General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Linda T. Betz; Nora Penzel; Lana Kambeitz-Ilankovic; Marlene Rosen; Katharine Chisholm; Alexandra Stainton; Theresa K. Haidl; Julian Wenzel; Alessandro Bertolino; Stefan Borgwardt; Paolo Brambilla; Rebekka Lencer; Eva Meisenzahl; Stephan Ruhrmann; Raimo K. R. Salokangas; Frauke Schultze-Lutter; Stephen J. Wood; Rachel Upthegrove; Nikolaos Koutsouleris; Joseph Kambeitz

doi:10.1038/s41537-020-00129-w

General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Linda T. Betz^*
, Nora Penzel
, Lana Kambeitz-Ilankovic
, Marlene Rosen
, Katharine Chisholm
, Alexandra Stainton
, Theresa K. Haidl
, Julian Wenzel
, Alessandro Bertolino
, Stefan Borgwardt
, Paolo Brambilla
, Rebekka Lencer
, Eva Meisenzahl
, Stephan Ruhrmann
, Raimo K. R. Salokangas
, Frauke Schultze-Lutter
, Stephen J. Wood
, Rachel Upthegrove
, Nikolaos Koutsouleris
, Joseph Kambeitz

^*Corresponding author for this work

grid.6190.e 0000 0000 8580 3777 Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne University of Cologne Cologne Germany
grid.6190.e 0000 0000 8580 3777 Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne University of Cologne Cologne Germany; grid.5252.0 0000 0004 1936 973X Department of Psychiatry and Psychotherapy Ludwig-Maximilian-University Munich Germany
grid.6572.6 0000 0004 1936 7486 Institute for Mental Health University of Birmingham Birmingham UK; grid.488501.0 Orygen Melbourne VIC Australia; grid.1008.9 0000 0001 2179 088X Centre for Youth Mental Health University of Melbourne Melbourne VIC Australia
grid.7644.1 0000 0001 0120 3326 Department of Neurological and Psychiatric Sciences University of Bari Bari Italy
grid.6612.3 0000 0004 1937 0642 Department of Psychiatry (UPK) University of Basel Basel Switzerland; grid.4562.5 0000 0001 0057 2672 Department of Psychiatry and Psychotherapy University of Lübeck Lübeck Germany
grid.4708.b 0000 0004 1757 2822 Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico University of Milan Milan Italy
grid.4562.5 0000 0001 0057 2672 Department of Psychiatry and Psychotherapy University of Lübeck Lübeck Germany; grid.5949.1 0000 0001 2172 9288 Department of Psychiatry University of Münster Münster Germany; grid.5949.1 0000 0001 2172 9288 Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience University of Münster Münster Germany
grid.411327.2 0000 0001 2176 9917 Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University Düsseldorf Germany
grid.1374.1 0000 0001 2097 1371 Department of Psychiatry University of Turku Turku Finland
grid.411327.2 0000 0001 2176 9917 Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University Düsseldorf Germany; grid.440745.6 0000 0001 0152 762X Department of Psychology and Mental Health, Faculty of Psychology Airlangga University Surabaya Indonesia
grid.6572.6 0000 0004 1936 7486 Institute for Mental Health University of Birmingham Birmingham UK
grid.5252.0 0000 0004 1936 973X Department of Psychiatry and Psychotherapy Ludwig-Maximilian-University Munich Germany; grid.419548.5 0000 0000 9497 5095 Max-Planck Institute of Psychiatry Munich Germany; grid.13097.3c 0000 0001 2322 6764 Institute of Psychiatry Psychology and Neuroscience, King’s College London London UK

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Abstract

Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.

Original language	English
Article number	40
Journal	npj Schizophrenia
Volume	6
Issue number	1
DOIs	https://doi.org/10.1038/s41537-020-00129-w
Publication status	Published - 15 Dec 2020

Bibliographical note

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Final published version, 2.12 MBLicence: CC BY 3.0
General psychopathology links burden of recent life events
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Final published version, 1.26 MBLicence: CC BY 3.0

Cite this

Betz, L. T., Penzel, N., Kambeitz-Ilankovic, L., Rosen, M., Chisholm, K., Stainton, A., Haidl, T. K., Wenzel, J., Bertolino, A., Borgwardt, S., Brambilla, P., Lencer, R., Meisenzahl, E., Ruhrmann, S., Salokangas, R. K. R., Schultze-Lutter, F., Wood, S. J., Upthegrove, R., Koutsouleris, N., & Kambeitz, J. (2020). General psychopathology links burden of recent life events and psychotic symptoms in a network approach. npj Schizophrenia, 6(1), Article 40. https://doi.org/10.1038/s41537-020-00129-w

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abstract = "Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.",

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note = "This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.",

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Betz, LT, Penzel, N, Kambeitz-Ilankovic, L, Rosen, M, Chisholm, K, Stainton, A, Haidl, TK, Wenzel, J, Bertolino, A, Borgwardt, S, Brambilla, P, Lencer, R, Meisenzahl, E, Ruhrmann, S, Salokangas, RKR, Schultze-Lutter, F, Wood, SJ, Upthegrove, R, Koutsouleris, N & Kambeitz, J 2020, 'General psychopathology links burden of recent life events and psychotic symptoms in a network approach', npj Schizophrenia, vol. 6, no. 1, 40. https://doi.org/10.1038/s41537-020-00129-w

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AU - Betz, Linda T.

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AU - Kambeitz-Ilankovic, Lana

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AU - Chisholm, Katharine

AU - Stainton, Alexandra

AU - Haidl, Theresa K.

AU - Wenzel, Julian

AU - Bertolino, Alessandro

AU - Borgwardt, Stefan

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AU - Lencer, Rebekka

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AU - Schultze-Lutter, Frauke

AU - Wood, Stephen J.

AU - Upthegrove, Rachel

AU - Koutsouleris, Nikolaos

AU - Kambeitz, Joseph

N1 - This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

PY - 2020/12/15

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N2 - Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions.

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General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Abstract

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