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Social Psychiatry and Psychiatric Epidemiology

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01-09-2006 | ORIGINAL PAPER

Evidence that the urban environment specifically impacts on the psychotic but not the affective dimension of bipolar disorder

Authors: Nil Kaymaz, MD, Lydia Krabbendam, MA, PhD, Ron de Graaf, MA, PhD, Willem Nolen, MD, PhD, Margreet ten Have, MA, PhD, Jim van Os, MD, PhD

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 9/2006

Abstract

Objectives

High rates of psychotic disorders and psychotic symptoms have been found in urban environments but reports for bipolar affective illness have been inconsistent, possibly due to failure to stratify for comorbid psychotic symptoms. It was hypothesised, therefore, that any effect of urbanicity on the bipolar phenotype would be moderated by comorbid psychotic symptoms.

Methods

In a random, representative population cohort of 7049 adults with no history of non-affective psychotic disorder, the cumulative incidence of bipolar and psychotic symptoms and syndromes, assessed with the CIDI, was examined over five levels of population density of place of residence. Similarly, the degree of comorbidity between broadly and narrowly defined bipolar phenotypes on the one hand, and the dichotomous presence of broadly (17.2%) and narrowly defined (3.8%) psychotic symptoms on the other, was examined as a function of population density of place of residence.

Results

The rate of bipolar disorder, however defined, was progressively higher in more urbanised areas. However, in models of bipolar phenotypes, a strong interaction between comorbid psychosis and level of urbanicity was apparent, indicating that the greater the degree of psychotic comorbidity, the greater the effect size of the urban environmental factor. For bipolar disorder without psychosis, no effect of urbanicity was apparent.

Conclusions

The results suggest differential environmental causal effects on affective and cognitive dimensions of bipolar psychopathology that are nevertheless strongly comorbid within the same categorically defined disorder, possibly due to the effect of shared genetic risk factors.

Van Os J (2004) Does the urban environment cause psychosis? Br J Psychiat 184(4):287–288CrossRef

Kessler RC, Rubinow DR, Holmes C, Abelson JM, Zhao S (1997) The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychol Med 27(5):1079–1089PubMedCrossRef

Sundquist K, Frank G, Sundquist J (2004) Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden. Br J Psychiat 184(4):293–298CrossRef

Mortensen PB, Pedersen CB, Melbye M, Mors O, Ewald H (2003) Individual and familial risk factors for bipolar affective disorders in Denmark. Arch Gen Psychiat 60(12):1209–1215PubMedCrossRef

Kendler KS, McGuire M, Gruenberg AM, Spellman M, O’Hare A, Walsh D (1993) The Roscommon Family Study. II. The risk of nonschizophrenic nonaffective psychoses in relatives. Arch Gen Psychiat 50(8):645–652PubMed

Erlenmeyer Kimling L, Adamo UH, Rock D, Roberts SA, Bassett AS, Squires Wheeler E, et al. (1997) The New York High-Risk Project. Prevalence and comorbidity of axis I disorders in offspring of schizophrenic parents at 25-year follow-up. Arch Gen Psychiat 54(12):1096–1102PubMed

Kendler KS, Gruenberg AM, Tsuang MT (1986) A DSM-III family study of the nonschizophrenic psychotic disorders. Am J Psychiat 143(9):1098–1105PubMed

Judd LL, Akiskal HS (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 73(1–2):123–131PubMedCrossRef

Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rossler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73(1–2):133–146PubMedCrossRef

10.

Bijl RV, Ravelli A, Van Zessen G (1998) Prevalence of psychiatric disorder in the general population: results from the Netherlands mental health survey and incidence study. Soc Psychiat Psychiat Epidemiol 33:587–596CrossRef

11.

Bijl RV, Van Zessen G, Ravelli A, De Rijk C, Langendoen Y (1998) The Netherlands mental health survey and incidence study (NEMESIS): objectives and design. Soc Psychiat Psychiat Epidemiol 33:581–587CrossRef

12.

Alegria M, Bijl RV, Lin E, Walters EE, Kessler RC (2000) Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands. Arch Gen Psychiat 57(4):383–391PubMedCrossRef

13.

Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, et al. (1988) The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiat 45(12):1069–1077PubMed

14.

