Hostname: page-component-7479d7b7d-fwgfc Total loading time: 0 Render date: 2024-07-10T23:15:09.826Z Has data issue: false hasContentIssue false
  • English
  • Français

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 Open the ORCID record for Andrea A. Jones [Opens in a new window] ,
Kristina M. Gicas ,
Sara Mostafavi Open the ORCID record for Sara Mostafavi [Opens in a new window] ,
Melissa L. Woodward Open the ORCID record for Melissa L. Woodward [Opens in a new window] ,
Olga Leonova ,
Fidel Vila-Rodriguez Open the ORCID record for Fidel Vila-Rodriguez [Opens in a new window] ,
Ric M. Procyshyn Open the ORCID record for Ric M. Procyshyn [Opens in a new window] ,
Alex Cheng ,
Tari Buchanan  and
Donna J. Lang Open the ORCID record for Donna J. Lang [Opens in a new window]
...Show all authors
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Homelessness and precarious housingmortalitymultilevel vector autoregressionnetwork analysispsychotic disorderpsychotic symptomssubstance dependence
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 13 , October 2022 , pp. 2559 - 2569
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
Ayano, G., Tesfaw, G., & Shumet, S. (2019). The prevalence of schizophrenia and other psychotic disorders among homeless people: A systematic review and meta-analysis. BMC Psychiatry, 19(1), 370–384. https://doi.org/10.1186/s12888-019-2361-7CrossRefGoogle ScholarPubMed
Bates, D., Maechler, M., Bolker, B., & Walker, S. (2015). Fitting linear mixed-effects models using lme4. Journal of Statistical Software, 67(1), 1–48.CrossRefGoogle Scholar
Bebbington, P. E., Craig, T., Garety, P., Fowler, D., Dunn, G., Colbert, S., … Kuipers, E. (2006). Remission and relapse in psychosis: Operational definitions based on case-note data. Psychological Medicine, 36, 1551–1562. https://doi.org/10.1017/S0033291706008579CrossRefGoogle ScholarPubMed
Bornheimer, L. A., & Jaccard, J. (2017). Symptoms of depression, positive symptoms of psychosis, and suicidal ideation among adults diagnosed with schizophrenia within the clinical antipsychotic trials of intervention effectiveness. Archives of Suicide Research, 21(4), 633–645. https://doi.org/10.1080/13811118.2016.1224990CrossRefGoogle ScholarPubMed
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16, 5–13. https://doi.org/10.1002/wps.20375CrossRefGoogle ScholarPubMed
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9(1), 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608CrossRefGoogle Scholar
Bousman, C. A., McKetin, R., Burns, R., Woods, S. P., Morgan, E. E., Atkinson, J. H., … Grant, I. (2015). Typologies of positive psychotic symptoms in methamphetamine dependence. American Journal on Addictions, 24(2), 94–97. https://doi.org/10.1111/ajad.12160CrossRefGoogle ScholarPubMed
Bringmann, L. F., Lemmens, L. H. J. M., Huibers, M. J. H., Borsboom, D., & Tuerlinckx, F. (2015). Revealing the dynamic network structure of the beck depression inventory-II. Psychological Medicine, 45(04), 747–757. https://doi.org/10.1017/S0033291714001809CrossRefGoogle ScholarPubMed
Bringmann, L. F., Vissers, N., Wichers, M., Geschwind, N., Kuppens, P., Peeters, F., … Tuerlinckx, F. (2013). A network approach to psychopathology: New insights into clinical longitudinal data. PLoS ONE, 8(4), e60188. https://doi.org/10.1371/journal.pone.0060188CrossRefGoogle ScholarPubMed
Bulteel, K., Tuerlinckx, F., Brose, A., & Ceulemans, E. (2016). Using raw VAR regression coefficients to build networks can be misleading. Multivariate Behavioral Research, 51(2–3), 330–344. https://doi.org/10.1080/00273171.2016.1150151CrossRefGoogle ScholarPubMed
