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Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study

Published online by Cambridge University Press:  16 April 2013

C. Morgan ,
U. Reininghaus ,
P. Fearon ,
G. Hutchinson ,
K. Morgan ,
P. Dazzan ,
J. Boydell ,
J. B. Kirkbride ,
G. A. Doody  and
P. B. Jones
...Show all authors
C. Morgan*
Affiliation:
NIHR Biomedical Research Centre, and Section of Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK
U. Reininghaus
Affiliation:
NIHR Biomedical Research Centre, and Section of Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK
P. Fearon
Affiliation:
Trinity College, Dublin, Ireland
G. Hutchinson
Affiliation:
Psychiatry Unit, University of the West Indies, Trinidad
K. Morgan
Affiliation:
Department of Psychology, Westminster University, London, UK
P. Dazzan
Affiliation:
NIHR Biomedical Research Centre and Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK
J. Boydell
Affiliation:
NIHR Biomedical Research Centre and Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK
J. B. Kirkbride
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
G. A. Doody
Affiliation:
Division of Psychiatry, University of Nottingham, Nottingham, UK
P. B. Jones
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
R. M. Murray
Affiliation:
NIHR Biomedical Research Centre and Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK
T. Craig
Affiliation:
NIHR Biomedical Research Centre, and Section of Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK NIHR Biomedical Research Centre and Psychosis Studies Department, Institute of Psychiatry, King's College, London, UK
*
*Address for correspondence: C. Morgan, Ph.D., Section of Social Psychiatry, Institute of Psychiatry, King's College London, London, UK. (Email: [email protected])
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Abstract

Background

There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects.

Method

All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls.

Results

There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample.

Conclusions

Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.

Keywords

Interactionmediationpsychosissocial adversity
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 407 - 419
Copyright
Copyright © Cambridge University Press 2013 

