Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study
Open accessAbstract
Background: There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects. Method: All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls. Results: There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample. Conclusions: Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.
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The synergy of social adversity and other factors such as drug abuse and familial risk, in combination with exposure to childhood trauma, may push individuals beyond the threshold for psychotic disorder.
“suggesting that it is the synergy of social adversity and other factors such as drug abuse and familial risk which, in combination with exposure to childhood trauma, may push individuals beyond the threshold for psychotic disorder”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [32]
The Results (Synergistic Effects; page unavailable) and Discussion report that childhood parental separation and adult social disadvantage interacted synergistically to increase psychosis risk. The Sociodevelopmental Pathway discussion also proposes that childhood adversity may interact with later stressors, including substance use. But the paper does not establish synergy involving drug abuse or familial risk; its Methodological Limitations section treats substance use as an unmeasured possible confounder and parental history as a limited proxy for genetic risk. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere seems to be a synergistic interplay between different risk factors, such as between childhood abuse and adult life events, as well as cannabis use, suggesting that exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along the pathway to psychotic disorder.
“There seems to be a synergistic interplay between different risk factors, such as between childhood abuse and adult life events, as well as cannabis use 31,32 , suggesting that exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along the pathway to psychotic disorder.”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [32]
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Experimental — accuracy not yet measuredMorgan et al reported a complex interplay between different environmental risk factors.
“Our results are in line with Morgan et al's report 31,32 of a complex interplay between different environmental risk factors”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [32]
Since associations between one exposure and outcomes remain after controlling for other exposures, it is likely that additive effects and/or synergistic effects operate between risk factors.
“Since associations between one exposure and outcomes remain after controlling for the other exposures (Schäfer and Fisher, 2011), it is likely that additive effects and/or synergistic effects operate between risk factors (Morgan et al., 2014; Guloksuz et al., 2015; Lataster et al., 2012; Morgan et al., 2008; Schäfer and Fisher, 2011).”
From The effects of psychosocial stress on dopaminergic function and the acute stress response (2019) · cites this paper as Morgan et al., 2014
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- Authors
- Morgan, C., Reininghaus, U., Fearon, P., Hutchinson, G., Morgan, K., Dazzan, P., Boydell, J., Kirkbride, J. B., Doody, G. A., Jones, P. B., Murray, R. M., & Craig, T.
- Affiliations
- King's College London (GB)
- Trinity College Dublin (IE)
- University of the West Indies (TT)
- University of Westminster (GB)
- University of Cambridge (GB)
- University of Nottingham (GB)
- Corresponding author
- Morgan, C.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-04-16
- Volume
- 44
- Issue
- 2
- Pages
- 407-419
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4081841
- OpenAlex
- W2158685026
- Cited by
- 97
- References
- 29
- Citations by year
- 2026: 15 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 12 · 2016: 13 · 2015: 6 · 2014: 4
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- Funders
- Wellcome Trust (WT087417, 087417)
- National Institute for Health and Care Research (RP-PG-0606-1335, PDF-2011-04-065)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- psychosis risk, childhood adversity, parental separation, parental death, educational attainment, social deprivation, self-esteem, mediation, synergistic effect, first-episode psychosis, ethnic differences, socio-environmental risk factors
- MeSH terms
- Adolescent, Adult, Child Abuse, England, Environment, Female, Humans, Life Change Events, London, Male, Middle Aged, Models, Psychological, Psychotic Disorders, Self Concept, Social Environment, Multicenter Studies as Topic, Case-Control Studies, Young Adult
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