Cermolacce, M., Sass, L., & Parnas, J. (2010). What is bizarre in bizarre delusions? A critical review. Schizophrenia Bulletin, 36(4), 667–679. https://doi.org/10.1093/schbul/sbq001CrossRefGoogle ScholarPubMed
Chang, W. C., Wong, C. S. M., Or, P. C. F., Chu, A. O. K., & Hui, C. L. M. (2019). Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: A network analysis approach. Psychological Medicine, 50(12), 2019–2027. https://doi.org/10.1017/S0033291719002113.CrossRefGoogle ScholarPubMed
Chen, E. Y. H., Hui, C. L. M., Lam, M. M. L., Chiu, C. P. Y., Law, C. W., Chung, D. W. S., … Honer, W. G. (2010). Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: Randomised controlled trial. BMJ (Clinical Research Ed.), 341, c4024. https://doi.org/10.1136/bmj.c4024CrossRefGoogle ScholarPubMed
Compton, M. T., Potts, A. A., Wan, C. R., & Ionescu, D. F. (2012). Which came first, delusions or hallucinations? An exploration of clinical differences among patients with first-episode psychosis based on patterns of emergence of positive symptoms. Psychiatry Research, 200(2–3), 702–707. https://doi.org/10.1016/j.psychres.2012.07.041CrossRefGoogle ScholarPubMed
Corcoran, R., Mercer, G., & Frith, C. D. (1995). Schizophrenia, symptomatology and social inference: Investigating “theory of mind” in people with schizophrenia. Schizophrenia Research, 17(1), 5–13. https://doi.org/10.1016/0920-9964(95)00024-GCrossRefGoogle Scholar
Epskamp, S., Cramer, A., Waldorp, L., Schmittmann, V., & Borsboom, D. (2012). Qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1–18.CrossRefGoogle Scholar
Epskamp, S., Waldorp, L. J., Mõttus, R., & Borsboom, D. (2018). The Gaussian graphical model in cross-sectional and time-series data. Multivariate Behavioral Research, 53(4), 453–480. https://doi.org/10.1080/00273171.2018.1454823CrossRefGoogle ScholarPubMed
Esfahlani, F. Z., Sayama, H., Froster Visser, K., & Strauss, G. P. (2017). Sensitivity of the positive and negative syndrome scale (PANSS) in detecting treatment effects via network analysis. Innovations in Clinical Neuroscience, 14(11), 59–68.Google ScholarPubMed
Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529–1540. https://doi.org/10.1016/S0140-6736(14)61132-6CrossRefGoogle ScholarPubMed
Gaetz, S., Barr, C., Friesen, A., Harris, B., Hill, C., Kovacs-Burns, K., … Marsolais, A. (2012). Canadian definition of homelessness. Toronto: Canadian Observatory on Homelessness Press.Google Scholar
Galderisi, S., Rucci, P., Kirkpatrick, B., Mucci, A., Gibertoni, D., Rocca, P., … Pacitti, F. (2018). Interplay among psychopathologic variables, personal resources, context-related factors, and real-life functioning in individuals With schizophrenia: A network analysis. JAMA Psychiatry, 75(4), 396–404. https://doi.org/10.1001/jamapsychiatry.2017.4607CrossRefGoogle ScholarPubMed
Gicas, K. M., Jones, A. A., Panenka, W. J., Giesbrecht, C., Lang, D. J., Vila-rodriguez, F., … Honer, W. G. (2019). Cognitive profiles and associated structural brain networks in a multimorbid sample of marginalized adults. PLoS ONE, 14(6), e0218201. https://doi.org/10.1371/journal.pone.0218201CrossRefGoogle Scholar
Global Burden of Disease Study 2013 Collaborators (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the global burden of disease study 2013. Lancet, 386, 743–800. https://doi.org/10.1016/S0140-6736(15)60692-4CrossRefGoogle Scholar
Greene, T., Gelkopf, M., Epskamp, S., & Fried, E. (2018). Dynamic networks of PTSD symptoms during conflict. Psychological Medicine, 48(14), 2409–2417. https://doi.org/10.1017/S0033291718000351CrossRefGoogle ScholarPubMed
