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Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study.
JAMA Psychiatry. 2018 01 01; 75(1):36-46.JP

Abstract

Importance

Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s.

Objectives

To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors.

Design, Setting, and Participants

An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics.

Exposures

Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures.

Main Outcomes and Measures

Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist.

Results

A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95% CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95% CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95% CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95% CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95% CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95% CI, 0.2-0.5).

Conclusions and Relevance

This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses.

Authors+Show Affiliations

Department of Psychiatry, University of Cambridge, Cambridge, England.Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, England.Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, England.Unit of Psychiatry, "P. Giaccone" General Hospital, Palermo, Italy.Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France.Rivierduinen Institute for Mental Health Care, Leiden, the Netherlands. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.Cambridge Institute of Public Health, University of Cambridge, Cambridge, England.Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain. Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy.Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy.Etablissement Public de Santé Maison Blanche, Paris, France.EA 7280 Npsydo, Université Clermont Auvergne, Clermont-Ferrand, France.Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, Oviedo, Spain.Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental, Valencia, Spain.Department of Psychiatry, Servicio de Psiquiatría Hospital "Virgen de la Luz," Cuenca, Spain.Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Spain.Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.Department of Preventive Medicine, Faculdade de Medicina, Universidade of São Paulo, São Paulo, Brazil.Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, England.Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Psychiatry, University of Cambridge, Cambridge, England. CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England.Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, England. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands. Department Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, the Netherlands.Department of Health Service and Population Research, Institute of Psychiatry, King's College London, London, England.Psylife Group, Division of Psychiatry, University College London, London, England.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29214289

Citation

Jongsma, Hannah E., et al. "Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study." JAMA Psychiatry, vol. 75, no. 1, 2018, pp. 36-46.
Jongsma HE, Gayer-Anderson C, Lasalvia A, et al. Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. JAMA Psychiatry. 2018;75(1):36-46.
Jongsma, H. E., Gayer-Anderson, C., Lasalvia, A., Quattrone, D., Mulè, A., Szöke, A., Selten, J. P., Turner, C., Arango, C., Tarricone, I., Berardi, D., Tortelli, A., Llorca, P. M., de Haan, L., Bobes, J., Bernardo, M., Sanjuán, J., Santos, J. L., Arrojo, M., ... Kirkbride, J. B. (2018). Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. JAMA Psychiatry, 75(1), 36-46. https://doi.org/10.1001/jamapsychiatry.2017.3554
Jongsma HE, et al. Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. JAMA Psychiatry. 2018 01 1;75(1):36-46. PubMed PMID: 29214289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. AU - Jongsma,Hannah E, AU - Gayer-Anderson,Charlotte, AU - Lasalvia,Antonio, AU - Quattrone,Diego, AU - Mulè,Alice, AU - Szöke,Andrei, AU - Selten,Jean-Paul, AU - Turner,Caitlin, AU - Arango,Celso, AU - Tarricone,Ilaria, AU - Berardi,Domenico, AU - Tortelli,Andrea, AU - Llorca,Pierre-Michel, AU - de Haan,Lieuwe, AU - Bobes,Julio, AU - Bernardo,Miguel, AU - Sanjuán,Julio, AU - Santos,José Luis, AU - Arrojo,Manuel, AU - Del-Ben,Cristina Marta, AU - Menezes,Paulo Rossi, AU - Velthorst,Eva, AU - Murray,Robin M, AU - Rutten,Bart P, AU - Jones,Peter B, AU - van Os,Jim, AU - Morgan,Craig, AU - Kirkbride,James B, AU - ,, PY - 2017/12/8/pubmed PY - 2019/9/13/medline PY - 2017/12/8/entrez SP - 36 EP - 46 JF - JAMA psychiatry JO - JAMA Psychiatry VL - 75 IS - 1 N2 - Importance: Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s. Objectives: To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors. Design, Setting, and Participants: An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics. Exposures: Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures. Main Outcomes and Measures: Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist. Results: A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95% CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95% CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95% CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95% CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95% CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95% CI, 0.2-0.5). Conclusions and Relevance: This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses. SN - 2168-6238 UR - https://www.unboundmedicine.com/medline/citation/29214289/Treated_Incidence_of_Psychotic_Disorders_in_the_Multinational_EU_GEI_Study_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2017.3554 DB - PRIME DP - Unbound Medicine ER -