Understanding psychosis complexity through a syndemic framework: A systematic review.

Psychotic conditions pose significant challenges due to their complex aetiology and impact on individuals and communities. Syndemic theory offers a promising framework to understand the interconnectedness of various health and social problems in the context of psychosis. This systematic review aims to examine existing literature on testing whether psychosis is better understood as a component of a syndemic. We conducted a systematic search of 7 databases, resulting in the inclusion of five original articles. Findings from these studies indicate a syndemic characterized by the coexistence of various health and social conditions, are associated with a greater risk of psychosis, adverse health outcomes, and disparities, especially among ethnic minorities and deprived populations. This review underscores the compelling need for a new paradigm and datasets that can investigate how psychosis emerges in the context of a syndemic, ultimately guiding more effective preventive and care interventions as well as policies to improve the health of marginalised communities living in precarity.

Ethnic inequality, multimorbidity and psychosis: can a syndemic framework resolve disputed evidence?

Syndemic theory is described as population-level clustering or co-occurrence of health conditions in the context of shared aetiologies that interact and can act synergistically. These influences appear to act within specific places of high disadvantage. We suggest ethnic inequality in experiences and outcomes of multimorbidity, including psychosis, may be explained through a syndemic framework. We discuss the evidence for each component of syndemic theory in relation to psychosis, using psychosis and diabetes as an exemplar. Following this, we discuss the practical and theoretical adaptations to syndemic theory in order to apply it to psychosis, ethnic inequality and multimorbidity, with implications for research, policy, and practice.

Ethnic inequalities in involuntary admission under the Mental Health Act: an exploration of mediation effects of clinical care prior to the first admission.

BACKGROUND: Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission. AIMS: This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care. METHOD: In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association. RESULTS: Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission. CONCLUSIONS: Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.

Escala de Discriminação Cotidiana para Adolescentes e Jovens: Adaptação e Evidências Psicométricas / Everyday Discrimination Scale for Adolescents and Youth: Adaptation and Psychometric Evidence / Escala de Discriminación en la Vida Cotidiana para Adolescentes y Jóvenes: Adaptación y Pruebas Psicométricas

A discriminação tem um impacto negativo na saúde mental e nos desfechos acadêmicos e socioemocionais das pessoas. Um dos instrumentos mais usados para medir a frequência de experiências de discriminação é a Escala de Discriminação Cotidiana. Contudo, esta escala não foi ainda adaptada ao contexto brasileiro. Desta forma, o objetivo deste estudo foi adaptar e validar a Escala de Discriminação Cotidiana em uma amostra de adolescentes e jovens brasileiros de nível socioeconômico baixo e descrever os motivos de discriminação mais prevalentes. Analisou-se as equivalências linguísticas e a estrutura factorial da escala. A amostra foi composta de 995 estudantes pobres, advindos do Ensino Fundamental de cinco escolas públicas do Estado do Rio de Janeiro e de duas universidades públicas do Estado do Ceará, com idade entre 11 e 29 anos (M = 15,81, DP = 3,55), 54,8% constituída por mulheres (n = 522). A Análise Fatorial Exploratória realizada revelou uma estrutura unifatorial, com boa confiabilidade e validade. Os motivos de discriminação mais frequentes foram a aparência física e o nível socioeconômico. Os achados sugerem que a versão adaptada da escala apresenta qualidades psicométricas que permitem a sua utilização junto a adolescentes e jovens brasileiros.

Discrimination has a negative impact on people's mental health and academic and socio-emotional outcomes. One of the most commonly used instruments to assess the frequency of discrimination experiences is the Everyday Discrimination Scale. However, this instrument has not yet been adapted to the Brazilian context. Hence, this study aimed to adapt and validate the Everyday Discrimination Scale to a sample of Brazilian adolescents and young adults of low socioeconomic level and describe the most prevalent grounds for discrimination. Linguistic equivalences and the scale's factorial structure were analyzed. The sample comprised 995 students with a background of poverty, attending five public elementary schools in Rio de Janeiro State and two public universities of Ceará State, aged between 11 and 29 years old (M = 15,81; SD = 3,55), of which 54,8% (n = 522) were women. The Exploratory Factor Analysis revealed a unifactorial structure, with good reliability and convergent validity. Among the reasons mentioned for the perceived discrimination, physical appearance and socioeconomic level were the most frequent. The findings suggest the scale's adapted version presents psychometric qualities that allow its use with Brazilian adolescents and young people.

