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Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study

Published online by Cambridge University Press:  05 April 2011

R. Kuepper ,
J. van Os ,
R. Lieb ,
H.-U. Wittchen  and
C. Henquet
R. Kuepper
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
J. van Os*
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
R. Lieb
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany University of Basel, Department of Psychology, Division of Epidemiology and Health Psychology, Basel, Switzerland
H.-U. Wittchen
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden, Germany
C. Henquet
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands Mondriaan Zorggroep, Division Addiction Care, South Limburg, The Netherlands
*
*Address for correspondence: J. van Os, Ph.D., Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (location DOT12), 6200 MD Maastricht, The Netherlands. (Email: j.vanos@sp.unimaas.nl)
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Abstract

Background

Cannabis use is considered a component cause of psychotic illness, interacting with genetic and other environmental risk factors. Little is known, however, about these putative interactions. The present study investigated whether an urban environment plays a role in moderating the effects of adolescent cannabis use on psychosis risk.

Method

Prospective data (n=1923, aged 14–24 years at baseline) from the longitudinal population-based German Early Developmental Stages of Psychopathology cohort study were analysed. Urbanicity was assessed at baseline and defined as living in the city of Munich (1562 persons per km2; 4061 individuals per square mile) or in the rural surroundings (213 persons per km2; 553 individuals per square mile). Cannabis use and psychotic symptoms were assessed three times over a 10-year follow-up period using the Munich version of the Composite International Diagnostic Interview.

Results

Analyses revealed a significant interaction between cannabis and urbanicity [10.9% adjusted difference in risk, 95% confidence interval (CI) 3.2–18.6, p=0.005]. The effect of cannabis use on follow-up incident psychotic symptoms was much stronger in individuals who grew up in an urban environment (adjusted risk difference 6.8%, 95% CI 1.0–12.5, p=0.021) compared with individuals from rural surroundings (adjusted risk difference −4.1%, 95% CI −9.8 to 1.6, p=0.159). The statistical interaction was compatible with substantial underlying biological synergism.

Conclusions

Exposure to environmental influences associated with urban upbringing may increase vulnerability to the psychotomimetic effects of cannabis use later in life.

Keywords

Cannabiscohort studyinteractionpsychosisurban environment
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2121 - 2129
Copyright
Copyright © Cambridge University Press 2011

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