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Reply to: ‘To the editor: how statistics killed the cat’ – E. F. Torrey, R. H Yolken

Published online by Cambridge University Press:  22 June 2017

F. Solmi*
Affiliation:
Division of Psychiatry, University College London, London, UK
J. F. Hayes
Affiliation:
Division of Psychiatry, University College London, London, UK
G. Lewis
Affiliation:
Division of Psychiatry, University College London, London, UK
J. B. Kirkbride
Affiliation:
Division of Psychiatry, University College London, London, UK
*
*Address for correspondence: F. Solmi, Ph.D., Division of Psychiatry, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. (Email: francesca.solmi@ucl.ac.uk)
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Abstract

Type
Correspondence
Copyright
Copyright © Cambridge University Press 2017 

Torrey and Yolken raise two concerns about our study (Solmi et al. Reference Solmi, Hayes, Lewis and Kirkbride2017). The first relates to the use of psychotic experiences, as opposed to diagnosed schizophrenia, as the outcome for our analyses. They suggested that this approach could be over-inclusive and result in a dilution of the association between the exposure and the outcome. We agree with Torrey and Yolken that psychotic experiences and schizophrenia are different outcomes and we acknowledged this issue in our study as a potential limitation. Adolescents who report psychotic experiences are, nevertheless, at increased risk of developing psychosis and other psychopathology later in life (Fisher et al. Reference Fisher, Caspi, Poulton, Meier, Houts, Harrington, Arseneault and Moffitt2013). In this cohort, they have also been shown to share a number of features and risk factors that are typically observed in individuals with schizophrenia [e.g. lower IQ (Horwood et al. Reference Horwood, Salvi, Thomas, Duffy, Gunnell, Hollis, Lewis, Menezes, Thompson, Wolke, Zammit and Harrison2008); impaired social cognition (Sullivan et al. Reference Sullivan, Thompson, Kounali, Lewis and Zammit2017); higher residential mobility (Singh et al. Reference Singh, Winsper, Wolke and Bryson2014) and neighbourhood deprivation (Solmi et al. Reference Solmi, Colman, Weeks, Lewis and Kirkbridein press)]. We therefore hypothesised that, if a link between cat ownership and schizophrenia existed, we would have found this association with broadly-defined phenotypical presentations of psychosis, as we do with these other risk factors.

The second concern related to our choice of confounders. Torrey and Yolken argue that the statistically significant association which we reported between cat ownership in childhood and psychotic experiences at age 13 years in univariable analyses was artificially removed by inappropriate adjustment for variables (i.e. indicators of socioeconomic status) which lie on the causal pathway between our exposure (cat ownership) and our outcome (psychotic experiences). Adjustment for confounding is necessary to take account of alternative potential explanations for an observed association. We do not believe socioeconomic status lies on the causal pathway between cat ownership and psychotic experiences, since that would imply that owning a cat leads to lower socioeconomic status, which, in turn, causes psychotic experiences. Different socioeconomic backgrounds might, however, be associated with different patterns of cat ownership, and are also known to be associated with psychosis [with higher rates of the latter in more deprived settings (Morgan et al. Reference Morgan, Kirkbride, Hutchinson, Craig, Morgan, Dazzan, Boydell, Doody, Jones, Murray, Leff and Fearon2008)], thus providing theoretical support for our use of socioeconomic status as a confounder (our full causal model is presented in online Supplementary Figs S1 and S2). Torrey and Yolken's proposal that low socioeconomic status might lead to increased exposure to Toxoplasma gondii in faeces compared with those of higher socioeconomic status implies effect modification. We thank Torrey and Yolken for their interest in our paper, and hope that our reply clarifies these issues.

References

Fisher, HL, Caspi, A, Poulton, R, Meier, MH, Houts, R, Harrington, H, Arseneault, L, Moffitt, TE (2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Cambridge University Press Psychological Medicine 43, 20772086.Google Scholar
Horwood, J, Salvi, G, Thomas, K, Duffy, L, Gunnell, D, Hollis, C, Lewis, G, Menezes, P, Thompson, A, Wolke, D, Zammit, S, Harrison, G (2008). IQ and non-clinical psychotic symptoms in 12-year-olds: results from the ALSPAC birth cohort. The British Journal of Psychiatry: the Journal of Mental Science 193, 185191.CrossRefGoogle ScholarPubMed
Morgan, C, Kirkbride, J, Hutchinson, G, Craig, T, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2008). Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study. Psychological Medicine 38, 1701.Google Scholar
Singh, SP, Winsper, C, Wolke, D, Bryson, A (2014). School mobility and prospective pathways to psychotic-like symptoms in early adolescence: a prospective birth cohort study. Journal of the American Academy of Child and Adolescent Psychiatry 53, 518527. e1.Google Scholar
Solmi, F, Colman, I, Weeks, M, Lewis, G, Kirkbride, JB (2017). Trajectories of neighborhood cohesion in childhood, and psychotic and depressive symptoms at age 13 and 18 years. Journal of the American Academy of Child and Adolescent Psychiatry, doi: http://dx.doi.org/10.1016/j.jaac.2017.04.003.CrossRefGoogle ScholarPubMed
Solmi, F, Hayes, JF, Lewis, G, Kirkbride, JB (2017). Curiosity killed the cat: no evidence of an association between cat ownership and psychotic symptoms at age 13 and 18 years in a UK general population cohort. Psychological Medicine 47, 16591667.CrossRefGoogle Scholar
Sullivan, SA, Thompson, A, Kounali, D, Lewis, G, Zammit, S (2017). The longitudinal association between external locus of control, social cognition and adolescent psychopathology. Springer–Berlin–Heidelberg Social Psychiatry and Psychiatric Epidemiology 113, doi: 10.1007/s00127-017-1359-z. [Epub ahead of print].Google ScholarPubMed