Steinberg and Durell (1968) revisited: increased rates of First Episode Psychosis following military induction in Greek Army Recruits

Abstract

Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.

The diathesis-stress model in the emergence of major psychiatric disorders during military service

“…A key conclusion of the study is that adaptation stress during military service, favors the onset of psychotic episodes, early during this period. This finding is in agreement with similar studies of the past [19][20][21] reporting an increase in the incidence of first psychotic episodes during the first months of military service period. It is reasonable to assume that the initial adjustment period implies increased stress compared with the period of time that follows (for this reason 53.4% of total hospitalizations occur during the first two months of military service period) and that individuals with the lower stress resilience or lower stress tolerance are more vulnerable to a disorder onset.…”

“…The question arises whether these individuals were ill before military recruitment, so the hospitalization during the first month of military service period may reflect the first detection of the disorder. It is noted that previous studies 19,21 have ruled out this possibility demonstrating that the disorder onset occurs during the military service period. Moreover, psychological and psychiatric evaluation of all recruits take place during the recruitment process, and in this way, individuals with an established disorder are excluded from military service through postponement or discharge without hospitalization.…”

“…28 During military service, a conscript may be exposed to stressors that may be considered as a kind of threat for the social self. 29 The recruit has to adapt to a new, demanding environment away from the family and social network safety, potentially experiencing situations that may be perceived as social devaluation, intimidation, isolation, 21 resembling the social defeat hypothesis, 30 increasing the risk for psychotic symptomatology onset.…”

“…17 The adaptative stress predisposes to subsequent emergence mainly of anxiety disorders, 18 but has also been associated with psychosis onset, early during the military service period. [19][20][21] As the adaptation to military life can be a framework of a naturalistic study for the impact of psychosocial stress on psychologically predisposed individuals, it would be interesting to study the diathesis-stress model in relation to the onset of major psychiatric disorders.…”

Organization framework and preliminary findings from the Athens First‐Episode Psychosis Research Study

“…Epidemiological studies have demonstrated the association of certain environmentally mediated risks with psychosis. These risk factors include urbanicity (Richardson, Hameed, Perez, Jones, & Kirkbride, ), cannabis use (Schoeler et al, ; Setién‐Suero et al, ), immigration (Kirkbride et al, ), obstetric or perinatal complications (Rubio‐Abadal et al, ), psychosocial stress (Dimitrakopoulos et al, ), childhood adversities or abuse and others (Bifulco, Bernazzani, Moran, & Jacobs, ; Stilo et al, ; Trotta et al, ). However, there is great variability in individuals regarding the reverberations of environmental exposures, hence in the field of psychosis biopsychosocial interaction seems to work in a complex way (European Network of National Networks studying Gene‐Environment Interactions in Schizophrenia, ; Van Os, Rutten, & Poulton, ).…”