在尼日利亚拉各斯，连接不良童年经历与精神病风险的途径：结构方程建模方法

IF 3.5 2区医学 Q1 PSYCHIATRY

Schizophrenia Research Pub Date : 2025-10-10 DOI:10.1016/j.schres.2025.09.030

Abiodun O. Adewuya , Olabisi E. Oladipo , Robin Emsley , Laila Asmal

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引用次数: 0

摘要

童年不良经历（ace）是精神病的确定危险因素，但来自低收入和中等收入国家（LMICs）的证据仍然有限。本研究调查了尼日利亚的ace、类精神病经历（ple）和精神病诊断之间的关系，检查了心理和认知介导途径。方法来自拉各斯州心理健康调查的数据包括1953名成年人：945例持续性PLEs（包括95例精神病）和1008例匹配对照。采用probit链接的广义结构方程模型检验：(1)ace与精神病的直接关联；(2)常见精神障碍、心理弹性、自尊和认知功能的中介作用；(3)家族史和产科并发症的调节；(4)大麻使用、父母关系和成人创伤的影响。总体验证使用反向概率权重的完整代表性样本（N = 11,246）。结果模型拟合良好（CFI = 0.94, RMSEA = 0.057）。ace与ple （β = 0.225, p = 0.038）和精神病（β = 0.105, p = 0.002）有显著相关性。CMDs和弹性显著介导了这些关系，分别占总效应的21%和23%。认知功能介导了18%的关联，而自尊则没有显著的中介作用。家族史和产科并发症显著减缓ace -精神病途径。大麻使用和成人创伤无显著性差异；亲代亲缘关系表现出较弱的相关性。结论在尼日利亚，ace通过心理和认知途径与精神病有显著关联，且家族和围产期脆弱性放大了这种影响。中低收入国家的预防策略应结合创伤知情干预、增强复原力和以社区为基础的支持系统，针对已确定的中介机制。

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Pathways linking adverse childhood experiences to psychosis risk in Lagos, Nigeria: A structural equation modeling approach

Background

Adverse childhood experiences (ACEs) are established risk factors for psychosis, yet evidence from low- and middle-income countries (LMICs) remains limited. This study investigated associations between ACEs, psychotic-like experiences (PLEs), and psychosis diagnosis in Nigeria, examining psychological and cognitive mediating pathways.

Methods

Data from the Lagos State Mental Health Survey included 1953 adults: 945 cases with persistent PLEs (including 95 with psychosis) and 1008 matched controls. Generalized structural equation modeling with probit links examined: (1) direct ACE-psychosis associations; (2) mediation via common mental disorders (CMDs), resilience, self-esteem, and cognitive functioning; (3) moderation by family history and obstetric complications; and (4) contributions of cannabis use, parental bonding, and adult trauma. Population validation utilized the full representative sample (N = 11,246) with inverse probability weights.

Results

The model demonstrated acceptable fit (CFI = 0.94, RMSEA = 0.057). ACEs showed significant associations with PLEs (β = 0.225, p = 0.038) and psychosis (β = 0.105, p = 0.002). CMDs and resilience significantly mediated these relationships, accounting for 21 % and 23 % of total effects respectively. Cognitive functioning mediated 18 % of associations, while self-esteem showed non-significant mediation. Family history and obstetric complications significantly moderated ACE-psychosis pathways. Cannabis use and adult trauma were non-significant; parental bonding showed weak associations.

Conclusion

ACEs are significantly linked to psychosis in Nigeria through psychological and cognitive pathways, with effects amplified by familial and perinatal vulnerabilities. Prevention strategies in LMICs should integrate trauma-informed interventions, resilience enhancement, and community-based support systems targeting identified mediating mechanisms.

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来源期刊

Schizophrenia Research 医学-精神病学

CiteScore

7.50

自引率

8.90%

发文量

429

审稿时长

10.2 weeks

期刊介绍： As official journal of the Schizophrenia International Research Society (SIRS) Schizophrenia Research is THE journal of choice for international researchers and clinicians to share their work with the global schizophrenia research community. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest readership! Schizophrenia Research''s time to first decision is as fast as 6 weeks and its publishing speed is as fast as 4 weeks until online publication (corrected proof/Article in Press) after acceptance and 14 weeks from acceptance until publication in a printed issue. The journal publishes novel papers that really contribute to understanding the biology and treatment of schizophrenic disorders; Schizophrenia Research brings together biological, clinical and psychological research in order to stimulate the synthesis of findings from all disciplines involved in improving patient outcomes in schizophrenia.