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Poster #98 VALIDATION OF SUICIDE AS CAUSE OF DEATH IN CASES OF UNDETERMINED MANNER OF DEATH IN SCHIZOPHRENIA IN SWEDEN
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Poster #96 AGE OF ONSET IN FIRST EPISODE PSYCHOSIS: THE INFLUENCE AND INTERACTIONS OF THE ENVIRONMENTAL RISK FACTORS Brian N. O’Donoghue 1 , John P. Lyne 1 , Eric Roche 2 , Niall Turner 1 , Eadbhard O’Callaghan 1 , Mary Clarke 1 , Abbie Lane 3 1 DETECT Early Intervention for Psychosis Service Blackrock, Dublin, Ireland; 2 Cluain Mhuire mental health service Blackrock, Dublin, Ireland; 3 St John of God Hospitaller Service Stillorgan, Dublin, Ireland Background: A number of environmental factors have been demonstrated to be associated with the age of onset for psychotic disorders including cannabis, social class of origin and obstetrical complications. In addition, factors such as gender and a positive family history of a psychotic disorder that could have a biological or environmental mechanism have been demonstrated to influence the age of onset. These factors have been investigated extensively on an individual basis but there has been little research on the possible interactions between these factors and the overall influence on the age of onset. We aimed to determine the influence of these factors on the age of onset for a first episode of psychosis, at first individually and then collectively. Methods: All individuals aged between 16 and 65 years with a first episode of psychosis assessed by the DETECT Early Intervention service for Psychosis between February 2005 and August 2011 were included and individuals with a first episode of psychosis presenting to the Cluain Mhuire catchment area between 1995 and 1999 were also included. Diagnoses were established using the SCID assessment. Age of onset was defined as the age of presentation minus the duration of untreated psychosis. Social class of origin was determined from the father’s occupation as recorded on the subject’s birth certificate and was coded according to the census classification. Family history of a psychotic disorder was determined by clinical interview. Cox regression was used to investigate the effects of the environmental risk factors on the age of onset. Results: A total of 608 individuals were diagnosed with a first episode of psychosis (fep). Males developed a psychotic disorder at an age five years younger than females (p<0.001). Individuals with co-morbid cannabis abuse or dependence developed a first episode of psychosis an average six years younger (p<0.001). There was no difference in the median age of onset in individuals with a first episode of psychosis from families of higher or lower social class (p=0.15). There was also no difference in the median age of onset in individuals with a positive family history of a psychotic disorder (p=0.66). In multivariate analysis cox regression, cannabis abuse or dependence and social class of origin were associated with the age of onset. Discussion: Further understanding of the influences on the age of onset and the interactions between these factors could lead to insights into the aetiology of psychosis.
Poster #97 DEPRESSION, HOPELESSNESS AND SUICIDALITY IN FIRST EPISODE PSYCHOSIS AND THE RELATIONSHIP WITH THE SOCIAL CLASS OF ORIGIN Brian N. O’Donoghue 1 , John P. Lyne 1 , Felicity Fanning 1 , Niall Turner 1 , Eadbhard O’Callaghan 1 , Mary Clarke 1 , Abbie Lane 2 1 DETECT Early Intervention for Psychosis Service, Blackrock, Co Dublin, Ireland; 2 St John of God Hospitaller Service, Stillorgan, Co Dublin, Ireland Background: Depressive symptoms commonly co-occur with a first episode of psychosis and unfortunately there is a high incidence of acts of deliberate self-harm and suicide attempts prior to help seeking. Individuals diagnosed with schizophrenia from a higher social class of origin are at increased risk of dying by suicide as compared to individuals diagnosed with schizophrenia from families of lower social class. In particular, young men with high levels of premorbid functioning and high expectations who are subsequently diagnosed with schizophrenia are at a higher risk of dying by suicide. It has been hypothesised that this is due to the “lost potential” of the individual. In this study, we aimed to determine if the level of depressive symptoms and hopelessness in individuals with a first episode of psychosis were related to their social class of origin. Secondly, we aimed to determine if the levels of suicidal ideation and incidence and severity of suicide attempts was associated with the social class of origin. Methods: All individuals with a first episode of psychosis assessed by the
DETECT Early Intervention service for Psychosis between February 2007 and August 2011 were included. Diagnoses were established using the SCID assessment. The Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Scale for Suicidal Ideation and the Suicidal Intent Scale (SIS) were used to measure symptomatology and the incidence and severity of suicidality. Social class of origin was determined from the father’s occupation as recorded on the subject’s birth certificate and was coded according to the census classification. Results: Of the 300 individuals diagnosed with a first episode of psychosis, 230 were born in Ireland and the social class of origin could be determined for 84% (n=193). A total of 31% (n=41) of individuals with a first episode of psychosis had moderate or severe depressive symptoms at the time of presentation. There was no difference between the level of depressive symptoms (p=0.28) or hopelessness (tp=0.14) in individuals from a higher or lower social class of origin. A total of 10% (n=19) of individuals attempted suicide prior to being diagnosed with a first episode of psychosis. There was no difference in suicidal ideation between individuals of higher and lower social class of origin (p=0.19). There was also no difference in the proportion of individuals from lower or higher social classes of origin who attempted suicide (p=0.96), however there was a non-significant trend for individuals from lower social class of origin to have more serious suicide attempts (p=0.07). Discussion: Depression, hopelessness, suicidal ideation and suicide attempts are common in first episode psychosis however this study does not support previous findings that they are associated with the social class of origin. Further research into the predictors of suicide attempts in first episode of psychosis could help direct clinical practice in reducing the risk of suicide.
