不同欧洲地区亚临床精神病症状随人口密度的变化：来自多国欧盟基因与环境研究（EU-GEI）的发现。
Variation of subclinical psychosis as a function of population density across different European settings: Findings from the multi-national EU-GEI study.
作者信息
D'Andrea Giuseppe, Quattrone Diego, Tripoli Giada, Spinazzola Edoardo, Gayer-Anderson Charlotte, Jongsma Hannah E, Sideli Lucia, Stilo Simona A, La Cascia Caterina, Ferraro Laura, La Barbera Daniele, Tortelli Andrea, Velthorst Eva, de Haan Lieuwe, Llorca Pierre-Michel, Santos Jose Luis, Arrojo Manuel, Bobes Julio, Sanjuán Julio, Bernardo Miguel, Arango Celso, Kirkbride James B, Jones Peter B, Rutten Bart P, Schürhoff Franck, Szöke Andrei, van Os Jim, Vassos Evangelos, Selten Jean-Paul, Morgan Craig, Di Forti Marta, Tarricone Ilaria, Murray Robin M
机构信息
University of Montréal Hospital Reseach Centre (CRCHUM), Montréal, Québec, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP)-Montréal, Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.
出版信息
Acta Psychiatr Scand. 2025 Apr;151(4):506-520. doi: 10.1111/acps.13767. Epub 2024 Nov 1.
BACKGROUND
Urbanicity is a well-established risk factor for psychosis. Our recent multi-national study found an association between urbanicity and clinical psychosis in Northern Europe but not in Southern Europe. In this study, we hypothesized that the effect of current urbanicity on variation of schizotypy would be greater in North-western Europe countries than in Southern Europe ones.
METHODS
We recruited 1080 individuals representative of the populations aged 18-64 of 14 different sites within 5 countries, classified as either North-western Europe (England, France, and The Netherlands) with Southern Europe (Spain and Italy). Our main outcome was schizotypy, assessed through the Structured Interview for Schizotypy-Revised. Our main exposure was current urbanicity, operationalized as local population density. A priori confounders were age, sex, ethnic minority status, childhood maltreatment, and social capital. Schizotypy variation was assessed using multi-level regression analysis. To test the differential effect of urbanicity between North-western and Southern European, we added an interaction term between population density and region of recruitment.
RESULTS
Population density was associated with schizotypy (β = 0.248,95%CI = 0.122-0.375;p < 0.001). The addition of the interaction term improved the model fit (likelihood test ratio:χ = 6.85; p = 0.009). The effect of urbanicity on schizotypy was substantially stronger in North-western Europe (β = 0.620,95%CI = 0.362-0.877;p < 0.001) compared with Southern Europe (β = 0.190,95%CI = 0.083-0.297;p = 0.001).
CONCLUSIONS
The association between urbanicity and both subclinical schizotypy and clinical psychosis, rather than being universal, is context-specific. Considering that urbanization is a rapid and global process, further research is needed to disentangle the specific factors underlying this relationship.
背景
城市化是精神病的一个已明确的风险因素。我们最近的一项跨国研究发现，在北欧，城市化与临床精神病之间存在关联，但在南欧并非如此。在本研究中，我们假设，当前城市化对精神分裂症样人格障碍变异的影响在西北欧国家比在南欧国家更大。
方法
我们招募了1080名个体，他们代表了5个国家中14个不同地点的18 - 64岁人群，分为西北欧（英国、法国和荷兰）和南欧（西班牙和意大利）两组。我们的主要结局是精神分裂症样人格障碍，通过修订版精神分裂症样人格障碍结构化访谈进行评估。我们的主要暴露因素是当前的城市化程度，以当地人口密度来衡量。先验混杂因素包括年龄、性别、少数民族身份、童年期虐待和社会资本。使用多层次回归分析评估精神分裂症样人格障碍的变异。为了检验西北欧和南欧之间城市化的差异效应，我们加入了人口密度与招募地区之间的交互项。
结果
人口密度与精神分裂症样人格障碍相关（β = 0.248，95%置信区间 = 0.122 - 0.375；p < 0.001）。加入交互项改善了模型拟合度（似然比检验：χ = 6.85；p = 0.009）。与南欧（β = 0.190，95%置信区间 = 0.083 - 0.297；p = 0.001）相比，城市化对精神分裂症样人格障碍的影响在西北欧显著更强（β = 0.620，95%置信区间 = 0.362 - 0.877；p < 0.001）。
结论
城市化与亚临床精神分裂症样人格障碍及临床精神病之间的关联并非普遍存在，而是因背景而异。鉴于城市化是一个快速且全球性的过程，需要进一步研究以厘清这种关系背后的具体因素。
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