La discriminación tiene impacto negativo en la salud mental y los resultados académicos y socioemocionales de las personas. Uno de los instrumentos más utilizados para medir la frecuencia de las experiencias de discriminación es la Escala de Discriminación en la Vida Diaria. Sin embargo, esta escala aún no se ha adaptado al contexto brasileño. Por lo tanto, el objetivo de este estudio fue adaptar y validar la Escala de Discriminación Cotidiana en una muestra de adolescentes y jóvenes brasileños de nivel socioeconómico bajo y describir los motivos de discriminación más prevalentes. Se analizaron las equivalencias lingüísticas y la estructura factorial de la escala. La muestra estuvo compuesta por 995 alumnos pobres, provenientes de la Enseñanza Básica de cinco escuelas públicas del Estado de Río de Janeiro y de dos universidades públicas del Ceará, con edades comprendidas entre los 11 y los 29 años (M = 15,81, DT = 3,55), siendo el 54,8% mujeres (n = 522). El Análisis Factorial Exploratorio realizado reveló una estructura unifactorial, con buena fiabilidad y validez. Los motivos de discriminación más frecuentes fueron el aspecto físico y el nivel socioeconómico. Los resultados sugieren que la versión adaptada presenta cualidades psicométricas que permiten su uso con adolescentes y jóvenes brasileños.

Ethnic inequalities in clozapine use among people with treatment-resistant schizophrenia: a retrospective cohort study using data from electronic clinical records.

PURPOSE: Clozapine is the most effective intervention for treatment-resistant schizophrenia (TRS). Several studies report ethnic disparities in clozapine treatment. However, few studies restrict analyses to TRS cohorts alone or address confounding by benign ethnic neutropenia. This study investigates ethnic equity in access to clozapine treatment for people with treatment-resistant schizophrenia spectrum disorder. METHODS: A retrospective cohort study, using information from 11 years of clinical records (2007-2017) from the South London and Maudsley NHS Trust. We identified a cohort of service-users with TRS using a validated algorithm. We investigated associations between ethnicity and clozapine treatment, adjusting for sociodemographic factors, psychiatric multi-morbidity, substance misuse, neutropenia, and service-use. RESULTS: Among 2239 cases of TRS, Black service-users were less likely to be receive clozapine compared with White British service-users after adjusting for confounders (Black African aOR = 0.49, 95% CI [0.33, 0.74], p = 0.001; Black Caribbean aOR = 0.64, 95% CI [0.43, 0.93], p = 0.019; Black British aOR = 0.61, 95% CI [0.41, 0.91], p = 0.016). It was additionally observed that neutropenia was not related to treatment with clozapine. Also, a detention under the Mental Health Act was negatively associated clozapine receipt, suggesting people with TRS who were detained are less likely to be treated with clozapine. CONCLUSION: Black service-users with TRS were less likely to receive clozapine than White British service-users. Considering the protective effect of treatment with clozapine, these inequities may place Black service-users at higher risk for hospital admissions and mortality.

COVID-related hospitalization, intensive care treatment, and all-cause mortality in patients with psychosis and treated with clozapine.

Clozapine, an antipsychotic, is associated with increased susceptibility to infection with COVID-19, compared to other antipsychotics. Here, we investigate associations between clozapine treatment and increased risk of adverse outcomes of COVID-19, namely COVID-related hospitalisation, intensive care treatment, and death, amongst patients taking antipsychotics with schizophrenia-spectrum disorders. Using the clinical records of South London and Maudsley NHS Foundation Trust, we identified 157 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders, were taking antipsychotics (clozapine or other antipsychotics) at the time of COVID-19 pandemic in the UK and had a laboratory-confirmed COVID-19 infection. The following health outcomes were measured: COVID-related hospitalisation, COVID-related intensive care treatment and death. We tested associations between clozapine treatment and each outcome using logistic regression models, adjusting for gender, age, ethnicity, neighbourhood deprivation, obesity, smoking status, diabetes, asthma, bronchitis and hypertension using propensity scores. Of the 157 individuals who developed COVID-19 while on antipsychotics (clozapine or other antipsychotics), there were 28% COVID-related hospitalisations, 8% COVID-related intensive care treatments and 8% deaths of any cause during the 28 days follow-up period. amongst those taking clozapine, there were 25% COVID-related hospitalisations, 7% COVID-related intensive care treatments and 7% deaths. In both unadjusted and adjusted analyses, we found no significant association between clozapine and any of the outcomes. Thus, we found no evidence that patients with clozapine treatment at time of COVID-19 infection had increased risk of hospitalisation, intensive care treatment or death, compared to non-clozapine antipsychotic-treated patients. However, further research should be considered in larger samples to confirm this.