Poster #98 VALIDATION OF SUICIDE AS CAUSE OF DEATH IN CASES OF UNDETERMINED MANNER OF DEATH IN SCHIZOPHRENIA IN SWEDEN Eric M. Olsson 1 , Diana Hukic 2 , Lise-Lotte Nilsson 3 , Henrik Druid 4 , Martin Schalling 2 , Urban Ösby 2 1 Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 2 Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 3 Lund University, Lund, Sweden; 4 Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden Background: Approximately five percent of the patients suffering from schizophrenia will die from suicide. Research dealing with suicide is of great importance to improve the prognosis of schizophrenia. Most definitions of suicide include the intention or will of the patient who commits suicide. The epidemiological knowledge we have about suicide is based on register studies. The aim of this study is to validate the cause of death register in cases of undetermined manner of death for schizophrenic patients in Sweden. Methods: Patients have been selected using information from the Patient Register and the Cause of Death Register of the Swedish National Board of Health and Welfare. Patients from four different counties in Sweden, suffering from schizophrenia, who have died from suicide or where the cause of death has been uncertain have been selected. All cases with an undetermined manner of death were further investigated. The pathology records for these cases have been evaluated using a scoring system based on known risk factors for suicide and common sense. The scoring system arranges the cases with an undetermined cause of death into three categories. One where suicide is apparently the likely cause of death (group 1), one where suicide is possibly the cause of death (group 2) and one group where suicide is unlikely the cause of death (group 3). Results: A total number of 514 suicide cases have been identified. 285 cases with an undetermined manner of death have been examined. Using the created scoring system 56 of the 285 cases were classified as likely suicides (group 1), 127 as possible suicides (group 2) and in 102 cases the cause of death was classified as unlikely to be suicide. The ratio between certain suicides and cases with an undetermined manner of death in the different counties examined,was found to be 133/118 (Stockholm), 26/42 (Uppsala), 62/42 (Linköping), 293/83 (Skåne). Discussion: If you include the group of cases with an undetermined manner of death when studying suicide you are likely to overestimate the cases with 13 percent (102/799). If you choose to only include certain cases
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
of suicide from the cause of Death Register you are likely to dilute the results or underestimate with 36 percent (183/514). An approximation of the uncertainty is an important step to assess associations and towards understanding the mechanisms behind suicide among patients suffering from schizophrenia The differences in ratios between certain suicides and cases with an undetermined manner of death in the counties studied, imply that there is a need for national guidelines in forensic medicine to determine what should be classified as a suicide.
