Table 1.
Effect of stressful life events after onset of psychosis on hazard of subsequent relapse as indexed by hospital admission
|
Any stressful life events: hazard of relapse (n=253) |
Any stressful life events: hazard of relapse (with medication adherence; n=240) |
Number of stressful life events: hazard of relapse (n=253) |
Number of stressful life events: hazard of relapse (with medication adherence; n=240) |
||||||
|---|---|---|---|---|---|---|---|---|---|
| HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | ||
| Any stressful life events before first relapse | |||||||||
| No | 1 (ref) | .. | 1 (ref) | .. | .. | .. | .. | .. | |
| Yes | 2·60 (1·63–4·16) | <0·0001 | 2·60 (1·56–4·34) | 0·0003 | .. | .. | .. | .. | |
| Number of stressful life events before first relapse | .. | .. | .. | .. | 1·36 (1·09–1·69) | 0·0054 | 1·33 (1·06–1·68) | 0·015 | |
| Age of onset, years* | |||||||||
| <22 | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| 22 to <25 | 0·98 (0·72–1·35) | 0·91 | 1·0 (0·71–1·39) | 0·97 | 0·99 (0·72–1·36) | 0·96 | 1·02 (0·73–1·42) | 0·92 | |
| 25 to <30 | 0·64 (0·01–67·1) | 0·85 | 0·48 (0·00–64·9) | 0·77 | 0·66 (0·01–67·9) | 0·86 | 0·41 (0·00–53·4) | 0·72 | |
| 30 to <39 | 4·96 (0·00–865 241) | 0·79 | 9·43 (0·00–3 036 885) | 0·73 | 4·25 (0·00–677 502) | 0·81 | 12·6 (0·00–3 541 877) | 0·69 | |
| ≥39 | 0·19 (0·00–2961) | 0·74 | 0·13 (0·00–3175) | 0·70 | 0·23 (0·00–3129) | 0·76 | 0·12 (0·00–2402) | 0·67 | |
| Sex | |||||||||
| Female | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Male | 0·75 (0·47–1·21) | 0·24 | 0·59 (0·36–0·98) | 0·043 | 0·72 (0·45–1·16) | 0·18 | 0·56 (0·34–0·92) | 0·023 | |
| Ethnicity | |||||||||
| White | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Asian | 1·99 (0·73–5·44) | 0·18 | 1·47 (0·50–4·36) | 0·48 | 1·98 (0·73–5·39) | 0·18 | 1·41 (0·48–4·19) | 0·53 | |
| Black African or Caribbean | 2·30 (1·27–4·15) | 0·006 | 2·11 (1·15–3·90) | 0·016 | 2·23 (1·24–4·01) | 0·0076 | 2·04 (1·11–3·74) | 0·022 | |
| Mixed | 2·09 (0·77–5·72) | 0·15 | 2·17 (0·79–6·00) | 0·13 | 1·99 (0·74–5·39) | 0·17 | 1·91 (0·70–5·25) | 0·21 | |
| Other drug use | |||||||||
| Non-use | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Experimental | 0·52 (0·19–1·44) | 0·21 | 0·38 (0·12–1·19) | 0·10 | 0·60 (0·22–1·63) | 0·32 | 0·41 (0·14–1·27) | 0·12 | |
| Regular | 2·00 (0·98–4·10) | 0·058 | 1·76 (0·84–3·70) | 0·13 | 1·87 (0·92–3·78) | 0·083 | 1·69 (0·81–3·52) | 0·16 | |
| Nicotine use | |||||||||
| Non-use | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Intermittent | 2·31 (0·97–5·51) | 0·060 | 2·89 (1·19–7·02) | 0·019 | 2·33 (0·99–5·53) | 0·054 | 2·87 (1·19–6·89) | 0·019 | |
| Continued | 1·70 (0·93–3·10) | 0·082 | 1·95 (1·03–3·68) | 0·039 | 1·75 (0·96–3·16) | 0·066 | 1·99 (1·07–3·71) | 0·030 | |
| Alcohol use | |||||||||
| No use | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Continued | 1·28 (0·67–2·43) | 0·46 | 1·70 (0·85–3·41) | 0·13 | 1·28 (0·68–2·41) | 0·45 | 1·63 (0·82–3·22) | 0·16 | |
| Care intensity at onset | |||||||||
| Community mental health team | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Crisis team | 0·94 (0·26–3·43) | 0·93 | 0·80 (0·21–3·11) | 0·75 | 0·98 (0·27–3·56) | 0·97 | 0·77 (0·20–2·99) | 0·71 | |
| Non-compulsory admission | 2·40 (1·06–5·39) | 0·035 | 2·24 (0·98–5·14) | 0·056 | 2·59 (1·14–5·87) | 0·023 | 2·43 (1·05–5·59) | 0·037 | |
| Compulsory admission | 2·17 (0·99–4·72) | 0·052 | 2·08 (0·94–4·62) | 0·072 | 2·44 (1·12–5·34) | 0·026 | 2·32 (1·04–5·16) | 0·039 | |
| Relationship status | |||||||||
| In relationship | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Not in relationship | 1·49 (0·89–2·50) | 0·13 | 1·78 (1·01–3·14) | 0·045 | 1·53 (0·91–2·58) | 0·11 | 1·89 (1·07–3·34) | 0·028 | |
| Psychosis diagnosis | |||||||||
| Non-affective | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | 1 (ref) | .. | |
| Affective | 0·73 (0·39–1·37) | 0·33 | 0·90 (0·46–1·74) | 0·75 | 0·78 (0·42–1·46) | 0·44 | 0·98 (0·51–1·88) | 0·94 | |
| Medication adherence | |||||||||
| Regular compliance | .. | .. | 1 (ref) | .. | .. | .. | 1 (ref) | .. | |
| Irregular compliance | .. | .. | 1·82 (1·05–3·16) | 0·032 | .. | .. | 1·93 (1·11–3·35) | 0·019 | |
| Poor compliance | .. | .. | 4·53 (2·24–9·15) | <0·0001 | .. | .. | 4·40 (2·18–8·87) | <0·0001 | |
HRs included adjustment for sociodemographic factors (sex, ethnicity, and relationship status) and clinical factors (psychosis diagnosis, intensity of care at onset, and alcohol, nicotine, and other drug use; with analysis stratified by cannabis use). Where indicated, the model also adjusted for medication adherence. HR=hazard ratio.
*
Age of onset was modelled as a restricted cubic spline function with knots placed at ages of onset of 22 years, 25 years, 30 years, and 39 years.