World Health Organisation (1990) Composite International Diagnostic Interview (CIDI) Version 1.0. World Health Organisation, Geneva

15.

Smeets RMW, Dingemans PMAJ (1993) Composite International Diagnostic Interview (CIDI) Versie 1.1. World Health Organisation, Amsterdam/Geneva

16.

Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials [published erratum appears in Br J Psychiatry 1992 Jan; 160:136]. Br J Psychiat 159:645–653

17.

Cottler LB, Robins LN, Grant BF, Blaine J, Towle LH, Wittchen H-U, et al. (1991) The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. Br J Psychiat 159:653–658

18.

Semler G, Von Cranach M, Wittchen H-U (1987) Comparison between the Composite International Diagnostic Interview and the present state examination. Report to the WHO/ADAMHA task force on instrument development. World Health Organisation, Geneva

19.

Wacker HR, Battegay R, Mullejans R, Schlosser C (1990) Using the CIDI in the general population. In: Stefanis CN, Rabavilas AD, Soldatos CR (eds) Psychiatry: a world perspective. Elsevier Science Publishers, Amsterdam, pp 138–143

20.

Wittchen HU (1994) Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. J Psychiat Res 28(1):57–84PubMedCrossRef

21.

Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, et al. (1985) A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiat 42(7):657–666PubMed

22.

Anthony JC, Folstein M, Romanoski AJ, Von Korff MR, Nestadt GR, Chahal R, et al. (1985) Comparison of the lay diagnostic interview schedule and a standardised psychiatric diagnosis. Experience in Eastern Baltimore. Arch Gen Psychiat 42:667–675PubMed

23.

Cooper SA, Collacott RA (1994) Relapse of depression in people with Down’s syndrome. Br J Dev Disabil 40(78, Pt 1):32–37

24.

Spitzer RL, Williams JB, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiat 49(8):624–629PubMed

25.

Van Os J, Hanssen M, Bijl R-V, Ravelli A (2000) Straus (1969) revisited: a psychosis continuum in the general population? Schizophr Res 45(1–2):11–20PubMed

26.

Van Os J, Hanssen M, Bijl RV, Vollebergh W (2001) Prevalence of psychotic disorder and community level of psychotic symptoms: an urban–rural comparison. Arch Gen Psychiat 58(7):663–668PubMedCrossRef

27.

Krabbendam L, Myin-Germeys I, Graaf Rd, Vollebergh W, Nolen WA, Os Jv (2004) Dimensions of depression, mania, and psychosis in the general population. Psychol Med 34(7):1177–1186PubMedCrossRef

28.

Central Bureau of Statistics (1993) Bevolking der Gemeenten van Nederland. CBS-Publications, The Hague

29.

Lewis G, David A, Andreasson S, Allebeck P (1992) Schizophrenia and city life. Lancet 340(8812):137–140PubMedCrossRef

30.

Marcelis M, Navarro-Mateu F, Murray R, Selten JP, Van Os J (1998) Urbanization and psychosis: a study of 1942–1978 birth cohorts in The Netherlands. Psychol Med 28(4):871–879PubMedCrossRef

31.

Platt RW (1997) Logistic regression and odds ratios. Inj Prev 3(4):294PubMedCrossRef

32.

Darroch J (1997) Biologic synergism and parallelism [see comments]. Am J Epidemiol 145(7):661–668PubMed

33.

Corcoran C, Malaspina D (2001) Traumatic brain injury and schizophrenia. Int J Mental Health 30:17–33

34.

Van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H (2002) Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol 156(4):319–327PubMedCrossRef

35.

Van Os J, Hanssen M, Bak M, Bijl RV, Vollebergh W (2003) Do urbanicity and familial liability coparticipate in causing psychosis? Am J Psychiat 160(3):477–482PubMedCrossRef

36.

StataCorp (2001) STATA Statisctical Software: Release 7.0. College Station, Texas

37.

Van Os J, Pedersen CB, Mortensen PB (2004) Confirmation of synergy between urbanicity and familial liability in the causation of psychosis. Am J Psychiat 161(12):2312–2314PubMedCrossRef

38.

Cardno AG, Rijsdijk FV, Sham PC, Murray RM, McGuffin P (2002) A twin study of genetic relationships between psychotic symptoms. Am J Psychiat 159(4):539–545PubMedCrossRef

39.