Poster #99 NEIGHBOURHOOD-LEVEL SOCIO-ENVIRONMENTAL FACTORS AND INCIDENCE OF FIRST EPISODE PSYCHOSIS BY PLACE AT ONSET IN RURAL IRELAND Sami Omer 1,2 , James B. Kirkbride 3 , Dennis G. Pringle 4 , Vincent Russell 1,2 , Eadbhard O’Callaghan 5 , John L. Waddington 2 1 Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; 2 Royal College of Surgeons in Ireland, Dublin, Ireland; 3 Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; 4 Department of Geography, National University of Ireland, Maynooth, Ireland; 5 DETECT Early Psychosis Service, Blackrock, Dublin, Ireland Background: The body of literature on contextual research comes from urban settings, with rural areas featuring mainly in urban-rural comparisons. Little is known about associations between the social environment and rates of psychosis within rural settings, In this study, we set out to investigate whether such associations exist within a wholly rural context in Ireland using a dataset of unusual epidemiological completeness. Methods: Using the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS] database, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban-rural classification across electoral divisions. Results: Ecological analysis Material deprivation: For “all psychoses”, increase in level of deprivation was associated ordinally with increase in incidence rate among men; for women no such relationship was evident. When “non-affective psychoses” and “affective psychoses” were considered separately, the association between deprivation and incidence for males was found to be less consistent, whilst no association was again found for women. Social fragmentation: For “all psychoses”, the highest rate of psychosis among women was in the most socially fragmented areas [SIR 24.29, OR 1.72 (95% CI 1.13-2.25)]; this pattern was evident for both “non-affective psychoses” [SIR 10.12, OR 1.77 (1.17-2.68)] and “affective psychoses” [SIR 14.17, OR 1.68 (1.19-2.37)]. There were no significant associations between rate of psychosis and social fragmentation among men. Urban/rural classification: For “all psychoses”, the highest rates of psychosis among women was in the least rural areas [SIR 20.49, OR 1.57 (1.19-2.08)]; this pattern was evident for “non-affective psychoses” [SIR 9.16, OR 1.76 (1.14-2.71)] but not for “affective psychoses”. There were no significant associations between rates of psychosis and the urban/rural classification among men. Multilevel analysis: In the unadjusted multilevel model, no significant neighbourhood variation (i.e. random effects) in incidence rates was apparent. However, in the full model that adjusted for age and sex, increase in level of deprivation was associated with increase in risk; when stratified by sex, the effect was evident only among women. No such association was evident when the sample was restricted to those ages studied typically in first episode samples (15-64 years); a marginal interaction between age group and level of deprivation in the full sample (LRT P=0.08) suggested further that that the association between level of deprivation and risk for psychosis derived primarily from the group aged 65-74 years. When “non-affective psychoses” and “affective psychoses” were analysed separately, no associations between any neighbourhood-level variable and risk for psychosis were evident Discussion: To our knowledge, this is the first study to examine associations between neighbourhood-level socio-environmental risk factors and incidence of first episode psychosis within a rural setting. Our findings support an association between adverse socio-environmental factors and increased risk for psychosis by place at onset. This study suggests that poorer social environments, rather than urbanicity per se, may be relevant to the incidence of psychosis, though such exposures may have greater impact in more urban settings.
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Poster #100 SEVERE TRAUMA AND FIRST EPISODE PSYCHOSIS IN THE UK Adanna N. Onyejiaka 1 , Helen Fisher 1 , Charlotte E. Gayer-Anderson 1 , Anisa Kurti 1 , Susana Borges 1 , Grant McQueen 2 , Arune Keraite 1 , Dionne Harleston 3 , Monica Charalambides 1 , Rowena Handley 1 , Valeria Mondelli 1 , Marta Di Forti 1 , Robin M. Murray 1 , Carmine Pariante 1 , Paola Dazzan 1 , Craig Morgan 1 1 Institute of Psychiatry, King’s College London, London, United Kingdom; 2 University of Surrey, Guildford, Surrey, United Kingdom; 3 University of Birmingham Edgbaston, Birmingham, United Kingdom Background: There is consistent evidence, from numerous countries and in relation to many groups, that the incidence of schizophrenia and other psychoses is elevated in migrant and minority ethnic populations. There has been much speculation about the reasons for this, and there is some evidence implicating exposure to high levels of social adversity, broadly defined. However, the research to date has tended to rely on crude markers of adversity and there remains a lack of data on specific individual-level exposures. For instance, discrimination and trauma are strong candidate factors as both are more prevalent in migrant and minority ethnic populations, including experiences of trauma among migrants fleeing persecution and war. Using preliminary data from ongoing incidence and case-control studies of first episode psychosis in south-east London, we sought to investigate the impact of exposure to severe trauma during the life course on risk of psychosis in general and, more tentatively, in migrant and minority ethnic groups. Methods: Data for these analyses are drawn from an ongoing case-control study of first episode psychosis in