TY - JOUR
T1 - The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders
T2 - Findings From the EU-GEI Study
AU - Brink, Vera
AU - Andleeb, Humma
AU - Gayer-Anderson, Charlotte
AU - Arango, Celso
AU - Arrojo, Manuel
AU - Berardi, Domenico
AU - Bernardo, Miquel
AU - Bobes, Julio
AU - Del-Ben, Cristina Marta
AU - Ferraro, Laura
AU - de Haan, Lieuwe
AU - La Barbera, Daniele
AU - La Cascia, Caterina
AU - Lasalvia, Antonio
AU - Llorca, Pierre-Michel
AU - Menezes, Paolo Rossi
AU - Pignon, Baptiste
AU - Sanjuán, Julio
AU - Santos, José Luis
AU - Selten, Jean-Paul
AU - Tarricone, Ilaria
AU - Tortelli, Andrea
AU - Tripoli, Giada
AU - Velthorst, Eva
AU - Rutten, Bart P F
AU - van Os, Jim
AU - Quattrone, Diego
AU - Murray, Robin M
AU - Jones, Peter B
AU - Morgan, Craig
AU - Di Forti, Marta
AU - Jongsma, Hannah E
AU - Kirkbride, James B
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
PY - 2024/8/27
Y1 - 2024/8/27
N2 - BACKGROUND AND HYPOTHESIS: Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings.STUDY DESIGN: We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group.STUDY RESULTS: Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings.CONCLUSIONS: Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.
AB - BACKGROUND AND HYPOTHESIS: Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings.STUDY DESIGN: We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group.STUDY RESULTS: Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings.CONCLUSIONS: Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.
KW - epidemiology
KW - etiology
KW - social determinants of health
KW - social inequality
KW - substance use
UR - http://www.scopus.com/inward/record.url?scp=85202557330&partnerID=8YFLogxK
U2 - 10.1093/schbul/sbae072
DO - 10.1093/schbul/sbae072
M3 - Article
C2 - 38788048
SN - 0586-7614
VL - 50
SP - 1039
EP - 1049
JO - Schizophrenia bulletin
JF - Schizophrenia bulletin
IS - 5
ER -