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Can J Psychiatry. 2018 Aug;63(8):547-556. doi: 10.1177/0706743718762097. Epub 2018 Apr 16.

Social Determinants of Health and Preclinical Glycemic Control in Newly Diagnosed First-Episode Psychosis Patients.

Veru-Lesmes F1,2,3, Rho A1,2, King S2,3, Joober R1,2,3, Pruessner M1,2,3,4, Malla A1,2,3,5, Iyer SN1,2,3,5.

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1 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec.
2 Douglas Mental Health University Institute, Montreal, Quebec.
3 Department of Psychiatry, McGill University, Montreal, Quebec.
4 Department of Psychology, University of Konstanz, Konstanz, Germany.
Authors contributed equally to the work.



The abnormally high incidence of disorders of glucose metabolism (DGM) in psychotic-spectrum disorders (PSD) has often been attributed to the side effects of antipsychotics and unhealthy lifestyles. The influence of social determinants of health has been largely ignored, despite ample evidence linking social adversity with both PSD and DGM. The aim of this study is to examine the influence of well-established social determinants of health on preclinical levels of glycated hemoglobin (HbA1c) in a sample of first-episode psychosis (FEP) patients.


In a sample of newly admitted FEP patients, univariate analyses were used to select the main predictors of HbA1c levels from the following social determinants of health: childhood trauma, immigrant background, visible minority status, and indices of social and material deprivation. The predictors identified in the univariate analyses were tested in multivariate linear regression models including age, sex, BMI, depression, and physical anergia (proxy of sedentary behaviour) as covariates.


Univariate analyses identified visible minority status and childhood physical abuse as predictors of HbA1c. After controlling for covariates, minority status significantly predicted higher levels of glycated hemoglobin (β = 0.23; P = 0.01), and physical abuse had a marginally significant effect (β = 0.23; P = 0.06). Other predictors were not significantly associated.


FEP patients from a visible minority or who were victims of childhood physical abuse have higher levels of HbA1c at admission compared with other patients. This might suggest an increase in risk for the development of future DGM. If confirmed, preventive strategies could be tailored for these groups.


biopsychosocial; child maltreatment; first episode psychosis; immigrant mental health; income inequality; race; social determinants

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