病率是澳大利亚人口的四倍。本研究评估了同一批精神病患者的合并症和危险因素。
从包含 1992 年至 2015 年完整精神科记录的临床数据库中收集数据，提取所有接受偏远地区精神卫生服务治疗精神障碍的土著患者的数据。描述性分析和逻辑回归模型探索了不同种族和性别的亚组之间的差异，以及合并症和危险因素之间的关系。所有多变量模型都包括年龄、出生年份、性别和种族变量。
60%的参与者（ = 256）患有合并的精神或物质使用障碍。45%的参与者（ = 192）患有身体合并症。最常见的身体健康结果是伤害（29%， = 93）、糖尿病（18%， = 58）和心血管疾病（21%， = 68）。被认为在精神病发展中起潜在生物学或神经发育作用的危险因素在原住民（优势比 = 3.2；95%置信区间 = [2.0, 4.9]）中比托雷斯海峡岛民患者更常见，而在 1980 年后出生的（优势比 = 2.5；95%置信区间 = [1.6, 3.9]）比 1980 年前出生的更常见。环境或背景因素与原住民（优势比 = 3.8；95%置信区间 = [2.4, 6.0]）相比，托雷斯海峡岛民患者的风险显著增加。
我们的数据揭示了后来发展出精神病的土著儿童的围产期和早期环境。由于精神分裂症的危险因素可能是累积的和相互作用的，并且与神经发育脆弱的关键时期相互作用，我们的结果表明，1992 年至 2015 年间精神病患病率增加的可能原因。