south-east London. This study is designed to investigate the relationship between various forms of trauma and adversity and psychosis, and potential biological, psychological and social mechanisms, and contributes to the EU-GEI programme. Cases aged 18-64 are being recruited from in-patient and out-patient services within defined catchment areas. Controls are being recruited from the local population, according to quotas set to ensure the sample is representative of the population in terms of age, gender and ethnicity. Information on lifetime exposure to severe trauma (e.g. war, lack of shelter and serious injury) is being collected using the Harvard Trauma Questionnaire. Results: To date, 42 cases and 72 controls have been assessed with the Harvard Trauma questionnaire. Sixty percent (n=25) of cases reported having experienced at least one severe trauma compared with 44% (n=32) of controls (OR 1.84, 95% CI 0.84-4.02). When the total number of traumas was considered, cases on average (mean 1.84, sd 2.5) reported having experienced a greater number of traumatic events than controls (mean 0.72, sd 1.0) (t -3.39, df 112, p<0.01). When dichotomised, cases were over 3 times more likely to report 2 or more lifetime traumatic events than controls, independent of age, gender and ethnicity (adj. OR 3.29, 95% CI 1.2-8.9). There was no evidence that the relationship between trauma and psychosis varied by ethnic group and, given the current sample size, it was not possible to estimate with any confidence whether the prevalence of trauma was greater in migrant and minority ethnic groups. Discussion: In these preliminary analyses, we found evidence that lifetime experiences of severe trauma are more common in cases with psychosis than controls from the same local catchment area. Although the sample size is currently small, the effects of trauma on odds of psychosis appear similar in all ethnic groups. It may be though that trauma is more common in migrant and minority ethnic groups. If so, this may be one factor increasing population rates of disorder in these groups. Testing this will be a key focus of further analyses as the sample in this study accumulates.
Poster #101 MENTAL HEALTH LITERACY: ARE PSYCHOSES CATCHING UP WITH DEPRESSION? Frauke Schultze-Lutter, Chantal Michel, Renata Kulcsarova, Franziska Durstewitz, Nina Schnyder, Benno G. Schimmelmann University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: Earlier reports on mental health literacy reported that the knowledge about depression was much better than that about psychoses. Mental health literacy, however, is assumed to influence pathways-to-care
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Poster #96 AGE OF ONSET IN FIRST EPISODE PSYCHOSIS: THE INFLUENCE AND INTERACTIONS OF THE ENVIRONMENTAL RISK FACTORS Brian N. O’Donoghue 1 , John P. Lyne 1 , Eric Roche 2 , Niall Turner 1 , Eadbhard O’Callaghan 1 , Mary Clarke 1 , Abbie Lane 3 1 DETECT Early Intervention for Psychosis Service Blackrock, Dublin, Ireland; 2 Cluain Mhuire mental health service Blackrock, Dublin, Ireland; 3 St John of God Hospitaller Service Stillorgan, Dublin, Ireland Background: A number of environmental factors have been demonstrated to be associated with the age of onset for psychotic disorders including cannabis, social class of origin and obstetrical complications. In addition, factors such as gender and a positive family history of a psychotic disorder that could have a biological or environmental mechanism have been demonstrated to influence the age of onset. These factors have been investigated extensively on an individual basis but there has been little research on the possible interactions between these factors and the overall influence on the age of onset. We aimed to determine the influence of these factors on the age of onset for a first episode of psychosis, at first individually and then collectively. Methods: All individuals aged between 16 and 65 years with a first episode of psychosis assessed by the DETECT Early Intervention service for Psychosis between February 2005 and August 2011 were included and individuals with a first episode of psychosis presenting to the Cluain Mhuire catchment area between 1995 and 1999 were also included. Diagnoses were established using the SCID assessment. Age of onset was defined as the age of presentation minus the duration of untreated psychosis. Social class of origin was determined from the father’s occupation as recorded on the subject’s birth certificate and was coded according to the census classification. Family history of a psychotic disorder was determined by clinical interview. Cox regression was used to investigate the effects of the environmental risk factors on the age of onset. Results: A total of 608 individuals were diagnosed with a first episode of psychosis (fep). Males developed a psychotic disorder at an age five years younger than females (p<0.001). Individuals with co-morbid cannabis abuse or dependence developed a first episode of psychosis an average six years younger (p<0.001). There was no difference in the median age of onset in individuals with a first episode of psychosis from families of higher or lower social class (p=0.15). There was also no difference in the median age of onset in individuals with a positive family history of a psychotic disorder (p=0.66). In multivariate analysis cox regression, cannabis abuse or dependence and social class of origin were associated with the age of onset. Discussion: Further understanding of the influences on the age of onset and the interactions between these factors could lead to insights into the aetiology of psychosis.
