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Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis

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 contrib...

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Autores principales: Lewis, Gemma, Dykxhoorn, Jennifer, Karlsson, Håkan, Khandaker, Golam M., Lewis, Glyn, Dalman, Christina, Kirkbride, James B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066518/
https://www.ncbi.nlm.nih.gov/pubmed/32159742
http://dx.doi.org/10.1001/jamapsychiatry.2020.0103
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author Lewis, Gemma
Dykxhoorn, Jennifer
Karlsson, Håkan
Khandaker, Golam M.
Lewis, Glyn
Dalman, Christina
Kirkbride, James B.
author_facet Lewis, Gemma
Dykxhoorn, Jennifer
Karlsson, Håkan
Khandaker, Golam M.
Lewis, Glyn
Dalman, Christina
Kirkbride, James B.
author_sort Lewis, Gemma
collection PubMed
description 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 227 429 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.
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spelling pubmed-70665182020-03-16 Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis Lewis, Gemma Dykxhoorn, Jennifer Karlsson, Håkan Khandaker, Golam M. Lewis, Glyn Dalman, Christina Kirkbride, James B. JAMA Psychiatry Original Investigation 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 227 429 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. American Medical Association 2020-07 2020-03-11 /pmc/articles/PMC7066518/ /pubmed/32159742 http://dx.doi.org/10.1001/jamapsychiatry.2020.0103 Text en Copyright 2020 Lewis G et al. JAMA Psychiatry. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Lewis, Gemma
Dykxhoorn, Jennifer
Karlsson, Håkan
Khandaker, Golam M.
Lewis, Glyn
Dalman, Christina
Kirkbride, James B.
Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title_full Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title_fullStr Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title_full_unstemmed Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title_short Assessment of the Role of IQ in Associations Between Population Density and Deprivation and Nonaffective Psychosis
title_sort assessment of the role of iq in associations between population density and deprivation and nonaffective psychosis
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066518/
https://www.ncbi.nlm.nih.gov/pubmed/32159742
http://dx.doi.org/10.1001/jamapsychiatry.2020.0103
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