Abstract
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.
Keywords
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Article Info
Publication History
Published online: December 12, 2021
Accepted:
December 7,
2021
Received in revised form:
December 1,
2021
Received:
September 5,
2021
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© 2021 Society of Biological Psychiatry.
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