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Psychol Med. 2019 Jul 22:1-7. doi: 10.1017/S0033291719001739. [Epub ahead of print]

Vitamin D concentration and psychotic disorder: associations with disease status, clinical variables and urbanicity.

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Department of Psychiatry & Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Center,Maastricht,the Netherlands.
Department of Psychiatry,Icahn School of Medicine,Mount Sinai, NY,USA.
Department of Child and Adolescent Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,the Netherlands.
Department of Laboratory Medicine,University of Groningen, University Medical Center Groningen,Groningen,the Netherlands.
University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen,Groningen,the Netherlands.



The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity.


In a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group × urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed.


Vitamin D concentrations were significantly lower in patients (B = -8.05; 95% confidence interval (CI) -13.68 to -2.42; p = 0.005). In patients, higher vitamin D concentration was associated with lower positive (B = -0.02; 95% CI -0.04 to 0.00; p = 0.049) and negative symptom levels (B = -0.03; 95% CI -0.05 to -0.01; p = 0.008). Group differences were moderated by urbanicity at birth (χ2 = 6.76 and p = 0.001), but not by current urbanicity (χ2 = 1.50 and p = 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B = -5.11; 95% CI -9.41 to -0.81; p = 0.020), but not in controls (B = 0.72; 95% CI -4.02 to 5.46; p = 0.765).


Lower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.


Psychotic disorder; schizophrenia; urbanicity; vitamin D


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