Gunduz-Bruce, H., McMeniman, M., Robinson, D. G., Woerner, M. G., Kane, J. M., Schooler, N. R., & Lieberman, J. A. (2005). Duration of untreated psychosis and time to treatment response for delusions and hallucinations. American Journal of Psychiatry, 162(10), 1966–1969. https://doi.org/10.1176/appi.ajp.162.10.1966CrossRefGoogle ScholarPubMed
Hamaker, E. L., & Grasman, R. P. P. P. (2014). To center or not to center? Investigating inertia with a multilevel autoregressive model. Frontiers in Psychology, 5(1492), 1–15. https://doi.org/10.3389/fpsyg.2014.01492Google ScholarPubMed
Hasson-Ohayon, I., Goldzweig, G., Lavi-Rotenberg, A., Luther, L., & Lysaker, P. H. (2018). The centrality of cognitive symptoms and metacognition within the interacting network of symptoms, neurocognition, social cognition and metacognition in schizophrenia. Schizophrenia Research, 202, 260–266. https://doi.org/10.1016/j.schres.2018.07.007CrossRefGoogle Scholar
Honer, W. G., Cervantes-Larios, A., Jones, A. A., Vila-Rodriguez, F., Montaner, J. S., Tran, H., … Schultz, K. (2017). The Hotel Study – clinical and health service effectiveness in a cohort of homeless or marginally housed persons. Canadian Journal of Psychiatry, 62(7), 482–492. https://doi.org/10.1177/0706743717693781CrossRefGoogle ScholarPubMed
Hui, C. L. M., Honer, W. G., Lee, E. H. M., Chang, W. C., Chan, S. K. W., Chen, E. S. M., … Chen, E. Y. H. (2018). Long-term effects of discontinuation from antipsychotic maintenance following first episode schizophrenia and related disorders. Lancet Psychiatry, 5(5), 432–442. https://doi.org/10.1016/S2215-0366(18)30090-7CrossRefGoogle ScholarPubMed
Isvoranu, A.-M., Van Borkulo, C. D., Boyette, L. L., Wigman, J. T. W., Vinkers, C. H., Borsboom, D., … Myin-Germeys, I. (2017). A network approach to psychosis: Pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin, 43(1), 187–196. https://doi.org/10.1093/schbul/sbw055CrossRefGoogle ScholarPubMed
Johansson, M., Hjärthag, F., & Helldin, L. (2018). What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders: An exploratory follow-up study. Schizophrenia Research, 195, 103–109. https://doi.org/10.1016/j.schres.2017.09.007CrossRefGoogle Scholar
Jones, A. A., Gicas, K. M., Seyedin, S., Willi, T. S., Leonova, O., Vila-Rodriguez, F., … Honer, W. G. (2020). Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in vancouver, Canada. PLOS Medicine, 17(7), e1003172.CrossRefGoogle ScholarPubMed
Jones, A. A., Vila-Rodriguez, F., Leonova, O., Langheimer, V., Lang, D. J., Barr, A. M., … Honer, W. G. (2015). Mortality from treatable illnesses in marginally housed adults: A prospective cohort study. BMJ Open, 5(8), e008876. https://doi.org/10.1136/bmjopen-2015-008876CrossRefGoogle ScholarPubMed
Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160(1), 13–23. https://doi.org/10.1176/appi.ajp.160.1.13CrossRefGoogle Scholar
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261CrossRefGoogle Scholar
Kendler, K. (2017). The clinical features of paranoia in the 20th century and their representation in diagnostic criteria from DSM-III through DSM-5. Schizophrenia Bulletin, 43(2), 332–343. https://doi.org/10.1093/schbul/sbw161Google ScholarPubMed
Kendler, K., Zachar, P., & Craver, C. (2011). What kinds of things are psychiatric disorders? Psychological Medicine, 41, 1143–1150. https://doi.org/10.1017/S0033291710001844CrossRefGoogle ScholarPubMed
