Schizophrenia Bulletin Advance Access published online on September 12, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn113
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Which Environments for G x E? A User Perspective on the Roles of Trauma and Structural Discrimination in the Onset and Course of Schizophrenia
2 Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, European Graduate School of Neuroscience, PO Box 616 (location DOT 10), Maastricht, 6200 MD, The Netherlands
1 To whom correspondence should be addressed; tel: +31-43-3688666, fax: +31-43-3688689, e-mail: C.vanZelst{at}SP.unimaas.nl.
Now that schizophrenia researchers may be moving from unilateral molecular genetic approaches to models including so-called gene-environment interactions, the question rises which environments may be considered for such research and how a user perspective may inform the field. It is argued that trauma and stigma, or perhaps better structural discrimination, represent 2 important environmental factors that deserve more attention. Experiential evidence, collected by users, suggests that trauma in childhood and/or adulthood, before, during, and after the onset of schizophrenia, as well as stigma/structural discrimination, may play important roles in the onset and course of the disorder. A certain reluctance on the part of the professional schizophrenia research community to take these variables as serious as, eg, interesting but inconclusive etiological signals from prenatal hypoxia, prenatal folate deficiency, and prenatal toxoplasmosis is suggested. This article outlines the concepts of trauma and stigma and their negative consequences for the onset and course of schizophrenia. The importance of research into these factors and their possible relevance for gene-environment interactions is discussed. While gene-environment interaction research using these variables is indicated and may possibly prove productive, it is argued that such efforts may not be useful if no subsequent attempt is made to translate the results to the level of interventions, codeveloped by users, eg, in the area of coping with the vicious circle of environmental adversity that users can become exposed to.
Keywords: schizophrenia / psychosis / stigma / trauma / gene-environment interaction / discrimination