Moving Associated With Increased Risk for Psychosis in Children, Adolescents

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These data suggest that residential mobility may have a profound effect on the mental well-being of children and adolescents.
These data suggest that residential mobility may have a profound effect on the mental well-being of children and adolescents.

Residential mobility during childhood and adolescence is associated with the increased risk for psychotic disorders in early adulthood, according to study data published in JAMA Psychiatry.

Researchers abstracted data on Swedish-born individuals from the Total Population Register of Sweden. Study participants were followed-up from age 16 until a first diagnosis of a nonaffective psychotic disorder, emigration, death, or the end of 2011. National register linkage provided data on the number of residential moves experienced by participants between 4 age intervals: 0 to 6, 7 to 15, 16 to 19, and 20 or older. Researchers also assessed covariate exposures and sociodemographic variables, including gender, parental migration status, and parental history of severe mental illness, including nonaffective psychosis.

The prospective cohort included 1,440,383 participants, of whom 4537 (0.31%) had nonaffective psychotic disorder. Patients with psychotic disorder had a median age at diagnosis of 20.9. Individuals with nonaffective psychosis were more likely to be men and to come from a lower income quintile (both P <.001). Nonaffective psychosis was also associated with a foreign background, parental history of severe mental illness, death of a parent before age 15, and lower educational attainment (all P <.001). Before age 20, individuals with nonaffective psychosis were more likely to have moved at least once and moved a longer cumulative distance than control participants (P <.001). A dose-response relationship was observed between number of moves and the risk for psychosis; patients who had moved residences 1, 2, 3, or 4 or more times had hazard ratios [HR] of 1.13, 1.47, 1.46, and 1.83, respectively, for nonaffective psychosis (P <.001). Residential disruption between age 16 to 19 was associated with the highest risk for psychosis (adjusted HR, 1.99; 95% CI, 1.30-3.05) compared with patients who had never moved. During adulthood, 1 move was not associated with the risk for psychosis, but 4 or more changes in residence significantly increased the risk for psychosis (adjusted HR, 1.82; 95% CI, 1.51-2.20). Residential changes that disrupted social networks and necessitated school changes were also more strongly associated with the risk for psychosis.

These data suggest that residential mobility may have a profound effect on the mental well-being of children and adolescents. Thus, leveraging support for young patients with residential disruption may be crucial in mediating the risk for psychosis in early adulthood.

Reference

Price C, Dalman C, Zammit S, Kirkbride JB. Association of residential mobility over the life course with nonaffective psychosis in 1.4 million young people in Sweden [published online August 22, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.2233

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