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The association of social inequality with the onset, persistence, and progression of psychotic experiences along the extended psychosis phenotype: a 6-year follow-up study in a community-based sample

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Abstract

Purpose

This paper aims to investigate associations between early childhood and current indicators of socioeconomic inequality and the onset (incident), persistence and progression (increase in severity) of psychotic experiences (PEs) in a longitudinal follow-up of a community-based population.

Methods

Households in the metropolitan area of Izmir, Turkey were contacted in a multistage clustered probability sampling frame, at baseline (T1, n = 4011) and at 6-year follow-up (T2, n = 2185). Both at baseline and follow-up, PEs were assessed using Composite International Diagnostic Interview 2.1. The associations between baseline socioeconomic features and follow-up PEs were analysed using logistic regression models. Indicators of social inequality included income, educational level, current socioeconomic status (SES), social insurance, the area resided, ethnicity, parental educational level, and SES at birth.

Results

The risk of onset of PEs was significantly higher in lower education, lower SES, and slum-semi-urban areas. The persistence of PEs was significantly associated with the lowest levels of education and current SES, and rural residency. Persistent PEs were significantly and negatively associated with paternal SES at birth. Progression of PEs was significantly higher among respondents with educational achievements lower than university level and lower levels of SES, who have no social insurance and who reside in slum-semi-urban areas. Parental education and paternal SES at birth were not associated with the persistence of PEs.

Conclusion

Indicators of social inequality (low education, low SES, low income, and poverty in the neighbourhood) were associated with the onset and persistence of PEs and progression along the extended psychosis phenotype. The early indicators seem to have a modest life-long impact on the psychosis phenotype.

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Data availability

The data that support the findings of this study are available from the corresponding author, [T.B.], upon reasonable request.

Abbreviations

PE:

Psychotic experiences

CIDI:

Composite International Diagnostic Interview

SES:

Socioeconomic status

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Acknowledgements

The authors wish to acknowledge past and current members of the TürkSch project team, lay interviewers for data collection, and all the TürkSch participants who kindly participated in the study both in T1 (2008) and T2 (2014).

Funding

This work is a part of the TürkSch project, funded by the Scientific and Technological Council of Turkey (TÜBİTAK) 1001 program, under Project No: 107S053 and 112S476.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, 35340, Izmir, Turkey

    Tolga Binbay & Köksal Alptekin

  2. Çınarcık State Hospital, Yalova, Turkey

    Batuhan Erel

  3. Otto-von-Guericke-Universität Magdeburg|Clinic for Psychiatry and Psychotherapy, Magdeburg, Germany

    Rana Tibet Set

  4. Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Ege University, Izmir, Turkey

    Umut Kırlı

  5. Department of Psychiatry, Faculty of Medicine, Üsküdar University, Istanbul, Turkey

    Ceylan Ergül

  6. Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey

    Hayriye Elbi

  7. Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey

    Köksal Alptekin

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  1. Tolga Binbay
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  2. Batuhan Erel
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Contributions

Hayriye Elbi, Köksal Alptekin, Tolga Binbay and Umut Kırlı were responsible for the study conception and design. Tolga Binbay and Umut Kırlı were responsible for collection, extraction and coding of data included in the study. Umut Kırlı, Batuhan Erel, Rana Tibet Set and Tolga Binbay provided the analysis and interpretation. Tolga Binbay, Batuhan Erel, Rana Tibet Set, Umut Kırlı, Ceylan Ergül drafted the manuscript, and all other authors provided critical comments. All authors provided intellectual contribution and approved the final manuscript.

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Correspondence to Tolga Binbay.

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Binbay, T., Erel, B., Set, R.T. et al. The association of social inequality with the onset, persistence, and progression of psychotic experiences along the extended psychosis phenotype: a 6-year follow-up study in a community-based sample. Soc Psychiatry Psychiatr Epidemiol 59, 51–64 (2024). https://doi.org/10.1007/s00127-023-02422-2

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