Resilience in the face of peer victimization and perceived discrimination: The role of individual and familial factors.

BACKGROUND: Peer victimization and discrimination are two related forms of social victimization. However, the majority of studies only focus on one form or the other. This study investigates resilience in victims of both these forms of violence. OBJECTIVE: To identify individual and family level factors that foster, or hinder, resilience in the face of both peer victimization and perceived discrimination. PARTICIPANTS: In a sample of 2975 high-school students, 22% (n = 644) met the criteria for substantial social victimization. The sample's mean age was 16.5 years, 57% were girls, 19% were in vocational courses, 12% were from an ethnic minority background, and 5% were lesbian, gay, or bisexual. METHOD: A measure of resilience was created by regressing the mean levels of current mental health, self-esteem, and life satisfaction on the frequency of lifetime peer victimization and past year perceived discrimination. Regression analyses were conducted to identify correlates of resilience considering protective and vulnerability factors, including sociodemographic information, anxious personality, empathy, coping strategies, familial optimism, and the relationship with their mother and father. RESULTS: Resilience was associated with low anxious personality, four coping strategies (active, use of humor, low self-blame, low substance use), and satisfaction with the relationship with the mother. CONCLUSIONS: Resilience is related to both behavioral and meaning-making coping strategies, personality traits, and satisfaction in relationships. This study's findings can be used to tailor interventions to foster resilience in adolescents exposed to social victimization.

Gender disparities in clozapine prescription in a cohort of treatment-resistant schizophrenia in the South London and Maudsley case register.

BACKGROUND: Gender disparities in treatment are apparent across many areas of healthcare. There has been little research into whether clozapine prescription, the first-line treatment for treatment-resistant schizophrenia (TRS), is affected by patient gender. METHODS: This retrospective cohort study identified 2244 patients with TRS within the South London and Maudsley NHS Trust, by using a bespoke method validated against a gold-standard, manually coded, dataset of TRS cases. The outcome and exposures were identified from the free-text using natural language processing applications (including machine learning and rules-based approaches) and from information entered in structured fields. Multivariable logistic regression was carried out to calculate the odds ratios for clozapine prescription according to patients' gender, and adjusting for numerous potential confounders including sociodemographic, clinical (e.g., psychiatric comorbidities and substance use), neutropenia, functional factors (e.g., problems with occupation), and clinical monitoring. RESULTS: Clozapine was prescribed to 77% of the women and 85% of the men with TRS. Women had reduced odds of being prescribed clozapine as compared to men after adjusting for all factors included in the present study (adjusted OR: 0.66; 95% CI 0.44-0.97; p = 0.037). CONCLUSION: Women with TRS are less likely to be prescribed clozapine than men with TRS, even when considering the effects of multiple clinical and functional factors. This finding suggests there could be gender bias in clozapine prescription, which carries ramifications for the relatively poorer care of women with TRS regarding many outcomes such as increased hospitalisation, mortality, and poorer quality of life.

