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Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

Published online by Cambridge University Press:  18 January 2021

Andrea A. Jones*
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Kristina M. Gicas
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada Department of Psychology, York University, Toronto, Ontario, Canada
Sara Mostafavi
Affiliation:
Department of Statistics, University of British Columbia, Vancouver, Canada Department of Medical Genetics, University of British Columbia, Vancouver, Canada
Melissa L. Woodward
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Olga Leonova
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Fidel Vila-Rodriguez
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Ric M. Procyshyn
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Alex Cheng
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Tari Buchanan
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Donna J. Lang
Affiliation:
Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
G. William MacEwan
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
William J. Panenka
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
Alasdair M. Barr
Affiliation:
Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
Allen E. Thornton
Affiliation:
Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
William G. Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
*
Author for correspondence: Andrea A. Jones, E-mail: aajones@alumni.ubc.ca

Abstract

Background

People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality.

Method

The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models.

Results

Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55.

Conclusions

Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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