Poster #97 DEPRESSION, HOPELESSNESS AND SUICIDALITY IN FIRST EPISODE PSYCHOSIS AND THE RELATIONSHIP WITH THE SOCIAL CLASS OF ORIGIN Brian N. O’Donoghue 1 , John P. Lyne 1 , Felicity Fanning 1 , Niall Turner 1 , Eadbhard O’Callaghan 1 , Mary Clarke 1 , Abbie Lane 2 1 DETECT Early Intervention for Psychosis Service, Blackrock, Co Dublin, Ireland; 2 St John of God Hospitaller Service, Stillorgan, Co Dublin, Ireland Background: Depressive symptoms commonly co-occur with a first episode of psychosis and unfortunately there is a high incidence of acts of deliberate self-harm and suicide attempts prior to help seeking. Individuals diagnosed with schizophrenia from a higher social class of origin are at increased risk of dying by suicide as compared to individuals diagnosed with schizophrenia from families of lower social class. In particular, young men with high levels of premorbid functioning and high expectations who are subsequently diagnosed with schizophrenia are at a higher risk of dying by suicide. It has been hypothesised that this is due to the “lost potential” of the individual. In this study, we aimed to determine if the level of depressive symptoms and hopelessness in individuals with a first episode of psychosis were related to their social class of origin. Secondly, we aimed to determine if the levels of suicidal ideation and incidence and severity of suicide attempts was associated with the social class of origin. Methods: All individuals with a first episode of psychosis assessed by the
DETECT Early Intervention service for Psychosis between February 2007 and August 2011 were included. Diagnoses were established using the SCID assessment. The Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Scale for Suicidal Ideation and the Suicidal Intent Scale (SIS) were used to measure symptomatology and the incidence and severity of suicidality. Social class of origin was determined from the father’s occupation as recorded on the subject’s birth certificate and was coded according to the census classification. Results: Of the 300 individuals diagnosed with a first episode of psychosis, 230 were born in Ireland and the social class of origin could be determined for 84% (n=193). A total of 31% (n=41) of individuals with a first episode of psychosis had moderate or severe depressive symptoms at the time of presentation. There was no difference between the level of depressive symptoms (p=0.28) or hopelessness (tp=0.14) in individuals from a higher or lower social class of origin. A total of 10% (n=19) of individuals attempted suicide prior to being diagnosed with a first episode of psychosis. There was no difference in suicidal ideation between individuals of higher and lower social class of origin (p=0.19). There was also no difference in the proportion of individuals from lower or higher social classes of origin who attempted suicide (p=0.96), however there was a non-significant trend for individuals from lower social class of origin to have more serious suicide attempts (p=0.07). Discussion: Depression, hopelessness, suicidal ideation and suicide attempts are common in first episode psychosis however this study does not support previous findings that they are associated with the social class of origin. Further research into the predictors of suicide attempts in first episode of psychosis could help direct clinical practice in reducing the risk of suicide.
