Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford; and Centre for Psychiatry, Queen Mary University of London, UK.
National Institute of Health Research Applied Research Collaboration (NIHR ARC) North Thames, University College London; and Department of Psychiatry, University of Oxford, UK.
Br J Psychiatry. 2021 Dec;219(6):686-694. doi: 10.1192/bjp.2021.142.
Psychosis is associated with many forms of adversity, deprivation and living in urban areas.
To investigate whether psychosis is part of a syndemic of multiple adversities.
Drawing on UK Biobank (UKBB) data (Project ID: 57601), we sought to understand mechanisms by which childhood, recent/contemporary and place-based adversities might cluster and interact to be implicated in pathways by which psychoses evolve. We investigated the associations between adversities, potential mediating inflammatory markers and ICD-10 diagnoses (F20-F31) of psychotic disorders. We fitted logistic regression models initially including all relevant candidate variables and used backwards deletion to retain theoretically plausible and statistically significant (P < 0.05) associations with psychotic disorders. The candidate variables were entered in a partial least squares structural equation model (PLS-SEM) to test for syndemic interactions between risk factors. We tested whether the findings were sensitive to demographics, gender and ethnicity.
We fitted a PLS-SEM including psychosis as a syndemic outcome, and identified three latent constructs: lifetime adversity, current adversity and biomarkers. Factor loadings were above 0.30, and all structural paths were significant (P < 0.05). There were moderate associations between lifetime adversity and current adversity (standardised coefficient s.c. = 0.178) and between current adversity and biomarkers (s.c. = 0.227). All three latent constructs showed small but significant associations with psychosis (s.c. < 0.04). Lifetime adversity and current adversity were more strongly associated among ethnic minorities (combined) than White British people.
Our findings stress the importance of interactions between childhood and contemporary adversities in preventive and therapeutic interventions for psychotic disorders, especially among ethnic minorities.
精神病与多种逆境、剥夺和居住在城市地区有关。
研究精神病是否是多种逆境综合征的一部分。
利用英国生物库（UKBB）数据（项目 ID：57601），我们试图了解童年、近期/当代和基于地点的逆境如何聚类和相互作用，从而影响精神病演变的途径。我们研究了逆境、潜在的中介炎症标志物与 ICD-10 诊断（F20-F31）之间的关联，这些诊断与精神障碍有关。我们拟合了逻辑回归模型，最初包含所有相关候选变量，并使用向后删除法保留与精神障碍有理论上合理和统计学意义（P<0.05）的关联。候选变量被输入偏最小二乘结构方程模型（PLS-SEM）中，以测试风险因素之间的综合征相互作用。我们测试了这些发现是否对人口统计学、性别和种族敏感。
我们拟合了一个包含精神病作为综合征结果的 PLS-SEM，并确定了三个潜在的结构：终身逆境、当前逆境和生物标志物。因子负荷均高于 0.30，所有结构路径均具有统计学意义（P<0.05）。终身逆境和当前逆境之间存在中度关联（标准化系数 s.c. = 0.178），当前逆境和生物标志物之间存在中度关联（s.c. = 0.227）。所有三个潜在结构与精神病均存在微小但具有统计学意义的关联（s.c. <0.04）。在少数民族（合并）中，终身逆境和当前逆境之间的关联比英国白人更强。
我们的研究结果强调了童年和当代逆境之间相互作用在精神病预防和治疗干预中的重要性，尤其是在少数民族中。
