Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong.
Schizophr Res. 2021 Mar;229:46-52. doi: 10.1016/j.schres.2021.01.027. Epub 2021 Feb 19.
Ideas of reference (IOR) are often implicated in predicting psychosis onset. They have been conceptualized to present on a continuum, from oversensitive psychological reactions to delusional thoughts. It is however unknown to what extent IOR may be triggered by collective environmental stress. We obtained timely data from 9873 individuals to assess IOR in relation to trauma exposure in the 2019-2020 social unrest in Hong Kong. Two levels of IOR are distinguished: attenuated IOR (IOR-A), being the experience of feeling particularly referred to within a group; and exclusive IOR (IOR-E), the experience of feeling exclusively referred to while others are not. Logistic regressions showed that event-based rumination was a shared predictor for IOR-A (OR = 1.07, CI = 1.03-1.10) and IOR-E (OR = 1.09, CI = 1.02-1.17). For IOR-A, three categories of social unrest-related traumatic events (TEs) were significant predictors, including being attacked or having experienced sexual violence (OR = 4.14, CI = 1.93-8.85), being arrested (OR = 4.48, CI = 1.99-10.10), and being verbally abused (OR = 2.66, CI = 1.28-5.53). Being arrested was significant for IOR-E (OR = 3.87, CI = 1.03-14.52), though not when rumination was included. Education level also significantly predicted IOR-E (OR = 0.72, CI = 0.52-0.99). Further analysis revealed that rumination significantly mediated between TEs and IOR severity (β = 0.26, SE = 0.01, CI = 0.24-0.28). The findings are consistent with the hypothesis that IOR-A and IOR-E occur as levels on a continuum, but each has some distinctive correlates. Extrinsic events may play a more prominent role in IOR-A, while intrinsic factors, such as cognitive capacity, may play a more prominent role in IOR-E. The involvement of rumination across the IOR spectrum suggests an opportunity for intervention.
观念关联（IOR）通常被认为与精神病发作有关。IOR 被概念化为一个连续体，从过度敏感的心理反应到妄想思维。然而，目前还不清楚 IOR 在多大程度上可能会受到集体环境压力的触发。我们从 9873 个人那里及时获得了数据，以评估 2019-2020 年香港社会动荡期间创伤暴露与 IOR 之间的关系。IOR 区分出两个水平：减弱的 IOR（IOR-A），即个体在群体中感到特别被提及的体验；排他性的 IOR（IOR-E），即个体感到自己被单独提及而他人没有的体验。逻辑回归显示，事件性反刍是 IOR-A（OR=1.07，CI=1.03-1.10）和 IOR-E（OR=1.09，CI=1.02-1.17）的共同预测因素。对于 IOR-A，三类与社会动荡相关的创伤性事件（TE）是显著的预测因素，包括被攻击或经历性暴力（OR=4.14，CI=1.93-8.85）、被捕（OR=4.48，CI=1.99-10.10）和被言语虐待（OR=2.66，CI=1.28-5.53）。被捕对 IOR-E 也是显著的（OR=3.87，CI=1.03-14.52），尽管当考虑反刍时并非如此。教育水平也显著预测了 IOR-E（OR=0.72，CI=0.52-0.99）。进一步的分析显示，反刍在 TE 和 IOR 严重程度之间显著中介（β=0.26，SE=0.01，CI=0.24-0.28）。这些发现与假设一致，即 IOR-A 和 IOR-E 是连续体上的两个水平，但每个都有一些独特的相关性。外在事件可能在 IOR-A 中发挥更重要的作用，而内在因素，如认知能力，可能在 IOR-E 中发挥更重要的作用。反刍在整个 IOR 范围内的参与表明了干预的机会。
