Abstract
BackgroundLittle is known about the impact of different forms of childhood adversity (CA) on outcomes in first episode psychosis (FEP) patients beyond the first year of treatment. We investigated associations between different types of CA and 5-year outcomes in a well-characterised sample of FEP patients.MethodsA total of 237 FEP cases aged 18–65 years were followed on average for 5 years after first presentation to psychiatric services in South-London, UK. CA was assessed at service entry using the Childhood Experience of Care and Abuse Questionnaire. Using electronic clinical notes, extensive information was collected on clinical and social outcomes, service use, and self-injurious behaviours. As case analysis with missing data provides the most severely biased results we conducted multiple imputations to handle the missing data. We imputed the missing values using multiple imputations by chained equations (MICE). MICE has been shown to be a robust method for dealing with missing data across empirical and longitudinal studies.Results72.1% of the sample reported at least one form of CA. Childhood parental separation was associated with greater likelihood of non-compliance with antipsychotic medications (OR=2.44, 95% CI=1.11–5.39), compulsory admission (OR=2.40, 95% CI=1.32–4.37), and living alone (OR=1.99, 95% CI=1.04–3.81) by the end of the follow-up. Institutional care was associated with longer total length of inpatient stay (IRR=1.34, 95% CI=1.01–1.79); parental death was associated with compulsory admissions (OR=2.87, 95% CI=1.02–8.05) during the follow-up.DiscussionOur findings suggest some specificity in the detrimental impact of CA on service use and social functioning over a 5-year period following first contact with mental health services for psychosis. Clinicians should screen patients for CA and tailor interventions accordingly to improve outcomes.
Highlights
Little is known about the impact of different forms of childhood adversity (CA) on outcomes in first episode psychosis (FEP) patients beyond the first year of treatment
In the study “Schizophrenia and Other Psychoses Translational Research: Environment and Molecular Biology” (STREAM), we estimated the incidence of first-episode psychosis (FEP) in the catchment area of Ribeirão Preto, Brazil, and investigated the role of environmental and biological factors in the aetiology of the psychoses
Ribeirão Preto is the main city of the region, with a population of 604,682 inhabitants, population density of 929.8 inhabitants/Km2, per capita gross intern product (GIP) of U$ 9,143,20 and human development index (HDI) of 0.800, ranked 40th among 5,570 Brazilian municipalities
Summary
In the study “Schizophrenia and Other Psychoses Translational Research: Environment and Molecular Biology” (STREAM), we estimated the incidence of first-episode psychosis (FEP) in the catchment area of Ribeirão Preto, Brazil, and investigated the role of environmental and biological factors in the aetiology of the psychoses. We found a lower incidence rate of FEP in the main city of the catchment area, in comparison with the remaining cities of the region, which have a lower population density, but worse socioeconomic indicators. These preliminary results suggest an effect of socioeconomically deprived contexts in the incidence of psychosis in Brazil, as described in developed countries.[6] Further studies are needed to explore the environmental risk factors associated with differences in the incidence of psychosis in low and middle-income countries. Cristina Del-Ben*,1, Shuhama Rosana[1], Camila Loureiro[1], Taciana Ragazzi[1], Daniela Zanatta[1], Silvia Tenan[1], Jair Ferreira-Santos[1], Paulo Louzada-Junior[1], Antonio dos Santos[1], Craig Morgan[2], Paulo Menezes1 1Ribeirão Preto Medical School, University of São Paulo; 2Institute of Psychiatry, Psychology & Neuroscience, King’s College London
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