Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology
Open accessAbstract
Background: Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. Method: In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. Results: The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. Conclusions: In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.
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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 Guloksuz et al., 2015
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The effects of psychosocial stress on dopaminergic function and the acute stress response
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- Authors
- Guloksuz, S., van Nierop, M., Lieb, R., van Winkel, R., Wittchen, H.-U., & van Os, J.
- Affiliations
- University of Basel (CH)
- ORCID
- Lieb, R.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-03-25
- Volume
- 45
- Issue
- 11
- Pages
- 2389-2401
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2132803173
- Cited by
- 88
- References
- 17
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 12 · 2019: 12 · 2018: 10 · 2017: 12 · 2016: 9 · 2015: 4
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Lirias (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion)
- Funders
- European Commission (241909)
- Deutsche Forschungsgemeinschaft (WI 709/8-1, LA1148/1‐1, WI2246/7-1)
- Bundesministerium für Bildung und Forschung (LA1148/1-1, 01EB0140, 01EB9405/6, 01EB0440)
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- psychotic experiences, mood disorders, obsessive-compulsive disorder, cannabis use, childhood trauma, urbanicity, environmental risk factors, help-seeking, adolescents
- MeSH terms
- Help-Seeking Behavior, Adult Survivors of Child Adverse Events, Adolescent, Adult, Environmental Exposure, Female, Germany, Humans, Male, Models, Psychological, Obsessive-Compulsive Disorder, Psychopathology, Psychotic Disorders, Risk Factors, Severity of Illness Index, Urban Population, Mood Disorders, Substance-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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