TY - JOUR
T1 - Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population
T2 - a prospective study in the NEMESIS-2 cohort
AU - Guloksuz, Sinan
AU - Pries, Lotta Katrin
AU - ten Have, Margreet
AU - de Graaf, Ron
AU - van Dorsselaer, Saskia
AU - Klingenberg, Boris
AU - Bak, Maarten
AU - Lin, Bochao D
AU - van Eijk, Kristel R.
AU - Delespaul, Philippe
AU - van Amelsvoort, Therese
AU - Luykx, Jurjen J.
AU - Rutten, Bart P.F.
AU - van Os, Jim
N1 - Publisher Copyright:
© 2020 World Psychiatric Association
PY - 2020/6/1
Y1 - 2020/6/1
N2 - The validity and clinical utility of the concept of “clinical high risk” (CHR) for psychosis have so far been investigated only in risk-enriched samples in clinical settings. In this population-based prospective study, we aimed – for the first time – to assess the incidence rate of clinical psychosis and estimate the population attributable fraction (PAF) of that incidence for preceding psychosis risk states and DSM-IV diagnoses of non-psychotic mental disorders (mood disorders, anxiety disorders, alcohol use disorders, and drug use disorders). All analyses were adjusted for age, gender and education. The incidence rate of clinical psychosis was 63.0 per 100,000 person-years. The mutually-adjusted Cox proportional hazards model indicated that preceding diagnoses of mood disorders (hazard ratio, HR=10.67, 95% CI: 3.12-36.49), psychosis high-risk state (HR=7.86, 95% CI: 2.76-22.42) and drug use disorders (HR=5.33, 95% CI: 1.61-17.64) were associated with an increased risk for clinical psychosis incidence. Of the clinical psychosis incidence in the population, 85.5% (95% CI: 64.6-94.1) was attributable to prior psychopathology, with mood disorders (PAF=66.2, 95% CI: 33.4-82.9), psychosis high-risk state (PAF=36.9, 95% CI: 11.3-55.1), and drug use disorders (PAF=18.7, 95% CI: –0.9 to 34.6) as the most important factors. Although the psychosis high-risk state displayed a high relative risk for clinical psychosis outcome even after adjusting for other psychopathology, the PAF was comparatively low, given the low prevalence of psychosis high-risk states in the population. These findings provide empirical evidence for the “prevention paradox” of targeted CHR early intervention. A comprehensive prevention strategy with a focus on broader psychopathology may be more effective than the current psychosis-focused approach for achieving population-based improvements in prevention of psychotic disorders.
AB - The validity and clinical utility of the concept of “clinical high risk” (CHR) for psychosis have so far been investigated only in risk-enriched samples in clinical settings. In this population-based prospective study, we aimed – for the first time – to assess the incidence rate of clinical psychosis and estimate the population attributable fraction (PAF) of that incidence for preceding psychosis risk states and DSM-IV diagnoses of non-psychotic mental disorders (mood disorders, anxiety disorders, alcohol use disorders, and drug use disorders). All analyses were adjusted for age, gender and education. The incidence rate of clinical psychosis was 63.0 per 100,000 person-years. The mutually-adjusted Cox proportional hazards model indicated that preceding diagnoses of mood disorders (hazard ratio, HR=10.67, 95% CI: 3.12-36.49), psychosis high-risk state (HR=7.86, 95% CI: 2.76-22.42) and drug use disorders (HR=5.33, 95% CI: 1.61-17.64) were associated with an increased risk for clinical psychosis incidence. Of the clinical psychosis incidence in the population, 85.5% (95% CI: 64.6-94.1) was attributable to prior psychopathology, with mood disorders (PAF=66.2, 95% CI: 33.4-82.9), psychosis high-risk state (PAF=36.9, 95% CI: 11.3-55.1), and drug use disorders (PAF=18.7, 95% CI: –0.9 to 34.6) as the most important factors. Although the psychosis high-risk state displayed a high relative risk for clinical psychosis outcome even after adjusting for other psychopathology, the PAF was comparatively low, given the low prevalence of psychosis high-risk states in the population. These findings provide empirical evidence for the “prevention paradox” of targeted CHR early intervention. A comprehensive prevention strategy with a focus on broader psychopathology may be more effective than the current psychosis-focused approach for achieving population-based improvements in prevention of psychotic disorders.
KW - at risk mental states
KW - clinical high risk
KW - drug use disorders
KW - early intervention
KW - mood disorders
KW - prevention
KW - Psychosis
KW - ultra-high risk
UR - http://www.scopus.com/inward/record.url?scp=85084431743&partnerID=8YFLogxK
U2 - 10.1002/wps.20755
DO - 10.1002/wps.20755
M3 - Article
C2 - 32394548
SN - 1723-8617
VL - 19
SP - 199
EP - 205
JO - World Psychiatry
JF - World Psychiatry
IS - 2
ER -