Bouter Diandra C, Ravensbergen Susan J, de Neve-Enthoven Nita G M, Ercan Sibel, Bakker Benno, de Jong Mark H, Hoogendijk Witte J G, Grootendorst-van Mil Nina H
Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands.
Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, 3000 CA, Rotterdam, The Netherlands.
Schizophr Bull. 2025 Sep 8;51(5):1464-1472. doi: 10.1093/schbul/sbaf046.
Psychotic symptoms are common in adolescents and predictive of psychiatric disorders. Numerous risk factors have been shown to precede psychiatric disorders. However, investigating individual risk factors does not account for the cumulative effect these risk factors may have. Therefore, we combined well-researched environmental risk factors for psychotic disorder in a composite measure: the poly-environmental risk score (PERS).
Risk factors were assessed in a cohort of 801 adolescents (aged 15) at risk for psychopathology. Binarized risk factors included winter birth, low gestational age, low birth weight, ethnic minority status, urban living environment, cannabis use, victim of bullying, emotional abuse, physical abuse, sexual abuse, high paternal age, parental severe mental illness, parental divorce, and parental death. The PERS was weighted with the log odds derived from recent meta-analyses. At age 18, self-reported psychotic experiences (PE) and clinician-rated psychotic symptoms (PS) were assessed. This updated PERS was compared to previous PERS models, which included fewer risk factors and different weightings.
The PERS was associated with PE and PS. Specifically, a PERS between 3 and 4, and PERS > 4 corresponded with a 2.2- and 5.2-fold increase in the odds of psychotic symptoms in late adolescence. The updated 14-item PERS performed better compared to previous compositions of the PERS.
A composite score of childhood and adolescent risk factors measured at age 15 was associated with psychotic symptoms at age 18. Future research should consider the cumulative effect of risk factors when examining the determinants of psychopathology.
精神病性症状在青少年中很常见，且可预测精神疾病。已有众多风险因素被证明先于精神疾病出现。然而，对个体风险因素的研究并未考虑这些风险因素可能产生的累积效应。因此，我们将经过充分研究的精神病性障碍环境风险因素整合为一个综合指标：多环境风险评分（PERS）。
对801名有精神病理学风险的15岁青少年队列进行风险因素评估。二分类风险因素包括冬季出生、低胎龄、低出生体重、少数民族身份、城市生活环境、使用大麻、受欺凌受害者、情感虐待、身体虐待、性虐待、父亲年龄较大、父母患有严重精神疾病、父母离异以及父母死亡。PERS采用近期荟萃分析得出的对数优势进行加权。在18岁时，评估自我报告的精神病性体验（PE）和临床医生评定的精神病性症状（PS）。将这个更新后的PERS与之前的PERS模型进行比较，之前的模型包含的风险因素较少且权重不同。
PERS与PE和PS相关。具体而言，PERS在3至4之间以及PERS>4时，与青春期后期出现精神病性症状的几率分别增加2.2倍和5.2倍相对应。与之前的PERS组合相比，更新后的14项PERS表现更佳。
15岁时测量的儿童和青少年风险因素综合评分与18岁时的精神病性症状相关。未来研究在考察精神病理学的决定因素时应考虑风险因素的累积效应。
