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The impact of adverse social experiences in a sample of first episode psychosis patients

Student thesis: Doctoral ThesisDoctor of Philosophy

The robust evidence that the incidence of psychosis is elevated in many migrant
and minority ethnic population, especially the black population in the UK, has
led to a resurgence of interest in the potential role of socio-environmental
factors. A growing body of evidence suggests that experiences of social
adversity can increase risk of psychosis, particularly in the presence of other
known risk factors (e.g. genetic risk). The aims of this thesis are to investigate
the relationship between psychosis and a number of current and long-term
indicators of childhood and adulthood social adversity in patients suffering their
first episode of psychosis (n = 507) and in a control sample (425). Detailed data
on social adversity were collected as part of the GAP and EU-GEI studies.
Across all the domains considered, cases were more likely to report social
adversity than were controls. Social adversity, especially in the case of
cumulative exposure, was associated with up to a 9 fold increased risk of
psychosis, independent of potential confounders. Greater number of indicators
present and longer exposure result in progressively greater risk (linear
relationship). Contrary to my hypothesis, no evidence was found that social
adversity was more common in Black and other minority groups compared to
White British subjects. However, going beyond the study of each risk factor
individually, I found evidence that childhood adversity and adulthood adversity
combined synergistically to increase the odds of psychosis, and social adversity
in adulthood, combine with cannabis use, conferring a greater risk than would
be expected if each worked through a separate causal pathway. Although the
results were not significant, there was a trend towards an additive interaction
between adversity in adulthood and psychosis family history.
Original languageEnglish
Awarding Institution
Award date2015


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