Department of Psychosis, University Center Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
PsyLife Group, Division of Psychiatry, University College London, London, UK.
Schizophr Bull. 2024 Aug 27;50(5):1039-1049. doi: 10.1093/schbul/sbae072.
Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings.
We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group.
Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings.
Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.
最近的研究结果表明，首发精神病障碍（FEP）的发病率因环境剥夺程度和大麻使用情况而异，但这些因素尚未同时进行研究。我们假设，环境剥夺与 FEP 发病率的变化比环境之间每日或高浓度大麻使用的流行率更为相关。
我们使用来自欧盟-盖伊研究的 14 个环境中的 18-64 岁人群的发病率数据。我们以对照组中每日和高浓度大麻的使用情况为代表，来估算高危人群中的使用情况；采用链方程多重插补和后分层加权分别处理缺失数据和对照组的代表性问题。我们使用随机截距负二项回归模型来模拟 FEP 发病率，以研究与对照组中大麻使用、失业率和自住率之间的关联，同时控制人口密度、年龄、性别和移民/族裔群体。
在多变量调整后，较低的自住率与 FEP（调整后的发病率比 [aIRR]：0.76，95%CI：0.61-0.95）和非情感性精神病的发病率（aIRR：0.68，95%CI：0.55-0.83）独立相关。对照组中每日大麻使用的流行率与情感性精神病的发病率相关（aIRR：1.53，95%CI：1.02-2.31）。我们没有发现 FEP 发病率与失业率或高浓度大麻使用流行率之间的关联。敏感性分析支持这些发现。
环境层面较低的自住率和对照组中每日大麻使用的流行率的增加，独立地导致不同精神病障碍发病率的环境层面差异。减少接触这些有害环境因素的公共卫生干预措施可能会降低人群层面的精神病障碍负担。
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