Elsevier

Psychiatry Research

Volume 226, Issue 1, 30 March 2015, Pages 352-356
Psychiatry Research

Young for one׳s grade: A risk factor for psychotic experiences among adults in the National Comorbidity Survey-Replication

https://doi.org/10.1016/j.psychres.2015.01.017Get rights and content

Highlights

  • Tested school-related risk factors for psychotic experiences.

  • Factors of interest were school mobility and age relative to others in one׳s grade.

  • Perceived younger relative age increased risk for psychosis.

  • School-level interventions can target disadvantage and marginalization.

Abstract

School-related difficulties have received relatively little attention as environmental risk factors for psychotic experiences (PEs), despite being characterized by marginalization and social defeat during critical periods of psychological development. This study examined both childhood age relative to one׳s classmates and school mobility as risk factors for adult psychotic experiences in the National Comorbidity Survey-Replication (NCS-R). Weighted logistic regression models were used to explore the hypotheses that lifetime psychotic experiences reported on the World Health Organization psychosis screen would be more prevalent among those younger than their classmates during childhood and for those with frequent school mobility. Younger perceived relative age (odds ratio (OR)=2.05, 95% confidence interval=1.43–2.95) was independently associated with psychotic experiences in the fully adjusted model, but school mobility was not. School-related risk factors for psychosis provide promising points for community-level intervention, and support the claim that environmental factors characterized by disadvantage and marginalization contribute to psychosis etiology.

Introduction

Common environmental risk factors for psychosis and psychosis-like experiences share the characteristics of eliciting feelings of “social defeat” (Selten and Cantor-Graae, 2005) and of being “disadvantaged and different from the norm” (van Os, 2012). Accordingly, dimensional models of psychosis would predict that even common variation from the norm, and associated marginalization, should affect small but measurable changes in risk for psychosis. This is measureable by examining sub-threshold psychotic experiences (PEs), which occur in approximately 7.2% of the general population (Linscott and Van Os, 2013) and are predictive of greater risk for schizophrenia and other psychopathological outcomes (Werbeloff et al., 2012, Fisher et al., 2013). For example, childhood residential mobility, which is common in the population and likely influences an array of more immediate risk factors, has been linked to moderately increased risk for schizophrenia (Paksarian et al., 2014). School mobility in particular is prospectively related to increased risk for sub-threshold PEs, both directly and due to intermediary factors such as bullying (Singh et al., 2014).

One educational factor that has not been previously examined is perceived age relative to that of one׳s classmates during childhood. Younger perceived relative age may bestow additional risk due to potential disadvantages such as being persistently at a different stage of cognitive and socioemotional development relative to peers (Crick and Dodge, 1994) and perhaps greater risk for marginalization and chronic social defeat. This may also contribute to intermediary risk factors for psychosis such as bullying and victimization (Campbell and Morrison, 2007, Kelleher et al., 2008, Lataster et al., 2006, Mackie et al., 2011, Mackie et al., 2013, Schreier et al., 2009), which are reportedly more common in children of younger age relative to their school peers (Smith et al., 1999, Whitney and Smith, 1993). School-related risks factors were chosen as the focus of this study both for their direct community relevance, and for their unifying characteristics of marginalization and exclusion from “the norm”. Diathesis–stress models predict that such social stressors can increase one׳s risk for psychosis (Corcoran et al., 2003). Identifying common school-related risk factors can bolster the development of school-wide or community-wide interventions that minimize effects of marginalization during development.

This study examined the relationship between perceived age relative to one׳s classmates and risk for PEs in the National Comorbidity Survey-Replication (NCS-R; Kessler et al., 2004) with the hypothesis that risk would increase among those who perceive themselves to be of younger perceived relative age. We additionally predicted that this relationship would be independent of the effect of changing schools, which we likewise expected to be related to PEs in concurrence with recent studies (Paksarian et al., 2014, Singh et al., 2014).

Section snippets

Sample

The NCS-R was a lay-administered, face-to-face, household survey, conducted with adults (age 18+) in the general population of the United States between February 2001 and December 2002. The response rate was 73.0%, with demographic data collected on non-responders to facilitate appropriate weighting (Kessler et al., 2004). The interview was conducted in two parts. Part I, administered to all 9282 respondents, assessed core DSM-IV mental disorders using the World Health Organization World Mental

Results

The prevalence of psychotic experiences in this weighted sample 9.1% (SE=0.9), with more individuals reporting hallucinations, % (SE)=8.6 (0.9), than delusions, % (SE)=1.6 (0.2), in concurrence with past studies using the NCS-R (e.g., Kessler et al., 2005). Psychotic experiences were associated with one predictor of interest, perceived relative age, as well as with sex, and income to poverty ratio, but not school mobility, in univariate analyses (Table 1). Perceived relative age was not

Discussion

This is the first study to our knowledge to suggest that younger perceived relative age is associated with increased risk for psychotic experiences. The association was consistent across demographic groups and after adjustment for other childhood education-related variables, including school mobility. Given a possible link between younger perceived relative age with chronic experience of marginalization, these findings may support the notion that early social stress is related to psychosis

Financial support

None.

Conflicts of interest

None for any authors.

Acknowledgements

This work was supported in part by funding from the Maryland Department of Health and Mental Hygiene, Mental Hygiene Administration through the Center for Excellence on Early Intervention for Serious Mental Illness (OPASS# 14-13717G/M00B4400241).

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