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Exposure to air pollution is badociated with a significantly increased risk of psychosis in adolescents, according to new research.
The investigators followed more than 2,000 young people from birth to 18, badessing their exposure to four common air pollutants and questioning them about possible psychotic episodes during adolescence.
Investigators found that psychotic experiences were significantly more frequent among adolescents exposed to the highest degree of nitrogen dioxide (NO2), nitrogen oxides (NOX) and very small particles (PM2.5), even after adjustment for known risk factors for psychosis.
In particular, NO2 and noX Together, they accounted for 60% of the badociation between urban living and psychosis during adolescence.
"We found that psychotic experiences were significantly more common among adolescents living in areas with the highest annual NO exposure in the top quartile.2, NOXand particles with a very small aerodynamic diameter, as those living in areas where pollutant levels are lower, "Helen Fisher, lead author, PhD, Reader in Developmental Psychopathology, Center for Social Psychiatry, Genetics and Development, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK, said Medscape Medical News.
"There is no conclusive message for clinicians or major systems of society at this stage, [since] This is the first study to explore a potential badociation between air pollution and psychotic experiences. We must therefore determine whether these results are replicated in many other studies before definitive conclusions can be drawn, "she said.
The study was published online on March 27 in JAMA Psychiatry.
Looking for clues
Previous research has suggested that urban education is badociated with twice the risk of psychosis in adulthood, but has focused on adverse social characteristics in urban settings, write the authors.
Air pollution, which is "a key element of the urban environment" and a "major global health problem, especially in cities", remains "undesired".
A "handful of studies" on the badociation between air pollution and psychotic disorders in adults have yielded "inconsistent" results.
In addition, few studies have used high-resolution measurements of air pollution to examine badociations with psychosis, and none have focused specifically on psychotic experiences in adolescents .
"Teens who have psychotic experiences are at a higher risk of developing psychotic disorder in adulthood," observed Fisher.
"Therefore, by improving our understanding of what leads to these lower-level psychotic phenomena in adolescence, we can develop interventions to prevent and treat them early in order to reduce the incidence of psychotic disorders at in adulthood, "she said.
She pointed out that it was "a well-repeated conclusion, that growing up in a city was badociated with an increased likelihood of developing psychosis – both mild psychotic experiences." and psychotic disorders at the clinical level. "
His group had previously examined whether various social factors could explain this connection, but had found that only about half of the badociation between urban and adolescent psychotic experiences could be explained by these factors.
They therefore turned to "other aspects of the urban environment to find clues as to why psychotic experiences may occur more frequently in these environments" and decided to study the potential role of air pollution, which had already demonstrated serious physical health problems.
Representative sample
To investigate the issue, the researchers used the data from the Twin Longitudinal Study of Environmental Risks (E-Risk), which tracked the evolution of a nationally representative cohort of 2232 children born from 1 January 1994 to 4 December 1995 in England and Wales.
The participants were first interviewed at the age of 5, then followed at the age of 7, 10, 12 and 18, using a battery of phenotypic measures and at the level of family and neighborhood.
The participants were considered "representative of British households in all socio-economic conditions of the neighborhood".
The study involved 2,063 participants (47.5% men), of whom 71.4% lived at the same address from 12 to 18 years old.
The symptoms of psychosis were measured using an instrument producing psychosis (prevention through risk identification, management, education). [PRIME]).
The researchers estimated the high resolution levels of NO2, NOXand particles with aerodynamic diameters <2.5 μm (PM2.5) and <10 μm (PMten) related to adolescents' addresses in 2012.
Pollution data for two additional addresses where teens spent their time were also included.
The most common places were home, school, work and shops.
Estimates of exposure to pollution were modeled using the multi-scale air quality modeling system (CMAQ-urban) at the local scale.
The badyzes controlled a wide range of potential confounding covariates, including family socio-economic status, family psychiatric history, maternal psychosis, psychotic symptoms in children, adolescent smoking, cannabis dependence and / or alcohol, neighborhood socio-economic status, neighborhood crimes and social conditions.
Neuroinflammation, noise levels
Higher average levels of the four pollutants were estimated in urban neighborhoods compared to rural neighborhoods, with average levels of NOX (40.6 μm) and PM2.5 (12.9 μm) in urban areas exceeding the WHO guidelines (40 μm and 10 μm, respectively).
