Nicole Gunther

Shared social environment and psychiatric disorder: a multilevel analysis of individual and ecological effects

Abstract We examined associations, in terms of relative and population-attributable risks, between shared social environment at the neighbourhood level and (1) treated incidence of non-psychotic, non-organic disorders, and (2) subsequent level of service consumption. The multilevel analysis used linked records of all individuals in contact for the first time with any catchment area mental health service for non-psychotic, non-organic disorder over various specified time periods between 1981 and 1995. Socioeconomic indicators of 36 neighbourhoods in the city of Maastricht yielded a multivariately defined neighbourhood deprivation score. There were significant linear trends in the association between level of deprivation and treated incidence, especially in the population under 35 years of age (adjusted rate ratio for linear trend 1.17, 95% confident interval 1.11–1.23), who constituted around half of the patient population. The fraction of the incidence of psychiatric disorder attributable to deprivation was 17.8%. Multilevel analyses of rates of a second cohort, with cases divided according to level of service use over a standardised follow-up of 5 years after first contact with psychiatric services, revealed that the effect of deprivation scores on rates declined with intensity of out-patient service use, but increased with level of in-patient use. Up to 50% of in-patient episodes in this group could be attributed to neighbourhood level of deprivation. The increase in risk conferred by neighbourhood deprivation remained after adjustment for the individual-level equivalent. The findings therefore suggest that elements in the shared social environment influence both incidence and severity of non-psychotic, non-organic disorders, over and above any individual-level effect.

Children's mental health service use, neighbourhood socioeconomic deprivation, and social capital.

Abstract.Background:There is accumulating evidence that the shared social environment at the neighbourhood level exerts significant effects on health over and above individual level variables. The aim of this study was to assess the interactive influence of neighbourhood measures of socioeconomic deprivation and social capital (i. e. informal social control, social cohesion and trust) on children’s mental health service use, independent of individual level confounders.Methods:Two different data sources were used: 1) individual socioeconomic measures, derived from a case-control study in which case/control status indicated mental health service use or not, and 2) neighbourhood measures of socioeconomic deprivation and social capital. The data were subjected to multilevel logistic regression analysis.Results:Children living in more deprived neighbourhoods run a higher risk of coming into contact with mental health care services. The social capital variables (informal social control and social cohesion and trust) did not exert main effects, but strong trust and social cohesion between citizens in the neighbourhood mitigated the risk-increasing effect of socioeconomic deprivation on children’s mental health service use.Conclusions:The deleterious effects of socioeconomic deprivation on mental health service use in children are sensitive to the context of cohesion and trust in neighbourhoods. Effects of deprivation on children’s mental health cannot be interpreted without taking into account the context of social capital.

Persistence and outcome of auditory hallucinations in adolescence: A longitudinal general population study of 1800 individuals

BACKGROUND Auditory hallucinations are common in adolescents. However, it has been suggested that not the presence of low-grade psychotic experiences per se, but rather the level of persistence and associated clinical complications over time may lead to psychotic illness. The current paper investigated, in a large representative sample of adolescents, to what degree hallucinations persist, and whether persistence of hallucinations increases the risk of developing secondary delusional ideation and affective dysregulation. METHODS Data were derived from a general health screening of all 1912 adolescents living in the Maastricht area. Baseline assessment was in the second grade of secondary school (T0) and follow-up occurred 2 years later (T1). Questions included the psychosis screening questions (Poulton et al., 2000), the SDQ assessing general psychopathology and a question assessing depression. RESULTS Five percent of adolescents reported hallucinations at T0 and 27% of these hallucinations were still present 2 years later. Hallucinations at T0 were associated with increased levels of depressed mood and general psychopathology at T1, and the degree of persistence of hallucinations was associated with a progressively greater risk for T1 delusional ideation as well as increased levels of follow-up depressed mood and general psychopathology. CONCLUSION Although hallucinations in adolescents are a common and mainly transitory phenomenon, the persistence rate over time is far from negligible, and associated with clinical deterioration.

Phenotypically Continuous With Clinical Psychosis, Discontinuous in Need for Care: Evidence for an Extended Psychosis Phenotype

