Cogitation May Mediate Relationship Between Socioeconomic Adversity and Psychosis

The relationship between childhood socioenvironmental adversity and adolescent psychotic experiences may be mediated by cognitive ability, according to results of a study published in Schizophrenia Bulletin.

Data for this study were sourced from the Environmental Risk Longitudinal Twin Study which recruited a nationally representative birth cohort of 2232 twins born in England and Wales between 1994 and 1995. Participants were evaluated for socioeconomic status, socioenvironmental variables, and health and cognitive outcomes at 5, 7, 10, 12, and 18 years of age.

The primary outcome of this analysis was predictors for psychotic experiences by 18 years of age. Socioeconomic risk was defined as high neighborhood deprivation, neighborhood disorder, family disadvantage, physical risk, as well as high urbanicity, and air pollution.

At 18 years of age, 30.2% had at least 1 psychotic experience since the age of 12 years and 138 individuals reported 6 or more experiences.

Psychotic experiences were related with higher socioeconomic risk (adjusted hazard ratio [aHR], 1.72; 95% CI, 1.42-2.08; P <.001) and physical risk (aHR, 1.35; 95% CI, 1.13-1.61; P =.001) during childhood.

Increased socioeconomic risk at or before the age of 10 years associated with a significant decrease in intellectual quotient (IQ) score, crystalized ability, fluid ability, and working memory at 18 years of age whereas increased physical risk associated with decreased C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor (suPAR) levels.

For each unit increase in crystallized ability, risk for psychotic experience decreased (adjusted odds ratio [aOR], 0.92; 95% CI, 0.89-096) whereas risk was higher with each unit increase in suPAR (aOR, 1.18; 95% CI, 1.02-1.36).

The total effect of socioeconomic risk on psychotic experiences was mediated by cognitive ability (aOR, 1.06; 95% CI, 1.01-1.11) and crystalized ability (aOR, 1.09; 95% CI, 1.03-1.16). No significant mediators between physical risk and psychotic experiences were observed.

In a supplemental analysis, however, lower CRP and suPAR levels were related with urbanicity and air pollution, suggesting physical risk factors may play some role in the relationship between inflammation and psychotic experiences.

In an analysis assessing E-values, high total (odds ratio [OR], 2.61) and direct (OR, 2.34) effects were observed, indicating that unmeasured cofounders would need to have stronger confounding effects than the variables included in this study to nullify these associations.

This analysis may have been limited by not having access to longitudinal data about inflammation.

These data indicated that cognition may mediate the relationship between socioenvironmental factors and psychosis. Study authors concluded, “If replicated, these findings suggest that interventions to enhance cognitive development during childhood could increase resilience to psychotic experiences and potentially later psychopathology among children raised in disadvantaged circumstances.”