Threatening Life Events and Difficulties and Psychotic Disorder.

Craig Morgan,Thomas J Craig,Stephanie Beards,Kathryn Hubbard,Paola Dazzan,Valeria Mondelli,Charlotte Gayer-Anderson,Marta Di Forti,Helen L Fisher,Ulrich Reininghaus,Carmine Pariante,Robin Murray

doi:10.1093/schbul/sbaa005

Craig Morgan, Thomas J Craig + Show 10 more

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https://doi.org/10.1093/schbul/sbaa005

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Abstract

ObjectiveStressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence. MethodThis study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls. ResultsWe found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51–4.79]; 2 events OR 4.87 [95% CI 2.34–10.16]; ≥3 events OR 5.27 [95% CI 1.83–15.19]; 1 difficulty OR 3.02 [95% CI 1.79–5.09]; 2 difficulties OR 9.71 [95% CI 4.20–22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18–51.85]). ConclusionsThreatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.

Highlights

Life events have long been postulated as precipitants of psychoses.[1]
In our meta-analysis,[2] we found that exposure to recent life events was around 3 times more common among cases with psychosis than controls
When we compared the 121 cases who did not complete a Life Events and Difficulties Schedule (LEDS) interview with the 253 cases who did, there were no substantial differences by age, gender, and diagnosis

Summary

Introduction

Life events have long been postulated as precipitants of psychoses.[1]. In our meta-analysis,[2] we found that exposure to recent life events was around 3 times more common among cases with psychosis than controls (weighted summary odds ratio [OR] 3.19; 95% confidence intervals [CI] 2.15–4.75). It is possible that the higher reported prevalence of life events in patients with psychosis is an artifact of unreliable reporting, possibly influenced by the individual’s attempt to find an explanation for their disorder.[3,4] few studies to date have taken any steps to address the potential influence of recall bias (eg, by carefully eliciting detailed accounts, using life course methods such as anchoring by key dates, to aid recall) Another possibility is that more events occur in the period prior to full onset due to the insidious development of symptoms or premorbid characteristics. Some studies have found that even when only independent events are considered there remains evidence of an association with psychosis.[1,5,6,7]

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