Social environment not linked to UHR psychosis transition

Research indicates that social deprivation and migrant status do not influence the risk of transition to psychosis in ultra-high-risk (UHR) individuals.

The findings, from Australia, add to a mixed body of evidence that suggests risk factors associated with psychosis in the overall population are not always also associated with the transition from prodromal symptoms to psychotic disorder.

The team, led by Brian O’Donoghue (Orygen Youth Health Research Centre, Parkville, Victoria), analysed data from the Personal Assessment and Crisis Evaluation (PACE) 400 study. In all, they included 219 people aged between 15 and 25 years attending a specialised clinic for UHR individuals between 2000 and 2006. All patients fulfilled criteria for at least one of three UHR groups: attenuated psychotic symptoms, brief limited intermittent psychotic symptoms, and trait and state risk factors.

Using an index of socioeconomic disadvantage derived from the Australian census, based on factors including income, education level, employment, and occupation, the authors separated participants into quartiles according to the level of deprivation corresponding to where they live. Overall, 31.5% were in quartile one (the most deprived), 35.5% in quartile two, 15.5% in quartile 3 and 17.5% in quartile four (the least deprived).

In the study, 8.8% were defined as first-generation migrants (who had moved to Australia after birth) and 41.9% were defined as second-generation migrants (one or both parents born outside of Australia).

Overall, 148 (67.6%) of participants were followed-up at a median of 4.77 years, by which time the mean Global Assessment of Functioning score had increased from 56.1 out of 100 at baseline to 66.5. Thirty-two (14.6%) individuals had transitioned to psychotic disorder, but there was no significant association between deprivation or migrant status and the risk of transition in any of the team’s analyses.

Writing in Schizophrenia Research, O’Donoghue and colleagues say that there could be several reasons for their findings.

They note that it would be preferable to conduct an epidemiological study with a long follow-up in order to tease cause from effect. The team also suggests that there could be selection bias in their study due to people from socially deprived areas and migrants being more likely to participate in research studies.

Additionally, patients from migrant populations have previously been shown to experience a longer duration of untreated psychosis than the native population and so may also be less likely to present during the prodromal period.

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