Environmental adversity is associated with attenuated positive symptoms and complex cognition in a long-term follow-up of the Philadelphia Neurodevelopmental Cohort

Background: Environmental adversity has been robustly associated with poor mental health outcomes, including psychosis spectrum (PS) symptoms and cognitive deficits. Environment may differentially impact males and females who differ in stress reactivity. We hypothesized that environmental adversity would predict later PS symptoms and neurocognitive deficits, and this relationship would be more pronounced in females. 

Study design: A sample of individuals (n = 343) from the racially diverse Philadelphia Neurodevelopmental Cohort, over-sampled for high and low adversity and psychosis risk at baseline (2009-2011), were assessed on average 11 years later. A baseline environment risk score (ERS) was calculated using established methods. The Structured Interview for Prodromal Syndromes assessed PS symptoms at follow-up, and the Penn Computerized Neurocognitive Battery assessed cognitive performance. Mixed-effects regressions were conducted for the full sample and stratified by sex assigned at birth. 

Study results: Higher baseline ERS was associated with greater PS symptoms (P = .006) at follow-up in the full sample. While there was no significant interaction of adversity × sex, after stratifying, ERS was predictive of total PS symptoms in females (P = .01). ERS impacted cognition in the full sample (P = .001) and in females (p = .003). Mixed-effects models did not reach significance for males. ANOVA results indicated that ERS impacted complex cognition specifically in the full sample (P = .001) and in females (P = .008) and trended toward significance in males (P = .049). 

Conclusions: Following early adversity, individuals are at risk for PS symptoms and cognitive deficits related to complex cognition. Copyright © 2025 The Author(s).