General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Linda T Betz,Eva Meisenzahl,Paolo Brambilla,Rebekka Lencer,Theresa Haidl ,Katharine Chisholm,Stefan Borgwardt,Rachel Upthegrove,Alexandra Stainton,Stephan Ruhrmann,Lana Kambeitz-Ilankovic,Raimo K R Salokangas,Alessandro Bertolino,Stephen Wood ,Nora Penzel,Marlene Rosen,Frauke Schultze‐Lutter ,Nikolaos Koutsouleris,Julian Wenzel,Joseph Kambeitz

doi:10.1038/s41537-020-00129-w

Abstract

Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.

Highlights

Stressful life events, such as losing a loved one, failure in an exam or change of residence, have been repeatedly linked to the onset, course and outcome of psychotic disorders[1,2,3,4,5,6,7]
We investigated the relationship between the burden of recent life events and specific symptoms in the early psychosis spectrum
We conducted a cross-sectional network analysis including all individual symptoms of the PANSS and cumulative burden of recent life events

Summary

INTRODUCTION

Stressful life events, such as losing a loved one, failure in an exam or change of residence, have been repeatedly linked to the onset, course and outcome of psychotic disorders[1,2,3,4,5,6,7]. In a previous network analysis, childhood trauma was found to connect to positive and negative symptoms only via symptoms of general psychopathology[12] These findings suggest that adverse events might result in psychosis through heightened emotional reactivity to stress and add to the accumulating evidence for an affective pathway to psychosis[13,20]. BDI Beck Depression Inventory, CHR clinical high risk, CTQ-SF Childhood Trauma Scale-Short Form, GAF global assessment of functioning, PANSS Positive and Negative Syndrome Scale, ROP recent-onset psychosis. When corrected for the influence of different types of childhood trauma, the major pathways from burden of recent life events to positive and negative symptoms via general psychopathology remain unaffected (Fig. 1b, d). The bootstrapping analysis showed that all estimated edges were included in the majority of estimated models, suggesting a general robustness of the results to sampling variation

DISCUSSION

Findings

CODE AVAILABILITY