Psychopathologic Precursors and Sociodemographic Risk Factors for the Schizophrenia Syndrome

TLDR

The study prospectively examines antecedent psychopathologic features and sociodemographic risk factors for schizophrenia using data from five community sites in the NIMH Epidemiologic Catchment Area Program. Three DSM‑III psychotic case definitions were operationalized with the Diagnostic Interview Schedule: (1) schizophrenia criterion A, (2) criterion A plus an affective episode, and (3) full schizophrenia. During a one‑year follow‑up, cumulative incidence rates were 0.79, 0.17, and 0.20 per 100 for criterion A, criterion A with affective episode, and full schizophrenia, respectively, and multivariable analysis showed that male gender, marital status, employment, and comorbid obsessive‑compulsive disorder, social phobia, and panic attacks markedly increased odds of developing DIS/DSM‑III schizophrenia, with never‑married men exhibiting a 50‑fold higher risk.

Abstract

• This article presents a prospective analysis of an antecedent psychopathologic features and sociodemographic risk factors in schizophrenia with data from five community sites in the National Institute of Mental Health Epidemiologic Catchment Area Program. Three nonoverlapping psychotic cases were defined using<i>DSM-III</i>definitions as implemented by the Diagnostic Interview Schedule (DIS): (1)<i>DSM-III</i>Schizophrenia Criterion A; (2) Criterion A and Affective Episode; and (3) full Schizophrenia. In a 1-year follow-up period, the cumulative incidence rate of Criterion A was 0.79 per 100, for Criterion A with Affective Episode it was 0.17 per 100, and for Schizophrenia the rate was 0.20 per 100. In multivariable logistic regression modeling, the patterns of associations between sociodemographic factors and DIS/<i>DSM-III</i>Schizophrenia resembled patterns in clinically based registry date. Male subjects had an earlier peak onset than female subjects, and marital status and employment were strongly related to odds of developing DIS/<i>DSMIII</i>Schizophrenia. An interaction between gender and never marrying showed never-married men at 50 times higher odds of developing DIS/<i>DSM-III</i>Schizophrenia, nevermarried women at 14 times higher odds, and married women at 2.5 times higher odds, relative to married men. Adjusting for sociodemographic factors, DIS/<i>DSM-III</i>Obsessive Compulsive Disorder and Social Phobia were both associated with more than 3.5 times increased odds of developing DIS/<i>DSM-III</i>Schizophrenia. Several other psychopathology items, including panic attacks, were associated with increased odds of developing DIS/<i>DSM-III</i>Schizophrenia. There were both similarities and differences in risk factor structure between DIS/<i>DSM-III</i>Schizophrenia and the other two defined categories of case.