Impact of life events on symptoms in psychotic disorders: 10-year longitudinal study following first admission

Abstract

Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms—namely psychosis, disorganization, negative symptoms, depression, and mania—remains unclear. Moreover, the differential effects of negative versus positive LEs is poorly understood. The present study utilizes an epidemiologic cohort of patients (N=428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48- and 120-month follow-ups. We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in psychotic (β= .07), disorganized (β= .07), manic (β= .08), and depressive symptoms (β= .06), and a decrease in negative symptoms (β= -.08). Conversely, positive LEs predicted fewer psychotic (β= -.04), disorganized (β= -.04), and negative (β= -.13) symptoms, and were unrelated to mood symptoms. Structural equation modeling confirmed that negative LEs predicted change in all symptoms, while positive LEs predicted change only in negative symptoms. In contrast, symptoms rarely predicted future LEs. These findings confirm that LEs have an effect on symptoms, and thus contribute to the burden of psychotic disorders. That LEs increase positive symptoms and decrease negative symptoms suggests at least two different mechanisms underlying the relationship between LEs and symptoms. Our findings underscore the need for close symptom monitoring in months following negative LEs, as symptoms may worsen during that time.