The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders

Environmental and psychopathological predictors of clinical high-risk of psychosis in adolescence

OBJECTIVES

Clinical high-risk of psychosis (CHRp) samples can be heterogeneous, consisting essentially of people with not only psychotic-like experiences but also nonspecific symptoms that may reflect common mental disorders such as depression, anxiety, or substance abuse pathologies. Few studies have attempted to analyze and understand psychosis risk in relation to both environmental (ER) and psychopathological risk (PsR) factors. This study aimed to determine the clinical risk of psychosis in adolescents.

METHODS

A representative sample of 1824 Spanish adolescents from the general population was evaluated using different scales to thoroughly examine the possible interaction of CHRp with various ER and PsR factors. Partial correlations were calculated to assess the relationships between the variables. A series of hierarchical linear regression models were then used to obtain a CHRp predictor model.

RESULTS

The CHRp predictor model indicated that PsR was the most significant determining factor, explaining 22% of the total associated variance of CHRp. However, the ER factor also emerged as a significant predictor of high-risk psychosis (accounting for 9% of the variance).

CONCLUSIONS

A predictive model for CHRp in adolescents was found, in which common psychological problems were presented as more determinant risk factors than ER disruptors. Furthermore, certain transdiagnostic processes, such as psychological inflexibility, may play a central role in the development of mental health problems, including psychosis. Specifying the mechanisms underlying the emergence of CHRp in adolescence is the key to optimizing the focus of preventive therapeutic interventions in these early stages.

Psychotic experiences and dissociation in adolescents: Within-person analysis in the Tokyo teen cohort

Although many cross-sectional studies showed that psychotic experiences (PEs) and dissociation were closely related, the longitudinal association between them remains unknown. Therefore, the aim of the current study was to examine the longitudinal association of these two symptoms throughout adolescence, under the hypothesis that these two symptoms are bidirectionally associated. Data were obtained from a population-based cohort, the Tokyo Teen Cohort study (TTC; N = 3171). PEs and dissociation were assessed at 10, 12, 14, and 16 years of age. PEs were assessed using a total score from five-item self-report questionnaires derived from the Diagnostic Interview Schedule for Children (DISC-C). Dissociation was assessed using subscale scores of the Child Behavior Checklist (CBCL) completed by primary caregivers. We examined the longitudinal relationship between PEs and dissociation using the random intercept cross-lagged panel model (RI-CLPM). The within-person component of the RI-CLPM revealed no significant cross-lagged effect of dissociation on PEs at any time point. On the other hand, there was a significant (p < 0.05) association between PEs at age 14 and dissociation at age 16 (β = 0.106, 95 % CI 0.047-0.165). The between-person component revealed a significant time-invariant relationship between the two symptoms (β = 0.324, 95 % CI 0.239-0.410). The longitudinal relationship between PEs and dissociation was limited at the within-person level, whereas the between-person correlation was significant. The only significant longitudinal pathway was from PEs to dissociation, suggesting that PEs may be a predictor of dissociation in mid-adolescence.

Psychotic-like experiences and problem drinking among adults in Japan

BACKGROUND

Psychotic-like experiences (PLEs) are common in the general population and have been linked to alcohol misuse and abuse. However, much of this research has been undertaken in Western countries. To address this deficit, the current study examined the association between PLEs and problem drinking in the Japanese general population.

METHODS

Data were used from 3717 adults (age 18-89) collected in an online survey in 2023. Information was obtained on PLEs with the PRIME Screen-Revised (PS-R), while problem drinking was assessed with the CAGE questionnaire (where a score of ≥ 2 was used to categorize cases). Logistic regression was used to examine the associations.

RESULTS

Problem drinking was prevalent in the study sample (12.5%). In an analysis that was adjusted for sociodemographic factors, self-rated health, smoking status and depressive symptoms, PLEs were associated with significantly higher odds for problem drinking in the total sample (OR: 1.70, 95%CI: 1.13-2.55). In a sex-stratified analysis PLEs were not linked to problem drinking in men (OR: 1.16, 95%CI 0.68-2.00), whereas women with PLEs had over 2.8 times higher odds for problem drinking (OR: 2.83, 95%CI: 1.54-5.21).

CONCLUSION

PLEs are associated with problem drinking in the Japanese general population and this association is especially pronounced in women. As problem drinking has been linked to a number of detrimental outcomes, future research should examine the potential effects of problem drinking in individuals with PLEs.