Berrettini W (2004) Bipolar disorder and schizophrenia: convergent molecular data. Neuromol Med 5(1):109–117CrossRef

40.

Berrettini W (2003) Evidence for shared susceptibility in bipolar disorder and schizophrenia. Am J Med Genet 123C(1):59–64CrossRef

41.

Kendler KS, Heath AC, Martin NG, Eaves LJ (1987) Symptoms of anxiety and symptoms of depression. Same genes, different environments? Arch Gen Psychiat 44(5):451–457PubMed

42.

Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ (1992) Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Arch Gen Psychiat 49(9):716–722PubMed

43.

Kendler KS (1996) Major depression and generalised anxiety disorder. Same genes, (partly) different environments – revisited. Br J Psychiat Suppl (30):68–75

44.

Mortensen PB, Pedersen CB, Westergaard T, et al. (1999) Effects of family history and place and season of birth on the risk of schizophrenia. N Engl J Med 340(8):603–608PubMedCrossRef

45.

Spauwen J, Krabbendam L, Roselind L, Wittchen HU, van Os J (2006) Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment. Psychol Med 36(3):407–415PubMedCrossRef

46.

Krabbendam L, van Os J (2005) Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophr Bull 31(4):795–799PubMedCrossRef

47.

Van Os J, Driessen G, Gunther N, Delespaul P (2000) Neighbourhood variation in incidence of schizophrenia: evidence for person–environment interaction. Brit J Psychiat 176:243–248PubMedCrossRef

48.

McKenzie K, Whitley R, Weich S (2002) Social capital and mental health. Brit J Psychatry 181:280–283CrossRef

49.

De Silva MJ, McKenzie K, Harpham T, Huttly SR (2005) Social capital and mental illness: a systematic review. J Epidemiol Commun Health 59(8):619–627CrossRef

50.

Drukker M, Kaplan C, Feron F, van Os J (2003) Children’s health related quality of life, neighbourhood socio-economic deprivation and social capital: a contextual analysis. Soc Sci Med 57(5):825–841PubMedCrossRef

51.

Drukker M, Buka SL, Kaplan C, McKenzie K, van Os J (2005) Social capital and young adolescents, perceived health in different sociocultural settings. Soc Sci Med 61(1):185–198PubMedCrossRef

52.

Blackwood NJ, Howard RJ, Bentall RP, Murray RM (2001) Cognitive neuropsychiatric models of persecutory delusions. Am J Psychiat 158(4):527–539PubMedCrossRef

53.

Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A Cognitive model of the positive symptoms of psychosis. Psychol Med 31(2):189–195PubMedCrossRef

54.

Bak M, Delespaul P, Hanssen M, de Graaf R, Vollebergh W, van Os J (2003) How false are “false” positive psychotic symptoms? Schizophr Res 62(1–2):187–189PubMedCrossRef

55.

Hennekens CH, Buring JE (1987) Analysis of epidemiologic studies: evaluating the role of bias. In: Hennekens CH, Buring JE (eds) Epidemiology in medicine. Little, Brown and Company, Toronto, pp 272–287

56.

Hopke PK, Liu C, Rubin DB (2001) Multiple imputation for multivariate data with missing and below-threshold measurements: time-series concentrations of pollutants in the Arctic. Biometrics 57(1):22–33PubMedCrossRef

57.

Rubin DB, Schenker N (1991) Multiple imputation in health-care databases: an overview and some applications. Stat Med 10(4):585–598PubMed

58.

Pedersen CB, Mortensen PB (2001) Evidence of a dose–response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiat 58(11):1039–1046PubMedCrossRef

Title: Evidence that the urban environment specifically impacts on the psychotic but not the affective dimension of bipolar disorder
Authors: Nil Kaymaz, MD
Lydia Krabbendam, MA, PhD
Ron de Graaf, MA, PhD
Willem Nolen, MD, PhD
Margreet ten Have, MA, PhD
Jim van Os, MD, PhD
Publication date: 01-09-2006
Publisher: Steinkopff-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 9/2006
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-006-0086-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evidence that the urban environment specifically impacts on the psychotic but not the affective dimension of bipolar disorder

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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