Klippel, A., Viechtbauer, W., Reininghaus, U., Wigman, J., Van Borkulo, C., Myin-germeys, I., & Wichers, M. (2018). The cascade of stress: A network approach to explore differential dynamics in populations varying in risk for psychosis. Schizophrenia Bulletin, 44(2), 328–337. https://doi.org/10.1093/schbul/sbx037CrossRefGoogle ScholarPubMed
Knerich, V., Jones, A. A., Seyedin, S., Siu, C., Dinh, L., Mostafavi, S., … Rutherford, A. R. (2019). Social and structural factors associated with substance use within the support network of adults living in precarious housing in a socially marginalized neighborhood of vancouver. PLOS ONE, 14(9), e0222611. https://doi.org/10.1371/journal.pone.0222611CrossRefGoogle Scholar
Koval, P., Kuppens, P., Allen, N. B., & Sheeber, L. (2012). Getting stuck in depression: The roles of rumination and emotional inertia. Cognition and Emotion, 26(8), 1412–1427. https://doi.org/10.1080/02699931.2012.667392CrossRefGoogle ScholarPubMed
Langdon, R., Ward, P. B., & Coltheart, M. (2010). Reasoning anomalies associated with delusions in schizophrenia. Schizophrenia Bulletin, 36(2), 321–330. https://doi.org/10.1093/schbul/sbn069CrossRefGoogle Scholar
Levine, S. Z., & Leucht, S. (2016). Identifying a system of predominant negative symptoms: Network analysis of three randomized clinical trials. Schizophrenia Research, 178(1–3), 17–22. https://doi.org/10.1016/j.schres.2016.09.002CrossRefGoogle ScholarPubMed
Lieberman, J. A., & First, M. B. (2018). Psychotic disorders. New England Journal of Medicine, 379(3), 270–280. https://doi.org/10.1056/NEJMra1801490CrossRefGoogle ScholarPubMed
Marneros, A., Pillmann, F., Haring, A., Balzuweit, S., & Blöink, R. (2005). Is the psychopathology of acute and transient psychotic disorder different from schizophrenic and schizoaffective disorders? European Psychiatry, 20(4), 315–320. https://doi.org/10.1016/j.eurpsy.2005.02.001CrossRefGoogle ScholarPubMed
McKetin, R., Baker, A. L., Dawe, S., Voce, A., & Lubman, D. I. (2017). Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders. Psychiatry Research, 251, 349–354. https://doi.org/10.1016/j.psychres.2017.02.028CrossRefGoogle ScholarPubMed
McKetin, R., Gardner, J., Baker, A. L., Dawe, S., Ali, R., Voce, A., … Lubman, D. I. (2016). Correlates of transient versus persistent psychotic symptoms among dependent methamphetamine users. Psychiatry Research, 238, 166–171. https://doi.org/10.1016/j.psychres.2016.02.038CrossRefGoogle ScholarPubMed
McKetin, R., Lubman, D. I., Baker, A. L., Dawe, S., & Ali, R. L. (2013). Dose-related psychotic symptoms in chronic methamphetamine users. JAMA Psychiatry, 70(3), 319. https://doi.org/10.1001/jamapsychiatry.2013.283CrossRefGoogle ScholarPubMed
Mueser, K. T., Rosenberg, S. D., Fox, L., Salyers, M. P., Ford, J. D., & Carty, P. (2001). Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychological Assessment, 13(1), 110–117. https://doi.org/10.1037/1040-3590.13.1.110CrossRefGoogle ScholarPubMed
Murphy, J., McBride, O., Fried, E., & Shevlin, M. (2018). Distress, impairment and the extended psychosis phenotype: A network analysis of psychotic experiences in an US general population sample. Schizophrenia Bulletin, 44(4), 768–777. https://doi.org/10.1093/schbul/sbx134CrossRefGoogle Scholar
Nelson, B., McGorry, P. D., Wichers, M., Wigman, J. T. W., & Hartmann, J. A. (2017). Moving from static to dynamic models of the onset of mental disorder. JAMA Psychiatry, 74(5), 528–534. https://doi.org/10.1001/jamapsychiatry.2017.0001CrossRefGoogle ScholarPubMed
Olfson, M., Lewis-Fernández, R., Weissman, M. M., Feder, A., Gameroff, M. J., Pilowsky, D., & Fuentes, M. (2002). Psychotic symptoms in an urban general medicine practice. The American Journal of Psychiatry, 159(8), 1412–1419. https://doi.org/10.1176/appi.ajp.159.8.1412CrossRefGoogle Scholar
