Background and hypothesis Childhood adversity (CA) increases the risk for several adult psychiatric conditions. It is unclear why some exposed individuals experience psychotic symptoms and others do not. We investigated whether a syndemic explained a psychotic outcome determined by CA. Study design We used self-reported cross-sectional data from 7461 British men surveyed in different population subgroups. Latent class analysis (LCA) identified categorical psychopathological outcomes. LCs were tested by interaction analysis between syndemic factors derived from confirmatory factor analysis according to CA experiences. Pathway analysis using partial least squares path modeling. Results A 4-class model with excellent fit identified an LC characterized by both psychotic and anxiety symptoms (class 4). A syndemic model of joint effects, adducing a 3-component latent variable of substance misuse (SM), high-risk sexual behavior (SH), violence and criminality (VC) showed synergy between components and explained the psychotic outcome (class 4). We found significant interactions between factor scores on the multiplicative scale, specific only to class 4 (psychosis), including SM × SH, SH × VC, and SM × VC (OR > 1, P < .05); and on the additive scale SM × SH (relative excess risk due to interaction >0, P < .05), but only for men who experienced CA. Conclusion Multiplicative synergistic interactions between SM, SH, and VC constituted a mechanism determining a psychotic outcome, but not for anxiety disorder, mixed anxiety disorder/depression, or depressive disorder. This was specific to men who had experienced CA along direct and syndemic pathways. Population interventions should target SM and VC in adulthood but prioritize primary prevention strategies for CA.

中文翻译：

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童年逆境决定了暴力、药物滥用和性行为对男性精神病谱系障碍的综合影响

背景和假设 童年逆境（CA）会增加多种成人精神疾病的风险。目前还不清楚为什么一些接触过的人会出现精神病症状，而另一些人则不会。我们调查了综合症是否可以解释 CA 确定的精神病结果。研究设计 我们使用了来自不同人口亚组的 7461 名英国男性的自我报告横断面数据。潜在类别分析（LCA）确定了分类的精神病理学结果。根据 CA 经验，通过验证性因素分析得出的流行病因素之间的相互作用分析来测试 LC。使用偏最小二乘路径建模进行路径分析。结果 具有良好拟合度的 4 类模型识别出以精神病和焦虑症状为特征的 LC（4 类）。联合效应的综合症模型，引入了药物滥用（SM）、高危性行为（SH）、暴力和犯罪（VC）的3个组成部分的潜在变量，显示了组成部分之间的协同作用，并解释了精神病结果（第4类）。我们发现乘法量表上的因素评分之间存在显着的交互作用，仅针对第 4 类（精神病），包括 SM × SH、SH × VC 和 SM × VC（OR > 1，P < .05）；以及在加法尺度 SM × SH 上（由于相互作用而导致的相对过度风险 > 0，P < .05），但仅适用于经历过 CA 的男性。结论 SM、SH 和 VC 之间的乘法协同相互作用构成了决定精神病结果的机制，但不适用于焦虑障碍、混合焦虑障碍/抑郁或抑郁障碍。这是针对经历过 CA 直接途径和综合症途径的男性所特有的。人群干预措施应针对成年期的 SM 和 VC，但优先考虑 CA 的一级预防策略。