Background

Persistent anxiety in childhood and adolescence could represent a novel treatment target for psychosis, potentially targeting activation of stress pathways and secondary nonresolving inflammatory response. Here, we examined the association between persistent anxiety through childhood and adolescence with individuals with psychotic experiences (PEs) or who met criteria for psychotic disorder (PD) at age 24 years. We also investigated whether C-reactive protein mediated any association.

Methods

Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were available in 8242 children at age 8 years, 7658 at age 10 years, 6906 at age 13 years, and 3889 at age 24 years. The Development and Well-Being Assessment was administered to capture child and adolescent anxiety. We created a composite score of generalized anxiety at ages 8, 10, and 13. PEs and PD were assessed at age 24, derived from the Psychosis-like Symptoms Interview. The mean of C-reactive protein at ages 9 and 15 years was used as a mediator.

Results

Individuals with persistent high levels of anxiety were more likely to develop PEs (odds ratio 2.02, 95% CI 1.26–3.23, p = .003) and PD at age 24 (odds ratio 4.23, 95% CI 2.27–7.88, p < .001). The mean of C-reactive protein at ages 9 and 15 mediated the associations of persistent anxiety with PEs (bias-corrected estimate −0.001, p = .013) and PD (bias-corrected estimate 0.001, p = .003).

Conclusions

Persistent high levels of anxiety through childhood and adolescence could be a risk factor for psychosis. Persistent anxiety is potentially related to subsequent psychosis via activation of stress hormones and nonresolving inflammation. These results contribute to the potential for preventive interventions in psychosis, with the novel target of early anxiety.

中文翻译：

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持续的童年和青少年焦虑和精神病风险：一项纵向出生队列研究

背景

儿童和青春期的持续焦虑可能代表精神病的新治疗目标，可能针对应激通路的激活和继发性未解决的炎症反应。在这里，我们研究了童年和青春期持续焦虑与有精神病经历 (PE) 或在 24 岁时符合精神病性障碍 (PD) 标准的个体之间的关联。我们还研究了 C 反应蛋白是否介导了任何关联。

方法

来自雅芳父母和儿童纵向研究 (ALSPAC) 的数据适用于 8242 名 8 岁儿童、7658 名 10 岁儿童、6906 名 13 岁儿童和 3889 名 24 岁儿童。进行发展和幸福感评估是为了捕捉儿童和青少年的焦虑。我们在 8 岁、10 岁和 13 岁时创建了广泛性焦虑的综合评分。PE 和 PD 在 24 岁时进行了评估，来自精神病样症状访谈。使用 9 岁和 15 岁时 C 反应蛋白的平均值作为中介。

结果

 持续高度焦虑的个体在 24 岁时更有可能发生 PE（比值比 2.02，95% CI 1.26–3.23，p = .003）和 PD（比值比 4.23，95% CI 2.27–7.88， p < . 001). 9 岁和 15 岁时 C 反应蛋白的平均值介导了持续性焦虑与 PE（偏差校正估计值 -0.001，p  = .013）和 PD（偏差校正估计值 0.001，p  = .003）的关联。

结论

童年和青春期持续的高度焦虑可能是精神病的危险因素。持续性焦虑可能通过应激激素的激活和未消退的炎症与随后的精神病有关。这些结果有助于以早期焦虑为新目标对精神病进行预防性干预的潜力。