Opsahl, T., Agneessens, F., & Skvoretz, J. (2010). Node centrality in weighted networks: Generalizing degree and shortest paths. Social Networks, 32(3), 245–251. https://doi.org/10.1016/j.socnet.2010.03.006CrossRefGoogle Scholar
Procyshyn, R. M., Bezchlibnyk-Butler, K., & Jeffries, J. (2019). Clinical handbook of psychotropic drugs (23rd ed.). Boston, MA: Hogrefe Publishing.CrossRefGoogle Scholar
Quan, H., Li, B., Couris, C. M., Fushimi, K., Graham, P., Hider, P., … Sundararajan, V. (2011). Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology, 173(6), 676–682. https://doi.org/10.1093/aje/kwq433CrossRefGoogle ScholarPubMed
Santor, D. A., Ascher-Svanum, H., Lindenmayer, J. P., & Obenchain, R. L. (2007). Item response analysis of the positive and negative syndrome scale. BMC Psychiatry, 7, 1–10. https://doi.org/10.1186/1471-244X-7-66CrossRefGoogle ScholarPubMed
Schuurman, N. K., Ferrer, E., de Boer-Sonnenschein, M., & Hamaker, E. L. (2016). How to compare cross-lagged associations in a multilevel autoregressive model. Psychological Methods, 21(2), 206–221. https://doi.org/10.1037/met0000062CrossRefGoogle Scholar
van Borkulo, C., Boschloo, L., Borsboom, D., Penninx, B. W. J. H., Waldorp, L. J., & Schoevers, R. A. (2015). Association of symptom network structure with the course of depression. JAMA Psychiatry, 72(12), 1219–1226. https://doi.org/10.1001/jamapsychiatry.2015.2079CrossRefGoogle Scholar
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45(3), 1–67. https://doi.org/10.18637/jss.v045.i03Google Scholar
van Rooijen, G., Isvoranu, A.-M., Kruijt, O. H., van Borkulo, C. D., Meijer, C. J., Wigman, J. T. W., … Bartels-Velthuis, A. A. (2018). A state-independent network of depressive, negative and positive symptoms in male patients with schizophrenia spectrum disorders. Schizophrenia Research, 193, 232–239. https://doi.org/10.1016/j.schres.2017.07.035CrossRefGoogle ScholarPubMed
Vila-Rodriguez, F., Panenka, W. J., Lang, D. J., Thornton, A. E., Vertinsky, T., Wong, H., … Honer, W. G. (2013). The hotel study: Multimorbidity in a community sample living in marginal housing. American Journal of Psychiatry, 170(12), 1413–1422. https://doi.org/10.1176/appi.ajp.2013.12111439CrossRefGoogle Scholar
Walker, S., Mackay, E., Barnett, P., Sheridan Rains, L., Leverton, M., Dalton-Locke, C., … Johnson, S. (2019). Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: A systematic review, meta-analysis, and narrative synthesis. The Lancet Psychiatry, 6(12), 1039–1053. https://doi.org/10.1016/S2215-0366(19)30406-7CrossRefGoogle ScholarPubMed
Wang, L. P., & Maxwell, S. E. (2015). On disaggregating between-person and within-person effects with longitudinal data using multilevel models. Psychological Methods, 20(1), 63–83. https://doi.org/10.1037/met0000030CrossRefGoogle ScholarPubMed
Wichers, M. (2014). The dynamic nature of depression: A new micro-level perspective of mental disorder that meets current challenges. Psychological Medicine, 44(7), 1349–1360. https://doi.org/10.1017/S0033291713001979CrossRefGoogle ScholarPubMed
Zammit, S., Lewis, G., Dalman, C., & Allebeck, P. (2010). Examining interactions between risk factors for psychosis. British Journal of Psychiatry, 196, 207–211. https://doi.org/10.1192/bjp.bp.109.070904CrossRefGoogle Scholar
Supplementary material: PDF

Jones et al. supplementary material

Jones et al. supplementary material

Download Jones et al. supplementary material(PDF)
PDF 301.7 KB