Trajectories of Adolescent Media Use and Their Associations With Psychotic Experiences

Importance

Adolescent media use is thought to influence mental health, but whether it is associated with psychotic experiences (PEs) is unclear.

Objective

To examine longitudinal trajectories of adolescent media use and their associations with PEs at 23 years of age.

Design, Setting, and Participants

This cohort study included participants from the Québec Longitudinal Study of Child Development (1998-2021): children who were born in Québec, Canada, and followed up annually or biennially from ages 5 months through 23 years. Data were analyzed between January 2023 and January 2024.

Exposures

Participants reported their weekly amount of television viewing, video gaming, computer use, and reading at ages 12, 13, 15, and 17 years.

Main Outcome and Measures

Lifetime occurrence of PEs was measured at 23 years of age. Covariables included sociodemographic, genetic, family, and childhood characteristics between ages 5 months and 12 years.

Results

A total of 1226 participants were included in the analyses (713 [58.2%] female, 513 [41.8%] male). For each media type, latent class mixed modeling identified 3 group-based trajectories, with subgroups following trajectories of higher use: television viewing, 128 (10.4%); video gaming, 145 (11.8%); computer use, 353 (28.8%); and reading, 140 (11.4%). Relative to lower video gaming, higher video gaming was preceded by higher levels of mental health and interpersonal problems at age 12 years. Adjusting for these risk factors mitigated the association between higher video gaming and PEs at age 23 years. The curved trajectory of computer use (189 [15.4%] participants), characterized by increasing levels of use until age 15 years followed by a decrease, was associated with higher PEs (estimated difference, +5.3%; 95% CI, +1.5% to +9.3%) relative to lower use (684 [55.8%] participants). This association remained statistically significant after covariable adjustment.

Conclusions and Relevance

This study found that longitudinal trajectories of media use during adolescence were modestly associated with PEs at age 23 years, likely reflecting the influence of shared risk factors. Understanding the environmental determinants and psychosocial functions of media use during adolescence may help better integrate digital technologies in the prevention and management of PEs.

Longitudinal relationships of psychotic-like experiences with suicidal ideation and self-harm in adolescents

Research in adolescents suggests associations between psychotic-like experiences (PLEs) and self-injurious thoughts and behaviors (SITBs), but insights into their temporal relationship, which may inform prediction, have been limited. Psychological distress (PD; symptoms of depression and anxiety) has been related to both PLEs and SITBs, and may modulate this relationship. Given that PLEs have been linked to the development of several mental disorders, and the relationships between SITBs and suicide, it is important to better understand their relationship. The present study sought to investigate these factors using a longitudinal school-based design. Adolescents (n = 1685, ages 12-18) completed annual self-report assessments (6 time points) on PLEs, SITBs (suicidal ideation (SI) and self-harm (SH)), as well as PD. The longitudinal associations between PLEs and SITBs were analyzed, employing two cross-lagged panel models (CLPMs), with and without adjustment for PD. Unadjusted CLPMs revealed significant bidirectional temporal associations between PLEs and SITBs (both SI and SH), suggesting that PLEs both predicted and were predicted by SITBs. When adjusting for PD, the effect of SI on PLEs remained significant, but not PLEs on SI; bidirectional associations between PLEs and SH also remained significant. A bidirectional longitudinal relationship where both PLEs and SITBs can precede (and perhaps predict) each other was suggested in adolescents. PD may play a particular role in situations where PLEs are followed by SI. Heightened awareness about relationships between these phenotypes may be an important step toward facilitating timely interventions for both mental disorders and suicide.

Psychotic-like experiences and associated factors in resident physicians: A Canadian cross-sectional study

AIM

Medical residency training is associated with a range of sociodemographic, lifestyle and mental health factors that may confer higher risk for psychotic-like experiences (PLEs) in residents, yet little research has examined this question. Thus, we aimed to document the prevalence and associated factors of PLEs among resident physicians.

METHODS

Physicians enrolled in residency programmes in the Province of Québec, Canada (four universities) were recruited in Fall 2022 via their programme coordinators and social media. They completed an online questionnaire assessing PLEs in the past 3 months (the 15-item Community Assessment of Psychic Experiences), as well as sociodemographic characteristics, lifestyle and mental health. Analyses included survey weights and gamma regressions.

