Translating the epidemiology of psychosis into public mental health: evidence, challenges and future prospects.
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Authors
Kirkbride, James
Coid, Jeremy W
Morgan, Craig
Fearon, Paul
Dazzan, Paola
Yang, Min
Lloyd, Tuhina
Harrison, Glynn L
Murray, Robin M
Jones, Peter B
Issue Date
2010-Jun
Type
Journal Article
Language
en
Keywords
Alternative Title
Abstract
Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. We conducted a theoretical exercise to estimate the proportion of psychotic illnesses that could be prevented if we could identify and remove all factors that lead to increased incidence associated with ethnic minority status and urbanicity. Measures of impact by population density and ethnicity were estimated from incidence rate ratios [IRR] obtained from two methodologically-similar first episode psychosis studies in four UK centres. Multilevel Poisson regression was used to estimate IRR, controlling for confounders. Population attributable risk fractions [PAR] were estimated for our study population and the population of England. We considered three outcomes; all clinically relevant ICD-10 psychotic illnesses [F10-39], non-affective psychoses [F20-29] and affective psychoses [F30-39]. One thousand and twenty-nine subjects, aged 18-64, were identified over 2.4 million person-years. Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. For non-affective psychoses only, PAR for population density was large and significant (27.5%); joint PAR with ethnicity was 61.7%. Effect sizes for common socio-environmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socio-environmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene-environment interactions that adopt a multi disciplinary perspective.
Description
Citation
Kirkbride, J., Coid, J. W., Morgan, C., Fearon, P., Dazzan, P., Yang, M., Lloyd, T., Harrison, G. L., Murray, R. M., & Jones, P. B. (2010). Translating the epidemiology of psychosis into public mental health: evidence, challenges and future prospects. Journal of public mental health, 9(2), 4–14. https://doi.org/10.5042/jpmh.2010.0324
Publisher
License
Journal
Journal of public mental health
Volume
9
Issue
2
PubMed ID
ISSN
1746-5729