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References

Bebbington, P, Jonas, S, Kuipers, E, King, M, Cooper, C, Brugha, T, Meltzer, H, McManus, S, Jenkins, R (2011). Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. British Journal of Psychiatry 199, 29–37.CrossRefGoogle ScholarPubMed
Brown, GW, Craig, TK, Harris, TO, Handley, RV, Harvey, AL, Serido, J (2007). Child-specific and family-wide risk factors using the retrospective Childhood Experience of Care & Abuse (CECA) instrument: a life-course study of adult chronic depression – 3. Journal of Affective Disorders 103, 225–236.CrossRefGoogle ScholarPubMed
Clarke, MC, Tanskanen, A, Huttunen, M, Leon, DA, Murray, RM, Jones, PB, Cannon, M (2011). Increased risk of schizophrenia from additive interaction between infant motor developmental delay and obstetric complications: evidence from a population-based longitudinal study. American Journal of Psychiatry 168, 1295–1302.Google Scholar
Collip, D, Myin-Germeys, I, Van, Os J (2008). Does the concept of ‘sensitization’ provide a plausible mechanism for the putative link between the environment and schizophrenia? Schizophrenia Bulletin 34, 220–225.Google Scholar
Cooper, C, Morgan, C, Byrne, M, Dazzan, P, Morgan, K, Hutchinson, G, Doody, G, Harrison, G, Leff, J, Jones, P, Ismail, K, Murray, R, Bebbington, P, Fearon, P (2008). Perceptions of disadvantage, ethnicity and psychosis: results from the AESOP study. British Journal of Psychiatry 192, 185–190.Google Scholar
Fisher, H, Schreier, A, Zammit, S, Maughan, B, Munafò, MR, Lewis, G, Wolke, D (2012). Pathways between childhood victimisation and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin. Published online 1 09 2012 . doi: 10.1093/schbul/sbs088.Google Scholar
Fowler, D, Hodgekins, J, Garety, P, Freeman, D, Kuipers, E, Dunn, G, Smith, B, Bebbington, PB (2012). Negative cognition depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophrenia Bulletin 38, 1063–1073.CrossRefGoogle ScholarPubMed
Gayer-Anderson, C, Morgan, C (2012). Social networks, support and early psychosis: a systematic review. Epidemiology and Psychiatric Science. Published online 26 07 2012 . doi: 10.1017/S2045796012000406.Google Scholar
Hafeman, DM (2008). A sufficient cause based approach to the assessment of mediation. European Journal of Epidemiology 23, 711–721.CrossRefGoogle Scholar
Hafeman, DM, Schwartz, S (2009). Opening the Black Box: a motivation for the assessment of mediation. International Journal of Epidemiology 38, 838–845.Google Scholar
Howes, OD, Kapur, S (2009). The dopamine hypothesis of schizophrenia: version III – the final common pathway. Schizophrenia Bulletin 35, 549–562.Google Scholar
Kendler, KS, Gardner, CO (2010). Interpretation of interactions: guide for the perplexed. British Journal of Psychiatry 197, 170–171.Google Scholar
Kirkbride, J, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, J, Mallett, R, Harrison, G, Murray, R, Jones, P (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry 63, 250–258.Google Scholar
Lederbogen, F, Kirsch, P, Haddad, L, Streit, F, Tost, H, Schuch, P, Wust, S, Pruessner, JC, Rietschel, M, Deuschle, M, Meyer-Lindenberg, A (2011). City living and urban upbringing affect neural social stress processing in humans. Nature 474, 498–501.Google Scholar
MacKinnon, D (2008). Introduction to Statistical Mediation Analysis. Lawrence Erlbaum Associates: New York.Google Scholar
Mallett, R, Leff, J, Bhugra, D, Pang, D, Zhao, JH (2002). Social environment, ethnicity and schizophrenia. Social Psychiatry and Psychiatric Epidemiology 37, 329–335.Google Scholar
Mondelli, V, Dazzan, P, Hepgul, N, Di Forti, M, Aas, M, D'Albenzio, A, Di Nicola, M, Fisher, H, Handley, R, Marques, TR, Morgan, C, Navari, S, Taylor, H, Papadopoulos, A, Aitchison, KJ, Murray, RM, Pariante, CM (2010). Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment. Schizophrenia Research 116, 234–242.Google Scholar
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655–664.Google Scholar
Morgan, C, Dazzan, P, Morgan, K, Jones, P, Harrison, G, Leff, J, Murray, R, Fearon, P (2006). First episode psychosis and ethnicity: initial findings from the AESOP study. World Psychiatry 5, 40–46.Google ScholarPubMed
Morgan, C, Fisher, H, Hutchinson, G, Kirkbride, J, Craig, TK, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2009). Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatrica Scandinavica 119, 226–235.Google Scholar
Morgan, C, Kirkbride, J, Hutchinson, G, Craig, T, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2008). Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study. Psychological Medicine 38, 1701–1715.Google Scholar
Morgan, C, Kirkbride, J, Leff, J, Craig, T, Hutchinson, G, McKenzie, K, Morgan, K, Dazzan, P, Doody, GA, Jones, P, Murray, R, Fearon, P (2007). Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychological Medicine 37, 495–503.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, B (1998–2012). Mplus Version 6.1. Muthén and Muthén: Los Angeles, CA.Google Scholar
National Institute of Mental Health (1992). Family Interview for Genetic Studies (FIGS). NIHM: Rockville, MD.Google Scholar
Pantazis, C, Gordon, D, Levitas, R (eds) (2006). Poverty and Social Exclusion in Britain: The Millenium Survey. The Policy Press: Bristol.Google Scholar
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.Google Scholar
Purcell, SM, Wray, NR, Stone, JL, Visscher, PM, O'Donovan, MC, Sullivan, PF, Sklar, P (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460, 748–752.Google ScholarPubMed
Reininghaus, U, Craig, TK, Fisher, HL, Hutchinson, G, Fearon, P, Morgan, K, Dazzan, P, Doody, GA, Jones, PB, Murray, RM, Morgan, C (2010). Ethnic identity, perceptions of disadvantage, and psychosis: findings from the AESOP study. Schizophrenia Research 124, 43–48.Google Scholar
Rosenberg, M (1989). Society and the Adolescent Self-Image. Wesleyan University Press: Middletown, CT.Google Scholar
Rothman, KJ, Greenland, S, Walker, AM (1980). Concepts of interaction. American Journal of Epidemiology 112, 467–470.Google Scholar
Schwartz, S (2006). Modern epidemiologic approaches to interaction: applications to studies of genetic interactions. In Genes, Behaviour and the Social Environment: Moving Beyond the Nature/Nurture Debate (ed. Hernandez, L. M. and Blazer, D. G.), pp. 310–337. National Academies Press: Washington, DC.Google Scholar
Schwartz, S, Susser, E (2006). Relationships among causes. In Psychiatric Epidemiology: Searching for the Causes of Mental Disorders (ed. Susser, E., Schwartz, S., Morabia, A. and Bromet, E. J.), pp. 62–74. Oxford University Press: Oxford.Google Scholar
Stilo, S, Di Forti, M, Mondelli, V, Falcone, AM, Russo, M, O Connor, J, Palmer, E, Paparelli, A, Kolliakou, A, Sirianni, M, Taylor, H, Handley, R, Dazzan, P, Pariante, C, Marques, T, Zoccali, R, David, AS, Murray, R, Morgan, C (2012). Social disadvantage: cause or consequence of impending psychosis? Schizophrenia Bulletin. Published online 22 October 2012 . doi: 10.1093/schbul/sbs112.Google Scholar
van Dam, DS, van der Ven, E, Velthorst, E, Selten, JP, Morgan, C, de Haan, L (2012). Childhood bullying and the association with psychosis in non-clinical and clinical samples: a review and meta-analysis. Psychological Medicine 42, 2463–2474.Google Scholar
van Os, J, Driessen, G, Gunther, N, Delespaul, P (2000). Neighbourhood variation in incidence of schizophrenia. Evidence for person–environment interaction. British Journal of Psychiatry 176, 243–248.Google Scholar
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203–212.Google Scholar
van Os, J, Pedersen, CB, Mortensen, PB (2004). Confirmation of synergy between urbanicity and familial liability in the causation of psychosis. American Journal Psychiatry 161, 2312–2314.Google Scholar
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient–control prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661–671.Google Scholar
Veling, W, Hoek, HW, Selten, JP, Susser, E (2011). Age at migration and future risk of psychotic disorders among immigrants in the Netherlands: a 7-year incidence study. American Journal of Psychiatry 168, 1278–1285.CrossRefGoogle ScholarPubMed
World Health Organization (1992). Schedules for Clinical Assessment in Neuropsychiatry. World Health Organization: Geneva.Google Scholar
Zammit, S, Lewis, G, Dalman, C, Allebeck, P (2010 a). Examining interactions between risk factors for psychosis. British Journal of Psychiatry 197, 207–211.Google Scholar
Zammit, S, Lewis, G, Rasbash, J, Dalman, C, Gustafsson, JE, Allebeck, P (2010 b). Individuals, schools, and neighborhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Archives of General Psychiatry 67, 914–922.CrossRefGoogle ScholarPubMed
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