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Frequent residential moves during youth may increase psychosis risk

James Kirkbride

Children and teenagers with more frequent disruption in their residential environments were at higher risk for nonaffective psychosis, according to findings published in JAMA Psychiatry.

The results also showed that moves requiring changes in school and social networks were most strongly linked to future nonaffective psychosis risk.

“We were interested in knowing whether residential instability, which may be a marker for disruption to family life and establishing friendships as a child or teenager, affected risk of psychotic disorder,” James Kirkbride, PhD, senior author and associate professor in the division of psychiatry at University College London, told Healio Psychiatry.

To assess the link between residential mobility over time and risk for nonaffective psychosis, researchers conducted a prospective cohort study of people living in Sweden between 1982 and 1995 and followed up until up to age 29 years. National register linkage provided exposure, outcome and covariate data for 1,440,383 participants. The investigators evaluated the exposures to distance moved and the number of residential moves for participants from 0 to 6 years, 7 to 15 years, 16 to 19 years, and 20 years and older.

In total, 4,537 participants had nonaffective psychotic disorder. More frequent moving during childhood was linked to an elevated risk for nonaffective psychosis independent of covariates. Moving one, two, three or four or more times between birth and age 6 years was tied to HRs of 1.13, 1.47, 1.46, and 1.83 (P < .001 for all) compared with never moving.

“In this study of over 1.4 million young people in Sweden, we found that those who moved houses more often in childhood and during their teenage years had a higher risk of developing psychotic disorders, such as schizophrenia by age 30,” Kirkbride said. “These findings weren’t explained by factors such as income, education or family history of severe mental illness.”

Price and colleagues observed stronger connections between moving and nonaffective psychosis risk when youth were aged 16 to 19 years, with those moving each year during this period experiencing a 1.99-fold (95% CI, 1.3-3.05) higher risk compared with those who never moved. Although one move during adulthood was not tied to psychosis risk (adjusted HR = 1.04; 95% CI, 0.94-1.14), moving four or more times was linked to increased risk (adjusted HR = 1.82; 95% CI, 1.51-2.23). However, distance moved after age 20 years was linked to a lower risk.

“The association between moving more frequently in childhood and adolescence and future psychotic disorder may be explained by a variety of social factors,” Kirkbride explained. “One important possible factor is disruption to school- and kinship-based networks during formative periods of childhood and adolescence. One possibility is moving frequently may make it more difficult to form and maintain friendships or have access to social support networks in times of stress.”

Furthermore, moving greater distances before age 16 years was independently linked to an elevated risk for nonaffective psychosis (adjusted HR = 1.11; 95% CI, 1.05-1.19), with evidence of effect for moves longer than 30 km.

“It’s important to remember that moving houses is really common, and psychotic disorders are very rare, so most of the time there is no need to worry. However, clinicians who see young people with suspected psychotic-like symptoms may wish to take into account their recent social and residential history,” Kirkbride told Healio Psychiatry. “Providing supportive networks and communities for young people who have recently moved to a new school or neighborhood may provide stronger social support and lower the impact of these findings, if causal.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.