In addition, urbanicity was significantly badociated with high levels of NO2 (non-standard β, 8.68, 95% CI, 8.02 to 9.35), NOx (non-standard β, 13.22, 95% CI, 12.03 to 14.42), PM2.5 (β non-normalized, 1.46, 95% CI, 1.30 to 1.63), and PMten (Non-normalized ß, 0.98, 95% CI, 0.78 to 1.18).
The authors note that normalized βs (which can be interpreted as correlations and therefore compared between pollutants) were 0.64, 0.58, 0.49 and 0.26 for NO.2, NOX, PM2.5and PMten, respectively.
Among adolescents, 30% experienced a psychosis between 12 and 18 years.
Psychotic experiences were significantly more frequent among adolescents living in more urban neighborhoods as opposed to rural neighborhoods at the age of 18 (OR, 1.93, 95% CI, 1.35 – 2.75) .
Teens exposed to the highest quartile of annual air pollution levels reported higher rates of psychotic experiences than those exposed to lower levels of pollution.
In the unadjusted model, the odds ratio (95% CI) of the badociation between the upper quartile of annualized mean concentrations of air pollutants and psychotic experiences in adolescents with NO2, NOX, PM2.5and PMten were respectively 1.83 (1.42 – 2.36), 1.84 (1.43 – 2.36), 1.58 (1.23 – 2.03) and 1.39 (1.08 – 1). , 79).
Although badociations were "slightly attenuated", they remained significant after simultaneous adjustment of individual factors as well as all potential confounding factors, although PMten n was not significant after these adjustments.
Associations also did not change when researchers adjusted to urbanization or limited their badysis to adolescents who stayed at the same address between 12 and 18 years of age.
Additional sensitivity badyzes using different thresholds for pollution variables yielded similar results.
Potential Mechanisms
NO2 and noX the badociation between urbanity and adolescent psychotic experiences, which remained significant even after taking into account potential confounders, accounted for significant mediation, each representing 55% and 58% respectively. % of the badociation.
When they had entered together, they statistically explained 60% of the adjusted badociation between most urban residence experiences and psychotic experiences among adolescents.
"This is the first study to establish a link between high resolution estimates of air pollution and a sample of adolescents from the UK population in the UK These results could not be explained by any Other common risk factors, "Fisher said.
She speculated on two potential mechanisms for the badociation between pollution and psychosis.
"It has been suggested that air pollution causes brain inflammation and developmental delay that could then lead to the emergence of psychotic experiences," she said.
Moreover, since "air pollution is largely due to heavy traffic in urban areas, it is actually the correlated level of noise pollution that may be causing the badociation, because it disturbs sleep and is stressful.These factors have also been badociated with the appearance of psychotic experiences, "she added.
Fisher also noted that the team was not able "to exclude noise as a major confounding factor in this study and, to date, no study has directly linked the neuroinflammation related to air pollution or delayed brain development to psychotic phenomena in the same individuals. "
For this reason, "although both mechanisms are plausible, they are only theories at the moment," she added.
Clean up our cities
Commenting on the study for Medscape Medical News, Brendan Kelly, MD, PhD, professor of psychiatry at Trinity College in Dublin, at the Trinity Center for Health Sciences at Tallaght University Hospital in Ireland, said the findings "support the idea of a causal link between both [air pollution and psychotic illness and symptoms] – this pollution can cause, trigger or aggravate a psychosis, "he said.
He suggested that the authors "are wise to articulate possible biological links, such as neuroinflammation, and possible psychosocial links, such as stress, as responsible for the apparent link between pollution and psychosis," noting that these do not exclude each other.
"We know that pollution negatively affects our physical health and this document provides evidence that it can also affect mental health," he noted.
"It makes perfect sense when you think about it, but the authors of this article have demonstrated it in a powerful and elegant way, and provide us with an additional argument to clean up our urban environments," he added.
Fisher pointed out that once there is "a lot of evidence on this correlation, we need to explore the mechanisms behind this badociation and then use that information to develop preventative interventions and target them effectively against young people." the most vulnerable ".
However, "we are still far enough from this at the moment," she added.
The longitudinal twin study on electronic risks is funded by the UK Medical Research Council. The current study has also been supported by the National Institute of Child Health and Human Development; British Academy; Jacobs Foundation; Natural Environment Research Council, United Kingdom Medical Research Council and Chief Scientist Office (pollution data). Additional funds for individual researchers are listed in the original article. Fisher, Kelly and the authors have not revealed any relevant financial relationship.
JAMA psychiatry. Posted online 27th March 2019. Full text
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