Competência educativa parental: estudo de propriedades psicométricas da escala com amostra brasileira / Parenting sense of competence: a study of the psychometric properties of the scale with a Brazilian sample / Competencia educativa parental: estudio de las propiedades psicométricas de la escala con una muestra brasileña

O Questionário de Autoavaliação da Competência Educativa Parental (QACEP) é um instrumento que tem por objetivo avaliar a percepção de competência dos pais em suas funções. No Brasil, sua utilização é escassa e o objetivo desta pesquisa é analisar as propriedades psicométricas do QACEP. Foi utilizada uma amostra de 151 mães e pais, a maioria com nível de escolaridade até o ensino médio e renda até dois salários mínimos. A análise fatorial confirmatória do modelo proposto com dois fatores - a percepção de eficácia e de satisfação - revelou bom ajustamento global aos dados recolhidos. Análises posteriores revelam que a satisfação parental aumenta com a idade dos pais, com o nível de escolaridade e salário auferido. Tendo em conta os diversos processos de validação conduzidos, recomenda-se o uso dessa versão do QACEP na investigação e prática clínica com pessoas de baixa renda no Brasil. (AU)

The Self-Assessment Questionnaire for Parental Educational Competency (PEC-SAQ) is an instrument that aims to evaluate the perception of parental competence in its functions. In Brazil, it is scarcely used and the objective of this research is to analyze the psychometric properties of PEC-SAQ. A sample of 151 mothers and fathers was used, the majority with education level up to high school and income up to two minimum wages. Confirmatory factor analysis of a proposed two-factor model (perception of efficacy and satisfaction) revealed a good overall adjustment to the data collected. Later analyses revealed that parental satisfaction increases with the parents' age, with the level of schooling and salary earned. Taking into account the different validation processes conducted, it is recommended to use this version of PEC-SAQ in research and clinical practice with low-income people in Brazil. (AU)

El Cuestionario de Autoevaluación de Competencia Educativa Parental (QACEP) es un instrumento que tiene por objetivo evaluar la percepción de competencia de los padres en sus tareas. En Brasil, su utilización es escasa y el objetivo de esta investigación es analizar las propiedades psicométricas del QACEP. Se utilizó una muestra de 151 madres y padres, la mayoría con nivel de escolaridad hasta Enseñanza Secundaria y una renta media familiar hasta dos salarios mínimos. El análisis factorial confirmatorio del modelo propuesto con dos factores - Eficacia y Satisfacción - mostró buen ajuste global a los datos recogidos. Análisis posteriores revelan que la satisfacción parental aumenta con la edad de los padres, con el nivel de escolaridad y con los ingresos familiares. Se recomienda el uso de esta versión del QACEP en la investigación y práctica clínica con personas de bajos ingresos en Brasil. (AU)

Resilience in the face of peer victimisation and discrimination: The who, when and why in five patterns of adjustment.

Victimisation has a negative effect on psychosocial functioning. Based on the resilience theory, and with a sample of 2975 Portuguese students, the present study aims to: i) identify patterns of adjustment in the face of peer victimisation and perceptions of discrimination; ii) explore the association between the patterns of adjustment and the characteristics of participants (the who) and of the victimisation (the when and why). Cluster analysis revealed five patterns of adjustment: Unchallenged; Externally Maladjusted; Internally Maladjusted; Resilient, and At-Risk. The results suggest that there is no complete resilience in the face of social victimisation. Group differences were found regarding: i) gender, type of course, sexual orientation, ethnicity, nationality, parental educational level and religious beliefs; ii) the age at which peer victimisation was more frequent, and; iii) the motives underlying discrimination. Globally considered, peer victimisation is representative of the wider cultural environment and interventions should also target social prejudices.

Resilience in LGB Youths: A Systematic Review of Protection Mechanisms / Resiliência em Jovens LGB: Uma Revisão Sistemática de Mecanismos de Proteção / Resiliencia en los Jóvenes LGB: Una Revisión Sistemática de los Mecanismos de Protección

Abstract: Given the mental health disparities among LGB and heterosexual youth, literature has increasingly emphasized the need to identify the mechanisms that promote resilience among sexual minorities. This systematic review sought to answer the question: what are the protection mechanisms against homophobia among LGB youth? Of the 147 references located in the search, 13 studies were analyzed. The identified protection mechanisms were organized by two criteria: specific to sexual orientation or general, and considered to be at the personal, relational and contextual level. Most of the mechanisms revealed to solely promote the positive adjustment in the presence of risk. General protective mechanisms frequently revealed to be more compensatory of the risks than those specific to sexual orientation.

