The Epidemiology of First-Episode Psychosis in Early Intervention in Psychosis Services: Findings From the Social Epidemiology of Psychoses in East Anglia [SEPEA] Study

OBJECTIVE: Few studies have characterized the epidemiology of first-episode psychoses in rural or urban settings since the introduction of early intervention psychosis services. To address this, the authors conducted a naturalistic cohort study in England, where such services are well established. METHOD: All new first-episode psychosis cases, 16-35 years old, presenting to early intervention psychosis services in the East of England were identified during 2 million person-years follow-up. Presence of ICD-10 F10-33 psychotic disorder was confirmed using OPCRIT [operational criteria for psychotic illness]. Incidence rate ratios were estimated following multivariable Poisson regression, adjusting for age, sex, ethnicity, socioeconomic status, neighborhood-level deprivation, and population density. RESULTS: Of 1,005 referrals, 687 participants (68.4%) fulfilled epidemiological and diagnostic criteria for first-episode psychosis (34.0 new cases per 100,000 person-years; 95% CI=31.5-36.6). Median age at referral was similar for men (22.5 years; interquartile range: 19.5-26.7) and women (23.4 years; interquartile range: 19.5-29.1); incidence rates were highest for men and women before 20 years of age. Rates increased for ethnic minority groups (incidence rate ratio: 1.4; 95% CI=1.1-1.6), as well as with lower socioeconomic status (incidence rate ratio: 1.3; 95% CI=1.2-1.4) and in more urban (incidence rate ratio: 1.4;95%CI=1.0-1.8) and deprived (incidence rate ratio: 2.1; 95% CI=1.3-3.3) neighborhoods, after adjustment for confounders. CONCLUSIONS: Pronounced variation in psychosis incidence, peaking before 20 years old, exists in populations served by early intervention psychosis services. Excess rates were restricted to urban and deprived communities, suggesting that a threshold of socioenvironmental adversity may be necessary to increase incidence. This robust epidemiology can inform service development in various settings about likely population-level need

Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study.

Objective: Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting. Method: We identified 687 people, 16-35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural-urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation. Results: People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63-6.25), black Caribbean (4.63; 95% CI: 2.38-8.98) and Pakistani (2.31; 95% CI: 1.35-3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77-1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33-3.62). Conclusions: Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural-urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk

Ethnic Minority Status, Age-at-Immigration and Psychosis Risk in Rural Environments: Evidence From the SEPEA Study

$\textbf{Objective}$: Several ethnic minority groups experience elevated rates of first-episode psychosis (FEP), but most studies have been conducted in urban settings. We investigated whether incidence varied by ethnicity, generation status, and age-at-immigration in a diverse, mixed rural, and urban setting. $\textbf{Method}$: We identified 687 people, 16-35 years, with an ICD-10 diagnosis of FEP, presenting to Early Intervention Psychosis services in the East of England over 2 million person-years. We used multilevel Poisson regression to examine incidence variation by ethnicity, rural-urban setting, generation status, and age-at-immigration, adjusting for several confounders including age, sex, socioeconomic status, population density, and deprivation. $\textbf{Results}$: People of black African (incidence rate ratio: 4.06; 95% confidence interval [CI]: 2.63-6.25), black Caribbean (4.63; 95% CI: 2.38-8.98) and Pakistani (2.31; 95% CI: 1.35-3.94) origins were at greatest FEP risk relative to the white British population, after multivariable adjustment. Non-British white migrants were not at increased FEP risk (1.00; 95% CI: 0.77-1.32). These patterns were independently present in rural and urban settings. For first-generation migrants, migration during childhood conferred greatest risk of psychotic disorders (2.20; 95% CI: 1.33-3.62). $\textbf{Conclusions}$: Elevated psychosis risk in several visible minority groups could not be explained by differences in postmigratory socioeconomic disadvantage. These patterns were observed across rural and urban areas of our catchment, suggesting that elevated psychosis risk for some ethnic minority groups is not a result of selection processes influencing rural-urban living. Timing of exposure to migration during childhood, an important social and neurodevelopmental window, may also elevate risk.This work was supported by a Sir Henry Wellcome Research Fellowship from the Wellcome Trust (WT085540 to J.B.K.), a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (101272/Z/13/Z to J.B.K.) and by the National Institute of Health Research (RP-PG-0606-1335 to J.P.). Prof Peter Jones directs the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England

The social epidemiology of psychotic disorders in a diverse, rural community:Initial findings from the SEPEA study

