Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
复制标题
DOI：
10.1001/jamapsychiatry.2020.0103
复制
发表时间：
2020-07-01
期刊：
影响因子：
25.8
通讯作者：
Kirkbride, James B.
中科院分区：
文献类型：
--
作者：
Lewis, Gemma;Dykxhoorn, Jennifer;Kirkbride, James B.
这项队列研究调查了低智商是否导致人口密度或贫困与非情感性精神病之间的关联，以及这些关联在瑞典军人中智商较低的人中是否更强。问题是，低智商是否有助于出生在人口更稠密或更贫困的地区与随后的非情感性精神病之间的关联，以及这些关联在智商较低的人中是否更强？在一项以人口为基础的全国范围内的227429名瑞典男性队列中，出生在人口稠密或贫困地区的人与成年后患非情感性精神病的风险增加有关。强有力的证据表明，出生在更贫困的地区与18岁时智商下降有关，这可以解释剥夺和非情感性精神病之间高达23%的联系，但没有发现智商影响效果的证据。这些发现表明，出生在更贫困的社区可能会通过影响认知发展在一定程度上增加成年男性患非情感性精神病的风险，这与更广泛的关于精神障碍相关的神经发育迟缓的文献是一致的。在人口更稠密或更贫困的地区出生或长大的重要性与成年后患非情感性精神病的风险增加有关，但到目前为止，很少有研究探讨一般认知能力在这些关联中的作用。目的探讨低智商是否导致人口密度或剥夺与非情感性精神病(中介)之间的关联，以及这种关联在低智商(效果修正)的人群中是否更强。设计、设置和参与者这项前瞻性队列研究评估了1982年1月1日至1988年12月31日在瑞典出生并在18岁时应征入伍的男性样本。数据收集时间为1982年1月1日至2016年12月31日，分析时间为2018年5月1日至12月31日。暴露了小区域水平的人口密度(每平方公里的人口)和出生时的社会经济贫困的持续测量。贫困是基于地区层面的社会、犯罪和失业数据。智商评估是在18岁应征入伍期间进行的(平均[SD]智商，100[15])。主要结果和衡量标准《国际疾病及相关健康问题统计分类》第十版首次诊断，从18岁到2016年12月31日记录在国家患者登记册上的非情感性精神病。结果研究样本包括227429名男性，从18岁到随访结束，他们被归类为精神疾病的风险。其中，1596名男性(0.7%)被诊断为非情感性精神病。在调整混杂因素后，人口密度(优势比[OR]，1.07；95%CI，1.04-1.14)和出生时的剥夺(OR，1.09；95%CI，1.02-1.13)每增加1-SD，非情感性精神病的患病几率就会增加。调整后智商与剥夺呈负相关(剥夺中每增加1-SD的效果估计：-0.70分；95%CI，-0.78至-0.62分)，但与人口密度无关。在中介分析中，基于潜在结果框架，23%(95%可信区间，17%-49%)的剥夺对非情感性精神病的总影响是由智商调节的。智商并没有改变剥夺或人口密度与非情感性精神病之间的联系。结论和相关性这些发现表明，出生在更贫困的社区可能会通过随后对认知发展的影响在一定程度上增加患非情感性精神病的风险，这与更广泛的与精神障碍相关的神经发育迟缓的文献一致。在贫困环境中找出导致这一过程的因素，可以为预防非情感性精神病的公共卫生战略提供依据。
This cohort study investigates whether lower IQ contributed to the association between population density or deprivation and nonaffective psychosis and whether these associations were stronger in people with lower IQ among Swedish military conscripts.Question Does lower IQ contribute to the association between being born into more densely populated or deprived areas and subsequent nonaffective psychosis, and are those associations stronger in people with lower IQ? Findings In a nationwide, population-based cohort of 227429 Swedish men, being born in more densely populated or deprived areas was associated with an increased risk of adult nonaffective psychosis. Strong evidence suggested that being born in more deprived areas was associated with reduced IQ at 18 years of age, which could account for as much as 23% of the association between deprivation and nonaffective psychosis, but no evidence of effect modification by IQ was found. Meaning These findings suggest that being born in more deprived neighborhoods may partly increase risk of nonaffective psychosis in adult men through its effects on cognitive development, consistent with the wider literature on neurodevelopmental delays associated with psychotic disorder.Importance Being born or raised in more densely populated or deprived areas is associated with increased risk of nonaffective psychosis in adulthood, but few studies to date have examined the role of general cognitive ability in these associations. Objective To investigate whether lower IQ contributed to the association between population density or deprivation and nonaffective psychosis (mediation) and whether these associations were stronger in people with lower IQ (effect modification). Design, Setting, and Participants This prospective cohort study evaluated a population-based sample of men born in Sweden from January 1, 1982, to December 31, 1988, and conscripted into military service at 18 years of age. Data were collected from January 1, 1982, to December 31, 2016, and analyzed from May 1 to December 31, 2018. Exposures Continuous measures of small area-level population density (persons per square kilometer) and socioeconomic deprivation at birth. Deprivation was based on area-level social, criminal, and unemployment data. IQ was assessed during conscription at 18 years of age (mean [SD] IQ, 100 [15]). Main Outcomes and Measures First diagnosis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, nonaffective psychosis from 18 years of age until December 31, 2016, recorded in the National Patient Register. Results The study sample included a total of 227429 men who were classified as at risk of psychosis from 18 years of age until the end of follow-up. Of these, 1596 men (0.7%) were diagnosed with nonaffective psychosis. After adjustments for confounders, odds of nonaffective psychosis increased per 1-SD increase in population density (odds ratio [OR], 1.07; 95% CI, 1.04-1.14) and deprivation (OR, 1.09; 95% CI, 1.02-1.13) at birth. IQ was negatively associated with deprivation after adjustments (effect estimate per 1-SD increase in deprivation: -0.70 points; 95% CI, -0.78 to -0.62 points) but not with population density. In mediation analyses, based on the potential outcome framework, 23% (95% CI, 17%-49%) of the total effect of deprivation on nonaffective psychosis was mediated by IQ. IQ did not modify associations between deprivation or population density and nonaffective psychosis. Conclusions and Relevance These findings suggest that being born in more deprived neighborhoods may partly increase risk of nonaffective psychosis through subsequent effects on cognitive development, consistent with the wider literature on neurodevelopmental delays associated with psychotic disorder. Identifying factors in deprived environments that give rise to this process could inform public health strategies to prevent nonaffective psychosis.