Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
Schizophr Res. 2021 Dec;238:137-144. doi: 10.1016/j.schres.2021.09.025. Epub 2021 Oct 19.
Accumulating evidence supports an association between residential instability and increased risk for psychosis, but the association between residential instability and conversion to psychosis among adolescents at clinical high risk (CHR) is unclear. In this study, we determined whether individual-level and area-level residential instability and their interaction are associated with conversion to psychosis within two years.
Data were collected as part of the North American Prodrome Longitudinal Study Phase 2. Individual-level residential instability, defined as having ever moved during lifetime, was derived from the Life Events Scale. Area-level residential instability, defined as the percentage of people who were not living in the same house five years ago, was derived from the U.S. Decennial Censuses.
This study included 285 adolescents at CHR (including 36 subjects who later converted to full psychosis). We found that individual-level residential instability was associated with conversion (adjusted OR = 2.769; 95% CI = 1.037-7.393). The interaction between individual-level and area-level residential instability was significant (p = 0.030). In a subgroup of CHR participants who have never moved (n = 91), area-level residential instability during childhood was associated with conversion (adjusted OR = 1.231; 95% CI = 1.029-1.473). Conversely, in a subgroup of CHR participants who resided in residentially stable areas during childhood (n = 142), the association between individual-level residential instability and conversion remained significant (adjusted OR = 15.171; 95% CI = 1.753-131.305).
These findings suggest that individual-level and area-level residential instability may be associated with conversion to psychosis.
越来越多的证据表明，居住不稳定与精神分裂症风险增加之间存在关联，但居住不稳定与处于临床高风险（CHR）的青少年向精神分裂症转变之间的关联尚不清楚。在这项研究中，我们确定个体层面和区域层面的居住不稳定及其相互作用是否与两年内向精神分裂症的转变有关。
数据是作为北美前驱纵向研究第二阶段的一部分收集的。个体层面的居住不稳定，定义为一生中曾有过搬家经历，来自生活事件量表。区域层面的居住不稳定，定义为五年前不在同一所房子居住的人数百分比，来自美国十年一次的人口普查。
本研究包括 285 名 CHR 青少年（包括 36 名后来发展为全面精神分裂症的患者）。我们发现，个体层面的居住不稳定与转化有关（调整后的 OR=2.769；95%CI=1.037-7.393）。个体层面和区域层面的居住不稳定之间的相互作用具有统计学意义（p=0.030）。在一组从未搬家过的 CHR 参与者中（n=91），童年时期的区域居住不稳定与转化有关（调整后的 OR=1.231；95%CI=1.029-1.473）。相反，在一组童年时期居住在居住稳定地区的 CHR 参与者中（n=142），个体层面的居住不稳定与转化之间的关联仍然显著（调整后的 OR=15.171；95%CI=1.753-131.305）。
这些发现表明，个体层面和区域层面的居住不稳定可能与向精神分裂症的转化有关。
