Testing syndemic models along pathways to psychotic spectrum disorder: implications for population-level preventive...

Area of Science:

• Psychiatry and Mental Health
• Social Determinants of Health
• Epidemiology

Background:

• Population-level preventive interventions are crucial for psychosis, particularly when influenced by social determinants.
• Childhood adversity (CA) is a significant risk factor for psychotic spectrum disorder (PSD).
• Syndemic models offer a framework to understand the interplay of various risk factors contributing to PSD.

Purpose of the Study:

• To test three syndemic models examining pathways from childhood adversity (CA) to psychotic spectrum disorder (PSD).
• To investigate the implications of these syndemic models for population-level preventive interventions.
• To explore the role of violence/criminality (VC), sexual behavior (SH), and substance misuse (SM) in the context of CA and PSD.

Main Methods:

• Cross-sectional analysis of 7461 British men across five population subgroups.
• Testing of additive and multiplicative synergistic interactions between VC, SH, and SM, considering CA and adult traumatic life events.
• Mediation and partial least squares path modeling to assess pathways from CA and syndemic factors to PSD.

Main Results:

• Multiplicative synergistic interactions were observed between VC, SH, and SM in men with CA and traumatic life events.
• Substance misuse (SM) was identified as the sole mediator of the pathway from CA to PSD.
• Traumatic life events influenced PSD through the syndemic pathway, with no direct effect.
• Higher syndemic scores and deprivation characterized men with both PSD and CA.

Conclusions:

• PSD can be broadly categorized into biologically-driven cases and those influenced by social determinants, including syndemic pathways linked to CA.
• Preventive strategies should prioritize mitigating the adverse developmental effects of CA on pathways leading to PSD.
• Targeted interventions for substance misuse (SM) during adolescence and early adulthood may prevent triggering effects in vulnerable individuals with a history of CA.