BACKGROUND Rates of self-reported psychotic experiences (SRPEs) in general population samples are high; however the reliability against interview-based assessments and the clinical significance of false-positive (FP) ratings remain unclear. DESIGN The second Netherlands Mental Health Survey and Incidence Study-2, a general population study. METHODS Trained lay interviewers administered a structured interview assessing psychopathology and psychosocial characteristics in 6646 participants. Participants with at least one SRPE (N = 1084) were reassessed by clinical telephone interview. RESULTS Thirty-six percent of participants with SRPEs were confirmed by clinical interview as true positive (TP). SPREs not confirmed by clinical interview (FP group) generated less help-seeking behavior and occurred less frequently compared with TP experiences (TP group). However, compared with controls without psychotic experiences, the FP group more often displayed mood disorder (relative risk [RR] 1.7, 1.4-2.2), substance use disorder (RR 2.0, 1.6-2.6), cannabis use (RR 1.5, 1.2-1.9), higher levels of neuroticism (RR 1.8, 1.5-2.2), affective dysregulation, and social dysfunction. The FP group also experienced more sexual (RR 2.0, 1.5-2.8) and psychological childhood trauma (RR 2.1, 1.7-2.6) as well as peer victimization (RR 1.5, 1.2-2.0) and recent life events (RR 2.0, 1.6-2.4) than controls without psychotic experiences. Differences between the FP group and the TP group across these domains were much smaller and less conclusive. DISCUSSION SRPEs not confirmed by clinical interview may represent the softest expression of an extended psychosis phenotype that is phenotypically continuous with clinical psychosis but discontinuous in need for care.

Does social defeat mediate the association between childhood trauma and psychosis? Evidence from the NEMESIS‐2 Study

Based on theoretical considerations and animal studies, mediation of ‘social defeat’ (SD) in the association between childhood trauma (CT) and psychosis was investigated.

Childhood social and early developmental factors associated with mental health service use.

Abstract.Background: The aim of this study was to determine the influence of family and child variables on the pathway to mental health care in children. Methods: A blinded, matched case control study was conducted, involving a retrospective analysis of prospectively collected data from routine examinations at the Youth Health Care Division from the Municipal Health Centre Maastricht (YHCD), where all children in a geographically defined area from foetal life through to age 19 years are periodically screened. The sample included 400 children, 80 referred to the Community Mental Health Centre in Maastricht and 320 matched controls, aged 6–13 years. Results: The most potent risk factors associated with mental health service use were: being small at birth, having a younger mother at delivery, living in a one-parent family, having a divorced mother and/or unemployed father, observations of externalising behaviour and/or motor developmental problems, speech problems and experiencing several adverse family circumstances. The group of variables pertaining to the family (e. g. one-parent family, parental mental health problems, etc.) influenced mental health service independently of the group of variables pertaining to the child (e. g. birth length, speech problems, etc.) and vice versa. Several combinations of risk factors, under realistic prevalence estimates, had positive predictive values of up to 26 %. Conclusion: Pathways to child psychiatric care are heavily influenced by the childs family environment as well as by deviance in social, motor and speech development. Independence of child developmental effects suggests these are not merely on the causal pathway between adverse family environment and psychiatric service use outcome. Combinations of risk factors may be useful to develop a screening approach with the possibility of early prevention.

Maastricht Assessment of Coping Strategies (MACS-I): a brief instrument to assess coping with psychotic symptoms

Objective: To examine the reliability of a brief instrument to assess coping with symptoms by patients with psychotic illness.

MACS-II: does coping enhance subjective control over psychotic symptoms?

Objective: Associations between subjective experience of control and the use of self‐initiated coping strategies were examined in patients with psychotic symptoms.

Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study

Background:  Accumulating evidence suggests that experiences of trauma and victimization during childhood are associated with an increased risk to develop clinical and subclinical psychosis in adulthood. A recent cross‐sectional study showed a significant association between trauma and psychotic experiences in adolescents. The current study aimed to extend these findings by investigating the longitudinal effects of negative life experiences on the risk for subclinical psychotic symptoms 2 years later in an adolescent general community sample.

Disentangling associations between poverty at various levels of aggregation and mental health

The present editorial discusses whether socioeconomic status of the individual and of the neighbourhood could be important in prevalence, treatment and prevention of psychiatric morbidity. Previous research showed that patients diagnosed with mental disorders are concentrated in socioeconomically disadvantaged areas. This could be the result of (1) an association between individual socioeconomic status and mental health, (2) an association between neighbourhood socioeconomic status and mental health, or (3) social selection. Research disentangling associations between individual and neighbourhood socioeconomic status on the one hand and mental health outcomes on the other, reported that neighbourhood socioeconomic disadvantage was associated with individual mental health over and above individual-level socioeconomic status, indicating deleterious effects for all inhabitants both poor and affluent. In conclusion, subjective mental health outcomes showed stronger evidence for an effect of neighbourhood socioeconomic status than research focussing on treated incidence. Within the group of patients, however, service use was higher in patients living in disadvantaged neighbourhoods. Social capital was identified as one of the mechanisms whereby neighbourhood socioeconomic disadvantage may become associated with observed reductions in mental health. After controlling for individual socioeconomic status, there is evidence for an association between neighbourhood socioeconomic status and objective as well as subjective mental health in adults. Evidence for such an association in young children is even stronger.