Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review
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ABSTRACT:
SUBMITTER: Varchmin L
PROVIDER: S-EPMC8569921 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSocial adversity is a risk factor for psychosis, but the translating mechanisms are not well understood. This study tests whether the relationship between social adversity and psychosis is mediated by cognitive vulnerability in the form of low perceived social rank, negative schemas related to self and other, and loneliness and whether the putative mediations are specific to psychosis or are largely explained by depression.MethodsThe study was a survey in a community sample (N = 2350) from Germany (n = 786), Indonesia (n = 844), and the United States (n = 720). Mediation path analysis with structural equation modeling was used to test for the specificity of the hypothesized paths to psychosis controlling for depression.ResultsSocial adversity had a significant medium to large effect on positive (R2 = .20) and negative symptoms (R2 = .38). Social rank, negative schemas, and loneliness significantly mediated the relationship between social adversity and negative symptoms and the models explained a large amount of the variance (R2 = .43-.44). For positive symptoms, only negative schemas were a significant mediator (R2 = .27).DiscussionThe results emphasize the role of social adversity in psychosis and support the assumption that cognitive vulnerability is a relevant translating mechanism as postulated by the social defeat hypothesis and cognitive models of psychosis. This underlines the relevance of the clinical practice of targeting beliefs in cognitive interventions for psychosis. It also indicates that targeting cognitive vulnerability in people experiencing social adversity could be a promising approach to prevention.
| S-EPMC5463978 | biostudies-literature
Project description:Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned. Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis. Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk. Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs. Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.
| S-EPMC6917652 | biostudies-literature
Project description:PurposeThis umbrella systematic review (SR) of SRs and meta-analysis seeks to comprehensively synthesize existing literature to identify and consolidate the diverse range of risk factors contributing to running-related injuries (RRIs).MethodsSystematic searches were conducted on June 28, 2023, across Web of Science, SPORTDiscus, Scopus, PubMed, and Cochrane Library. We included SRs, whether accompanied by meta-analyses or not, that focused on investigating risk factors for RRIs within observational studies. The methodological quality of the SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews II. To assess the extent of overlap across reviews, the corrected covered area metric was calculated.ResultsFrom 1509 records retrieved, 13 SRs were included. The degree of overlap between SRs was low (4%), and quality varied from critically low (n = 8) to low (n = 5). Two hundred seven outcomes assessed in 148 primary studies were identified as being associated with the occurrence of RRIs. The effect sizes of the associations for which risk measures were reported (n = 131) were classified as large (n = 30, 23%), medium (n = 38, 29%), small (n = 48, 37%) or no effect (n = 15, 11%). Running/training characteristics, health and lifestyle factors, along with morphological and biomechanical aspects, exhibit large effect sizes in increasing the risk for RRIs.ConclusionDrawing from the outcomes of the low-quality SRs and associations with large effect sizes, our findings indicate that running/training characteristics and health and lifestyle factors, as well as morphological and biomechanical aspects, are all implicated in elevating the risk of RRIs, emphasizing the multifactorial basis of injury incidence in running. Given the low quality and heterogeneity of SR, individual findings warrant cautious interpretation.
| S-EPMC11336318 | biostudies-literature
Project description:BACKGROUND/OBJECTIVE:Gestational diabetes mellitus (GDM) is a common pregnancy complication, with complex disease mechanisms, and several risk factors may contribute to its onset. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risk factors associated with GDM, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by convincing evidence. METHODS:We searched PubMed and ISI Web of Science from inception to December 2018 to identify meta-analyses examining associations between putative risk factors for GDM. For each meta-analysis we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. RESULTS:Thirty eligible meta-analyses were identified, providing data on 61 associations. Fifty (82%) associations had nominally statistically significant findings (P<0.05), while only 15 (25%) were significant at P<10-6 under the random-effects model. Only four risk factors presented convincing evidence:, low vs. normal BMI (cohort studies), BMI ~30-35 kg/m2 vs. normal BMI, BMI >35 kg/m2 vs. normal BMI, and hypothyroidism. CONCLUSIONS:The compilation of results from synthesis of observational studies suggests that increased BMI and hypothyroidism show the strongest consistent evidence for an association with GDM. Diet and lifestyle modifications in pregnancy should be tested in large randomized trials. Our findings suggest that women with known thyroid disease may be offered screening for GDM earlier in pregnancy.
| S-EPMC6474596 | biostudies-other
Project description:BackgroundInterpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.AimsWe aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence.MethodWe conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised.ResultsWe identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0-21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5-17.4%). There was evidence of small study effects and large heterogeneity.ConclusionsNational strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.Declarations of interestJ.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
| S-EPMC6157722 | biostudies-literature
Project description:Leukemia is the most common type of cancer among children and adolescents worldwide. The aim of this umbrella review was (1) to provide a synthesis of the environmental risk factors for the onset of childhood acute lymphoblastic leukemia (ALL) by exposure window, (2) evaluate their strength of evidence and magnitude of risk, and as an example (3) estimate the prevalence in the German population, which determines the relevance at the population level. Relevant systematic reviews and pooled analyses were identified and retrieved through PubMed, Web of Science databases and lists of references. Only two risk factors (low doses of ionizing radiation in early childhood and general pesticide exposure during maternal preconception/pregnancy) were convincingly associated with childhood ALL. Other risk factors including extremely low frequency electromagnetic field (ELF-MF), living in proximity to nuclear facilities, petroleum, benzene, solvent, and domestic paint exposure during early childhood, all showed some level of evidence of association. Maternal consumption of coffee (high consumption/>2 cups/day) and cola (high consumption) during pregnancy, paternal smoking during the pregnancy of the index child, maternal intake of fertility treatment, high birth weight (≥4000 g) and caesarean delivery were also found to have some level of evidence of association. Maternal folic acid and vitamins intake, breastfeeding (≥6 months) and day-care attendance, were inversely associated with childhood ALL with some evidence. The results of this umbrella review should be interpreted with caution; as the evidence stems almost exclusively from case-control studies, where selection and recall bias are potential concerns, and whether the empirically observed association reflect causal relationships remains an open question. Hence, improved exposure assessment methods including accurate and reliable measurement, probing questions and better interview techniques are required to establish causative risk factors of childhood leukemia, which is needed for the ultimate goal of primary prevention.
