Social disadvantage may increase risk for psychosis

By Mark Cowen, Senior medwireNews Reporter

Results from a UK study suggest that social disadvantage is associated with an increased risk for developing psychosis.

The researchers found that long-term separation from a parent, and death of a parent, before the age of 17 years were significantly associated with an increased risk for psychosis.

They also found that social disadvantage in adulthood was significantly associated with psychosis risk.

"Social disadvantage may be one environmental factor that interacts with genetic predisposition and other environmental factors to cause psychosis," suggest Simona Stilo (King's College London) and team.

The findings come from a study of 278 patients, aged 18-65 years, who were receiving treatment for a first episode of psychosis and 226 mentally healthy individuals (controls) from the same geographic location.

All of the participants were assessed for social disadvantage in three domains in childhood (parental separation, parental death, living arrangements) and adulthood (employment, living arrangements, and relationships) during interviews.

The team found that patients with psychosis were 3.04 times more likely to have experienced the death of a parent before the age of 17 years, and 1.98 times more likely to have experienced a long-term separation from one or both parents than controls.

Patients with psychosis were also 2.56 times more likely to have had at least two different family living arrangements before the age of 17 years than controls.

Furthermore, 67% of psychosis patients reported two or more markers of adult social disadvantage compared with 19% of controls, at an odds ratio (OR) of 9.03.

Regarding long-standing adult social disadvantage, the strength of the association decreased but remained significant for 1 year (OR=5.67) and 5 years (OR=2.57) prior to first contact with mental health services.

Stilo et al conclude in Schizophrenia Bulletin: "Associations need not imply causation; however these data add to an increasing body of research that suggests social disadvantage may contribute to precipitating the onset of psychosis or may index exposure to factors that render the individual more vulnerable."

They add: "Future research will need to further examine these associations and the role of social disadvantage in different ethnic groups as contributory explanation for the higher rates of psychosis among migrants and minority populations."

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