Poster #98 VALIDATION OF SUICIDE AS CAUSE OF DEATH IN CASES OF UNDETERMINED MANNER OF DEATH IN SCHIZOPHRENIA IN SWEDEN Eric M. Olsson 1 , Diana Hukic 2 , Lise-Lotte Nilsson 3 , Henrik Druid 4 , Martin Schalling 2 , Urban Ösby 2 1 Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 2 Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 3 Lund University, Lund, Sweden; 4 Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden Background: Approximately five percent of the patients suffering from schizophrenia will die from suicide. Research dealing with suicide is of great importance to improve the prognosis of schizophrenia. Most definitions of suicide include the intention or will of the patient who commits suicide. The epidemiological knowledge we have about suicide is based on register studies. The aim of this study is to validate the cause of death register in cases of undetermined manner of death for schizophrenic patients in Sweden. Methods: Patients have been selected using information from the Patient Register and the Cause of Death Register of the Swedish National Board of Health and Welfare. Patients from four different counties in Sweden, suffering from schizophrenia, who have died from suicide or where the cause of death has been uncertain have been selected. All cases with an undetermined manner of death were further investigated. The pathology records for these cases have been evaluated using a scoring system based on known risk factors for suicide and common sense. The scoring system arranges the cases with an undetermined cause of death into three categories. One where suicide is apparently the likely cause of death (group 1), one where suicide is possibly the cause of death (group 2) and one group where suicide is unlikely the cause of death (group 3). Results: A total number of 514 suicide cases have been identified. 285 cases with an undetermined manner of death have been examined. Using the created scoring system 56 of the 285 cases were classified as likely suicides (group 1), 127 as possible suicides (group 2) and in 102 cases the cause of death was classified as unlikely to be suicide. The ratio between certain suicides and cases with an undetermined manner of death in the different counties examined,was found to be 133/118 (Stockholm), 26/42 (Uppsala), 62/42 (Linköping), 293/83 (Skåne). Discussion: If you include the group of cases with an undetermined manner of death when studying suicide you are likely to overestimate the cases with 13 percent (102/799). If you choose to only include certain cases
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
of suicide from the cause of Death Register you are likely to dilute the results or underestimate with 36 percent (183/514). An approximation of the uncertainty is an important step to assess associations and towards understanding the mechanisms behind suicide among patients suffering from schizophrenia The differences in ratios between certain suicides and cases with an undetermined manner of death in the counties studied, imply that there is a need for national guidelines in forensic medicine to determine what should be classified as a suicide.
Poster #99 NEIGHBOURHOOD-LEVEL SOCIO-ENVIRONMENTAL FACTORS AND INCIDENCE OF FIRST EPISODE PSYCHOSIS BY PLACE AT ONSET IN RURAL IRELAND Sami Omer 1,2 , James B. Kirkbride 3 , Dennis G. Pringle 4 , Vincent Russell 1,2 , Eadbhard O’Callaghan 5 , John L. Waddington 2 1 Cavan-Monaghan Mental Health Service, Cavan Hospital, Cavan, Ireland; 2 Royal College of Surgeons in Ireland, Dublin, Ireland; 3 Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; 4 Department of Geography, National University of Ireland, Maynooth, Ireland; 5 DETECT Early Psychosis Service, Blackrock, Dublin, Ireland Background: The body of literature on contextual research comes from urban settings, with rural areas featuring mainly in urban-rural comparisons. Little is known about associations between the social environment and rates of psychosis within rural settings, In this study, we set out to investigate whether such associations exist within a wholly rural context in Ireland using a dataset of unusual epidemiological completeness. Methods: Using the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS] database, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban-rural classification across electoral divisions. Results: Ecological analysis Material deprivation: For “all psychoses”, increase in level of deprivation was associated ordinally with increase in incidence rate among men; for women no such relationship was evident. When “non-affective psychoses” and “affective psychoses” were considered separately, the association between deprivation and incidence for males was found to be less consistent, whilst no association was again found for women. Social fragmentation: For “all psychoses”, the highest rate of psychosis among women was in the most socially fragmented areas [SIR 24.29, OR 1.72 (95% CI 1.13-2.25)]; this pattern was evident for both “non-affective psychoses” [SIR 10.12, OR 1.77 (1.17-2.68)] and “affective psychoses” [SIR 14.17, OR 1.68 (1.19-2.37)]. There were no significant associations between rate of psychosis and social fragmentation among men. Urban/rural classification: For “all psychoses”, the highest rates of psychosis among women was in the least rural areas [SIR 20.49, OR 1.57 (1.19-2.08)]; this pattern was evident for “non-affective psychoses” [SIR 9.16, OR 1.76 (1.14-2.71)] but not for “affective psychoses”. There were no significant associations between rates of psychosis and the urban/rural classification among men. Multilevel analysis: In the unadjusted multilevel model, no significant neighbourhood variation (i.e. random effects) in incidence rates was apparent. However, in the full model that adjusted for age and sex, increase in level of deprivation was associated with increase in risk; when stratified by sex, the effect was evident only among women. No such association was evident when the sample was restricted to those ages studied typically in first episode samples (15-64 years); a marginal interaction between age group and level of deprivation in the full sample (LRT P=0.08) suggested further that that the association between level of deprivation and risk for psychosis derived primarily from the group aged 65-74 years. When “non-affective psychoses” and “affective psychoses” were analysed separately, no associations between any neighbourhood-level variable and risk for psychosis were evident Discussion: To our knowledge, this is the first study to examine associations between neighbourhood-level socio-environmental risk factors and incidence of first episode psychosis within a rural setting. Our findings support an association between adverse socio-environmental factors and increased risk for psychosis by place at onset. This study suggests that poorer social environments, rather than urbanicity per se, may be relevant to the incidence of psychosis, though such exposures may have greater impact in more urban settings.