| S-EPMC8773598 | biostudies-literature
Project description:Simple Summary Ovarian cancer is the most lethal cancer of the female genital tract despite major advances in both surgical and oncological treatments. This is in part due to difficulties in identifying those most at risk of developing ovarian cancer, and that there are currently no effective screening strategies. Whilst 20% of cases have a genetic component, the majority have no obvious cause. Many risk factors have been associated with ovarian cancer, although the strength of this evidence remains unclear. This umbrella review attempts to review the validity of associations between non-genetic risk factors and the risk of developing or dying from ovarian cancer. There were six associations that were supported by strong evidence. Greater height, BMI and use of HRT increased the risk, whilst the use of oral contraceptive pill reduced that risk. This review will enable further research into these areas and may promote identification of individuals at high risk. Abstract Several non-genetic factors have been associated with ovarian cancer incidence or mortality. To evaluate the strength and validity of the evidence we conducted an umbrella review of the literature that included systematic reviews/meta-analyses that evaluated the link between non-genetic risk factors and ovarian cancer incidence and mortality. We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews and performed a manual screening of references. Evidence was graded into strong, highly suggestive, suggestive or weak based on statistical significance of the random effects summary estimate and the largest study in a meta-analysis, the number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, and presence of excess significance bias. We identified 212 meta-analyses, investigating 55 non-genetic risk factors for ovarian cancer. Risk factors were grouped in eight broad categories: anthropometric indices, dietary intake, physical activity, pre-existing medical conditions, past drug history, biochemical markers, past gynaecological history and smoking. Of the 174 meta-analyses of cohort studies assessing 44 factors, six associations were graded with strong evidence. Greater height (RR per 10 cm 1.16, 95% confidence interval (CI) 1.11–1.20), body mass index (BMI) (RR ≥ 30 kg/m2 versus normal 1.27, 95% CI 1.17–1.38) and three exposures of varying preparations and usage related to hormone replacement therapy (HRT) use increased the risk of developing ovarian cancer. Use of oral contraceptive pill reduced the risk (RR 0.74, 95% CI 0.69–0.80). Refining the significance of genuine risk factors for the development of ovarian cancer may potentially increase awareness in women at risk, aid prevention and early detection.
| S-EPMC9179274 | biostudies-literature
Project description:BackgroundAlzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by intricate genetic and environmental etiology. The objective of this study was to identify robust non-genetic risk factors for AD through an updated umbrella review.MethodsWe conducted a comprehensive search of meta-analyses and systematic reviews on non-genetic risk factors associated with AD in PubMed, Cochrane, Embase, and Ovid Medline up to June 30, 2023. After collecting data, we estimated the summary effect size and their 95% confidence intervals. The degree of heterogeneity between studies was assessed using I2 statistics and a 95% prediction interval was determined. Additionally, we evaluated potential excess significant bias and small study effects within the selected candidate studies.ResultsThe umbrella review encompassed a total of 53 eligible papers, which included 84 meta-analyses covering various factors such as lifestyle, diet, environmental exposures, comorbidity or infections, drugs, and biomarkers. Based on the evidence classification criteria employed in this study, two factors as convincing evidence (Class I), including rheumatoid arthritis (RA), potentially reduced the risk of AD, but diabetes significantly increased the risk of AD. Furthermore, three factors as highly suggestive evidence (Class II), namely depression, high homocysteine, and low folic acid level, potentially increased the risk of AD.ConclusionOur findings highlight several risk factors associated with AD that warrant consideration as potential targets for intervention. However, it is crucial to prioritize the identified modifiable risk factors, namely rheumatoid arthritis, diabetes, depression, elevated homocysteine levels, and low folic acid levels to effectively address this complex neurodegenerative disorder.
| S-EPMC11266231 | biostudies-literature
Project description:BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.PurposeThis umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews.MethodsWe conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist.ResultsA total of 207,221 children with ASD and 22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17-1.52), macrosomia (OR, 1.11; 95% CI, 1.05-1.18), low birth weight (OR, 1.63; 95% CI, 1.48-1.81), very low birth weight (OR, 2.25; 95% CI, 1.79-2.83), small for gestational age (OR, 1.17; 95% CI, 1.09-1.24), jaundice (OR, 1.74; 95% CI, 1.42- 2.12), male sex (OR, 1.47; 95% CI, 1.39-1.55) and 1-minute Apgar score <7 (OR, 1.40; 95% CI, 1.26-1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1.ConclusionBased on these results, clinicians should consider the risk factors for ASD and screen children in clinics.
| S-EPMC11374450 | biostudies-literature
Project description:A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.
| S-EPMC10984497 | biostudies-literature