Background: The epidemiology of first episodepsychoses [FEP] is predominantly based on observational research from urban populations. It is unclear whether findings extend to more rural communities, particularly with regard to risk by place and ethnicity. Methods: All people, 16-35 years, referred to 6 early intervention in psychosis services [EIS] with suspected FEP over 3.5 years were identified in East Anglia. Participants were excluded if they had: previous contact with mental health services for psychosis; insufficient symptoms for EIS acceptance; residence outside the catchment, or; an organic basis to disorder. ICD-10 operationalised diagnoses (F10-33) were ascertained six months after EIS acceptance. Sociodemographic data were collected using a standardised schedule. Corresponding denominator data were estimated from the 2011 census. Poisson regression was used to analyse incidence. Results: 673 people with FEP were identified 33.3/100,000 person-years; 95%CI: 30.9-35.9). Median age-at-referral was around 22.5 years for men and women, although incidence was higher in men (incidence rate ratio [IRR]: 1.95; 95%CI: 1.64- 2.31), after adjustment for age, ethnicity and EIS. Rates were raised for several ethnic minority groups, including the black Caribbean, black African, Pakistani, Bangladeshi and Arabic groups, after control for confounding. Rates also varied by neighbourhood-level exposures, including deprivation (IRR: 1.015; 95%CI: 1.003-1.026), ethnic cohesion (IRR: 0.988; 95%CI: 0.977-0.999), proportion of single-person households (IRR: 1.029; 95%CI: 1.015-1.044) and proportion of 16-35 year olds (IRR: 0.988; 95%CI: 0.978-0.997). Conclusions: FEP incidence varies by ethnicity and place in rural communities in similar ways to more urban populations, with markers of neighbourhood-level social support and socioeconomic deprivation predictiveof incidence

Age at migration and risk of first episode psychosis in England:First epidemiological evidence from the SEPEA study

Aim: To test whether age-at-migration is associated with risk of first episode psychosis [FEP] Background: Although migrant populations experience elevated FEP risk compared with the white British population, it is unclear whether age-at-migration to the UK modifies this risk. Method: Incidence data on all people, aged 16-35 years, presenting with ICD-10 FEP (F10-33) as part of the 3.5-year SEPEA study were obtained. Participants were classified according to age-at-migration (“UK-born, white British”, “UK-born, ethnic minority”, 0-4[infancy], 5-12[childhood], 13-19[adolescence] or 20+ years) and broad ethnic group (non-British white ethnicities; black Caribbean, African & other black ethnicities; Pakistani & Bangladeshi; other Asian ethnicities; other ethnic groups). Poisson regression was used to model FEP incidence by age-at-migration, after adjustment for age and sex, using the 2011 census to estimate person-years at-risk. Results: We identified 664 participants with FEP over 2.02m person-years. Relative to the UK-born white British group, rates were raised amongst first generation black ethnic groups immigrating during infancy (incidence rate ratio [IRR]: 4.6; 95%CI: 2.6-8.4), childhood (IRR: 6.3; 95%CI: 2.8-14.1) and adolescence (IRR: 4.5; 95%CI: 2.3-8.6), with similar trends observed for non-British white (IRR: 2.2; 95%CI: 1.0-4.9; p=0.055) and Pakistani and Bangladeshi groups (IRR: 3.5; 95%CI: 0.9-14.1; p=0.076) immigrating during childhood. Other Asian immigrants, moving to the UK in adulthood, had lower FEP rates (IRR: 0.2; 95%CI: 0.1-0.9). Rates were elevated amongst UK-born ethnic minorities (IRR: 2.7; 95%CI: 2.1-3.5). Conclusion: Our data suggested that moving to the UK during childhood was most strongly associated with increased FEP risk; while migration in adulthood did not confer increased risk, UK-born ethnic minority populations experienced elevated rates

Polymer-ceramic Nanocomposite Dielectrics for Advanced Energy Storage

Inclusions of nanosized ceramic particles in a polymer matrix influence the dielectric properties of their composite more when compared to conventional microcomposites through a greater interfacial contact area between the filler particles and the polymer per volume. This review summarizes the research of and potential for polymer-ceramic nanocomposite use as electrostatic energy storage materials. a particular focus is made on the role of the interfacial region, properties and characterizations, and the significance of controlling the nanofiller surface for improving the energy storage capacity by nanocomposite dielectric capacitor films. Various types of surface modifications and methodologies that have been applied to ceramic nanofillers in an effort to control dielectric properties of the polymer nanocomposites are reviewed. Special mention is made of new structure-property-relationships at the interface through altering the chemical and electronic nature of the particle-polymer interface. Recent research results suggest that ligands, as a function of their electron density influence at the filler surface, reduce filler surface conductivity to maximize the dielectric energy storage density while reducing dielectric losses. the article concludes by briefly revisiting theoretical models of the filler-polymer interface structure property as an influence on properties of polymer-ceramic nanocomposite dielectrics