Evidence that the impact of hearing impairment on psychosis risk is moderated by the level of complexity of the social environment

van der Werf, Margriet; van Winkel, Ruud; van Boxtel, Martin; van Os, Jim

doi:10.1016/j.schres.2010.05.020

« Previous Next »Schizophrenia Research
Volume 122, Issue 1 , Pages 193-198, September 2010

Evidence that the impact of hearing impairment on psychosis risk is moderated by the level of complexity of the social environment

Margriet van der Werf
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, PO BOX 616 (VIJV), 6200MD Maastricht, The Netherlands
- Corresponding author. Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 616 (VIJV), 6200 MD Maastricht, The Netherlands. Tel.: +31 43 3688659; fax: +31 43 3884092.
Ruud van Winkel
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, PO BOX 616 (VIJV), 6200MD Maastricht, The Netherlands
- University Psychiatric Centre Catholic University Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium
Martin van Boxtel
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, PO BOX 616 (VIJV), 6200MD Maastricht, The Netherlands
Jim van Os
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, PO BOX 616 (VIJV), 6200MD Maastricht, The Netherlands
- Psychiatric Epidemiology King's College London, King's Health Partners Department of Psychosis Studies Institute of Psychiatry, London, UK

Received 26 January 2010; received in revised form 14 May 2010; accepted 15 May 2010. published online 07 June 2010.

Abstract

Background

It has been suggested that part of the increased vulnerability for psychosis in individuals with hearing impairment (HI) is the consequence of a decreased ability to form correct representations of the social world and attributions of intention of others. It was therefore hypothesized that associations between HI and psychosis risk would be sensitive to contextual variables representing higher level of social complexity, conceptualized as the population density of the social environment (‘urbanicity’).

Methods

Urbanicity and objective HI were assessed in the Maastricht Aging Study (MAAS), a longitudinal study of 1,823 participants from the general population in Maastricht, the Netherlands. Participants were tested at baseline (T0) and at 6-year (T2) and 12-year follow-up (T4). The degree to which the association between HI (T0-T2) and psychotic experiences at T4 was moderated by T0 urbanicity was examined.

Results

The association between HI and psychosis was conditional on level of urbanicity (interaction χ2=7.51, p=.006), with low effect size in non-urbanized areas (b=-0.81, 95% CI:-2.98, 1.36) and high effect size in the most urbanized areas (b=2.56, 95% CI: 0.47, 4.65). Although social isolation (b=1.74, p=.022) and loneliness (b=0.61, p<.001) were both associated with psychosis, they could not explain the observed interaction.

Conclusion

The findings suggest that level of complexity of the social world, in interaction with the individual's ability to correctly process this information, may impact on risk for psychotic experiences.

Keywords: Social environment, Urbanicity, Schizophrenia, Deafness