The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study

Vera Brink, Humma Andleeb, Charlotte Gayer-Anderson, Celso Arango, Manuel Arrojo, Domenico Berardi, Miquel Bernardo, Julio Bobes, Cristina Marta Del-Ben, Laura Ferraro, Lieuwe de Haan, Daniele La Barbera, Caterina La Cascia, Antonio Lasalvia, Pierre-Michel Llorca, Paolo Rossi Menezes, Baptiste Pignon, Julio Sanjuán, José Luis Santos, Jean-Paul SeltenIlaria Tarricone, Andrea Tortelli, Giada Tripoli, Eva Velthorst, Bart P F Rutten, Jim van Os, Diego Quattrone, Robin M Murray, Peter B Jones, Craig Morgan, Marta Di Forti, Hannah E Jongsma, James B Kirkbride

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1039-1049
Number of pages11
JournalSchizophrenia bulletin
Volume50
Issue number5
Early online date24 May 2024
DOIs
Publication statusPublished - 27 Aug 2024

Keywords

  • epidemiology
  • etiology
  • social determinants of health
  • social inequality
  • substance use

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