Journal Article Research Support, Non-U.S. Gov't Ppublish 12 citations
PubMed: 35048874 DOI: 10.1192/bjp.2021.142
Is psychosis a syndemic manifestation of historical and contemporary adversity? Findings from UK Biobank.
Br J Psychiatry 219(6):686-694
Authors: Kamaldeep Bhui, Kristoffer Halvorsrud, Roisin Mooney, Georgina M Hosang
Affiliations
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford; and Centre for Psychiatry, Queen Mary University of London, UK.
- National Institute of Health Research Applied Research Collaboration (NIHR ARC) North Thames, University College London; and Department of Psychiatry, University of Oxford, UK.
- Department of Psychiatry, University of Oxford, UK.
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.
Abstract
BACKGROUND
Psychosis is associated with many forms of adversity, deprivation and living in urban areas.
AIMS
To investigate whether psychosis is part of a syndemic of multiple adversities.
METHOD
Drawing on UK Biobank (UKBB) data (Project ID: 57601), we sought to understand mechanisms by which childhood, recent/contemporary and place-based adversities might cluster and interact to be implicated in pathways by which psychoses evolve. We investigated the associations between adversities, potential mediating inflammatory markers and ICD-10 diagnoses (F20-F31) of psychotic disorders. We fitted logistic regression models initially including all relevant candidate variables and used backwards deletion to retain theoretically plausible and statistically significant (P < 0.05) associations with psychotic disorders. The candidate variables were entered in a partial least squares structural equation model (PLS-SEM) to test for syndemic interactions between risk factors. We tested whether the findings were sensitive to demographics, gender and ethnicity.
RESULTS
We fitted a PLS-SEM including psychosis as a syndemic outcome, and identified three latent constructs: lifetime adversity, current adversity and biomarkers. Factor loadings were above 0.30, and all structural paths were significant (P < 0.05). There were moderate associations between lifetime adversity and current adversity (standardised coefficient s.c. = 0.178) and between current adversity and biomarkers (s.c. = 0.227). All three latent constructs showed small but significant associations with psychosis (s.c. < 0.04). Lifetime adversity and current adversity were more strongly associated among ethnic minorities (combined) than White British people.
CONCLUSIONS
Our findings stress the importance of interactions between childhood and contemporary adversities in preventive and therapeutic interventions for psychotic disorders, especially among ethnic minorities.
MeSH
Psychiatry, Psychotic Disorders, Id, Syndemic
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- Ethnic inequities in multimorbidity among people with psychosis: a retrospective cohort study. Epidemiol Psychiatr Sci, 2022
- A syndemic approach to the study of Covid-19-related death: a cohort study using UK Biobank data. J Public Health (Oxf), 2025
- Experience-based investigation and codesign of approaches to prevent and reduce Mental Health Act use (CO-PACT): a protocol. BMJ Open, 2022
- Testing syndemic models along pathways to psychotic spectrum disorder: implications for population-level preventive interventions. Psychol Med, 2025