title: Social disadvantage: cause or consequence of impending psychosis?
abstract: BACKGROUND
  An association between social disadvantage and established psychosis is well documented in the literature, but there remains a lack of data on the social circumstances of patients before they became ill. We investigated whether social disadvantage at, and prior to, first contact with psychiatric services, is associated with psychosis.
  
  
  METHODS
  We collected information on social disadvantage in childhood and adulthood from 278 cases presenting with their first episode of psychosis to the South London and Maudsley National Health Service Foundation Trust and from 226 controls recruited from the local population. Three markers of childhood social disadvantage and 3 markers of disadvantage in adulthood were analyzed.
  
  
  RESULTS
  Long term separation from, and death of, a parent before the age of 17 years were both strongly associated with a 2- to 3-fold-increased odds of psychosis. Cases were also significantly more likely to report 2 or more markers of adult social disadvantage than healthy controls (OR = 9.03) at the time of the first presentation with psychosis, independent of a number of confounders. When we repeated these analyses for long-standing adult social disadvantage, we found that the strength of the association decreased but still remained significant for 1 year (OR = 5.67) and 5 years (OR = 2.57) prior to the first contact.
  
  
  CONCLUSIONS
  Social disadvantage indexes exposure to factors operating prior to onset that increase the risk of psychosis, both during childhood and adulthood.
authors.affiliation: To whom correspondence should be addressed; Department of Health Service and Population Research, PO 52, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK; tel: +44 (0)207 848 5842, fax: +44 (0)2078480287, e-mail: simona.stilo@kcl.ac.uk.
authors.forename: Simona A
authors.initials: SA
authors.lastname: Stilo
authors.forename: Marta
authors.initials: M
authors.lastname: Di Forti
authors.forename: Valeria
authors.initials: V
authors.lastname: Mondelli
authors.forename: Aurora M
authors.initials: AM
authors.lastname: Falcone
authors.forename: Manuela
authors.initials: M
authors.lastname: Russo
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Connor
authors.forename: Emma
authors.initials: E
authors.lastname: Palmer
authors.forename: Alessandra
authors.initials: A
authors.lastname: Paparelli
authors.forename: Anna
authors.initials: A
authors.lastname: Kolliakou
authors.forename: Miriam
authors.initials: M
authors.lastname: Sirianni
authors.forename: Heather
authors.initials: H
authors.lastname: Taylor
authors.forename: Rowena
authors.initials: R
authors.lastname: Handley
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
authors.forename: Carmine
authors.initials: C
authors.lastname: Pariante
authors.forename: Tiago R
authors.initials: TR
authors.lastname: Marques
authors.forename: Rocco
authors.initials: R
authors.lastname: Zoccali
authors.forename: Anthony
authors.initials: A
authors.lastname: David
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001010:Anxiety, Separation / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D063129:Parental Death / Q000523:psychology; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D012306:Risk; D012959:Socioeconomic Factors; D013997:Time Factors; D014478:Unemployment / Q000523:psychology; D055815:Young Adult
keywords: environment; loss; schizophrenia; separation; social disadvantage; unemploy ment