Resumo: Considerando as disparidades observadas em diversos indicadores de ajustamentoentre jovens lésbicas,gay e bissexuais (LGB) e jovens heterossexuais, revelou-se importante de identificar os mecanismos que promovem a resiliência das minorias sexuais. Por meio de uma revisão sistemática, procurou-se responder à questão: quais são os mecanismos de proteção perante a homofobia junto dos jovens LGB? Das 147 referências localizadas na pesquisa sistemática, 13 estudos foram analisados. Os mecanismos de proteção identificados foram organizados de acordo com dois critérios: especificidade (serem gerais ou específicos à orientação sexual) e nível (pessoais, relacionaisou contextuais). Os resultados demonstram que a maioria destes mecanismos são unicamentepromotores do ajustamento positivo na presença do risco. Os mecanismos gerais revelaram-se mais frequentemente compensatórios dos riscos, do que os específicos.

Resumen: Considerando las disparidades observadas en varios indicadores de ajuste entre jóvenes gais, lesbianas y bisexuales y jóvenes heterosexuales, ha sido enfatizada en la literatura la necesidad de identificar los mecanismos que promueven la resiliencia entre las minorías sexuales. Esta revisión sistemática trató de responder la pregunta: ¿cuáles son los mecanismos de protección contra la homofobia entre los jóvenes LGB? De las 147 referencias localizadas en la búsqueda sistemática, 13 estudios fueron analizados. Los mecanismos de protección identificados fueron ordenados según dos criterios: específicos a la orientación sexual o generales, y considerando su nivel de expresión, personales, relacionales o contextuales. Los resultados demuestran que la mayoría de estos mecanismos son exclusivamente promotores del ajuste positivo en la presencia del riesgo. Los mecanismos de protección generales se revelan más a menudo compensatorios de los riesgos que los específicos.

Adaptação da escala de discriminação quotidiana para jovens portugueses / Adaptation of the everyday discrimination scale to portuguese youth

Resumo O objetivo deste estudo foi a adaptação da Escala de Discriminação Quotidiana para a população jovem portuguesa. Após tradução, ajustes semânticos aos itens, inclusão de dois itens para aumento da validade de constructo e a aferição da validade facial, os itens da escala foram respondidos por 2996 jovens estudantes do ensino secundário em Portugal. A Análise Fatorial Exploratória (AFE) revelou uma estrutura de dois fatores - Tratamento Injusto e Rejeição Pessoal - com quatro itens cada (sete itens da escala original e um formulado neste estudo). A Análise Fatorial Confirmatória (AFC) validou um modelo hierárquico, em que os dois fatores observados na AFE estão subordinados a um fator latente de segunda ordem, a Percepção de Discriminação. A escala permite diferenciar a discriminação percepcionada por grupos alvo de preconceito social, observando-se diferenças significativas nos valores reportados entre pessoas negras e brancas e entre jovens lésbicas, gays, bissexuais e participantes heterossexuais. O instrumento explica parcialmente variações ao nível de saúde mental, observando-se uma correlação negativa moderada entre a discriminação percepcionada e a saúde mental. Os resultados sugerem que a versão adaptada da escala apresenta validade de constructo, sendo bastante apropriada para avaliar e comparar a percepção de discriminação de jovens (AU).

Abstract The aim of this study was the adaptation of the Everyday Discrimination Scale to Portuguese youth. Scale items were subject to translation and adaptation, and two items were incorporated into the scale to increase construct validity. After establishing face validity, data from 2996 high school students were subject to Exploratory Factorial Analysis (EFA) and Confirmatory Factor Analysis (CFA). The EFA results portrayed a two-factor solution - Unfair Treatment and Personal Rejection - with four items each (seven items of the original scale and one prepared to this study). The CFA validated a hierarchical model in which the two factors observed in the EFA are subordinated to a second order latent factor, the Perception of Discrimination. The instrument was able to distinguish the perceptions of discrimination felt by prejudiced groups, since significant differences were observed between black and white participants, and between lesbian, gay and bisexual participants and their heterosexual counterparts. The instrument partially explains variations in mental health levels, given the observation of a negative correlation between perceived discrimination and mental health. The study concludes that this adapted version of the scale is a proper resource to the measurement and comparison of the perceptions of discrimination felt by the young (AU).