S221
Poster #100 SEVERE TRAUMA AND FIRST EPISODE PSYCHOSIS IN THE UK Adanna N. Onyejiaka 1 , Helen Fisher 1 , Charlotte E. Gayer-Anderson 1 , Anisa Kurti 1 , Susana Borges 1 , Grant McQueen 2 , Arune Keraite 1 , Dionne Harleston 3 , Monica Charalambides 1 , Rowena Handley 1 , Valeria Mondelli 1 , Marta Di Forti 1 , Robin M. Murray 1 , Carmine Pariante 1 , Paola Dazzan 1 , Craig Morgan 1 1 Institute of Psychiatry, King’s College London, London, United Kingdom; 2 University of Surrey, Guildford, Surrey, United Kingdom; 3 University of Birmingham Edgbaston, Birmingham, United Kingdom Background: There is consistent evidence, from numerous countries and in relation to many groups, that the incidence of schizophrenia and other psychoses is elevated in migrant and minority ethnic populations. There has been much speculation about the reasons for this, and there is some evidence implicating exposure to high levels of social adversity, broadly defined. However, the research to date has tended to rely on crude markers of adversity and there remains a lack of data on specific individual-level exposures. For instance, discrimination and trauma are strong candidate factors as both are more prevalent in migrant and minority ethnic populations, including experiences of trauma among migrants fleeing persecution and war. Using preliminary data from ongoing incidence and case-control studies of first episode psychosis in south-east London, we sought to investigate the impact of exposure to severe trauma during the life course on risk of psychosis in general and, more tentatively, in migrant and minority ethnic groups. Methods: Data for these analyses are drawn from an ongoing case-control study of first episode psychosis in south-east London. This study is designed to investigate the relationship between various forms of trauma and adversity and psychosis, and potential biological, psychological and social mechanisms, and contributes to the EU-GEI programme. Cases aged 18-64 are being recruited from in-patient and out-patient services within defined catchment areas. Controls are being recruited from the local population, according to quotas set to ensure the sample is representative of the population in terms of age, gender and ethnicity. Information on lifetime exposure to severe trauma (e.g. war, lack of shelter and serious injury) is being collected using the Harvard Trauma Questionnaire. Results: To date, 42 cases and 72 controls have been assessed with the Harvard Trauma questionnaire. Sixty percent (n=25) of cases reported having experienced at least one severe trauma compared with 44% (n=32) of controls (OR 1.84, 95% CI 0.84-4.02). When the total number of traumas was considered, cases on average (mean 1.84, sd 2.5) reported having experienced a greater number of traumatic events than controls (mean 0.72, sd 1.0) (t -3.39, df 112, p<0.01). When dichotomised, cases were over 3 times more likely to report 2 or more lifetime traumatic events than controls, independent of age, gender and ethnicity (adj. OR 3.29, 95% CI 1.2-8.9). There was no evidence that the relationship between trauma and psychosis varied by ethnic group and, given the current sample size, it was not possible to estimate with any confidence whether the prevalence of trauma was greater in migrant and minority ethnic groups. Discussion: In these preliminary analyses, we found evidence that lifetime experiences of severe trauma are more common in cases with psychosis than controls from the same local catchment area. Although the sample size is currently small, the effects of trauma on odds of psychosis appear similar in all ethnic groups. It may be though that trauma is more common in migrant and minority ethnic groups. If so, this may be one factor increasing population rates of disorder in these groups. Testing this will be a key focus of further analyses as the sample in this study accumulates.
Poster #101 MENTAL HEALTH LITERACY: ARE PSYCHOSES CATCHING UP WITH DEPRESSION? Frauke Schultze-Lutter, Chantal Michel, Renata Kulcsarova, Franziska Durstewitz, Nina Schnyder, Benno G. Schimmelmann University Hospital of Child and Adolescent Psychiatry Bern, Bern, Switzerland Background: Earlier reports on mental health literacy reported that the knowledge about depression was much better than that about psychoses. Mental health literacy, however, is assumed to influence pathways-to-care