RESULTS

The sample included 502 residents (mean age, 27.6 years; 65.9% women). Only 1.3% (95% CI: 0.5%, 4.0%) of residents met the screening cut-off for psychotic disorder. Factors associated with higher scores for PLEs included racialised minority status (relative difference: +7.5%; 95% CI: +2.2%, +13.2%) and English versus French as preferred language (relative difference: +7.9% 95% CI: +3.1%, +12.9%), as well as each additional point on scales of depression (relative difference: +0.8%; 95% CI: +0.3%, +1.3%) and anxiety (relative difference: +1.3%; 95% CI: +0.8%, +1.7%). In secondary analyses, racialised minority status was associated with persecutory items, but not with other PLEs. Gender, residency programmes and lifestyle variables were not associated with PLEs.

CONCLUSIONS

This study found low reports of PLEs in a sample of resident physicians. Associations of PLEs with minoritised status may reflect experiences of discrimination.

Neurocognitive consequences of adolescent sleep disruptions and their relationship to psychosis vulnerability: a longitudinal cohort study

Adolescence is a key period for neurocognitive maturation where deviation from normal developmental trajectories may be tied to adverse mental health outcomes. Cognitive disruptions have been noted in populations at risk for psychosis and are known to accompany periods of sleep deprivation. This study aims to assess the role of cognition as a mediator between sleep disruptions and psychosis risk. A cohort of 3801 high school students (51% female, mean age = 12.8, SD = 0.45 years) was recruited from 31 Montreal high schools. Measures of sleep, psychotic-like experiences, inhibition, working memory, perceptual reasoning, and delayed recall were collected from participants on a yearly basis over the five years of their high school education. A multi-level model mediation analysis was performed controlling for sex and time squared. Response inhibition was shown to be associated with, and to mediate (B = -0.005, SD = 0.003, p = 0.005*) the relationship between sleep disruptions (B = -0.011, SD = 0.004, p < 0.001*) and psychotic-like experiences (B = 0.411, SD = 0.170, p = 0.005*). Spatial working memory deficits on a given year were associated with a higher frequency of psychotic-like experiences that same year (B = -0.046, SD = 0.018, p = 0.005*) and the following year (B = -0.051, SD = 0.023, p = 0.010*), but were not associated with sleep disturbances. No significant associations were found between our variables of interest and either delayed recall or perceptual reasoning at the within person level. Findings from this large longitudinal study provide evidence that the association between sleep disruptions and psychosis risk is specifically mediated by inhibitory rather than general cognitive impairments. The association of spatial working memory, response inhibition, and sleep disruptions with psychotic-like experiences suggests that these factors may represent potential targets for preventative interventions.

Time to put aside the false dichotomy between personality disorders and psychotic symptoms

Unlike internalizing and externalizing symptoms, psychotic symptoms (e.g., hallucinations, delusions) are manifestations of personality disorders (PDs) that are more controversial and poorly understood. This leaves clinicians with very little guidance for clinical practice, especially for diagnosis. What is more, most reviews have focused strictly on the links between psychotic symptoms and the categorically defined borderline PD, which contrasts with the growing movement that emphasizes a dimensional perspective (especially in psychology). Thus, the objectives of this critical review will be to (a) expose typical cases where PDs and psychotic symptoms might cooccur; (b) assess the state of scientific knowledge surrounding PD and psychotic symptoms; and (c) provide clinicians and researchers with recommendations to keep the field moving forward. We conclude that researchers and clinicians should move past the false "PD or psychosis" dichotomy since they often cooccur, avoid (as far as possible) making psychotic symptoms an exclusion criterion in PD research to enhance ecological validity, and consider dimensional PD diagnosis as a potential unifying solution to the dilemma posed by this cooccurrence.

Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents

BACKGROUND

The relationship between psychosis and disordered eating remains a challenging area of research to which little interest was paid. Using longitudinal data, we aimed to explore the hypothesis that the pathways from psychotic experiences (PEs) to disordered eating (DE) and body-mass index (BMI) are mediated by body-image disturbances.

METHODS

A prospective longitudinal study was performed. High-school students (N = 510, 61.2% females, mean age of 16.05 ± 1.01 years) were asked to complete three scheduled assessments (Baseline, 6 months, and 12 months).

RESULTS

Two body image components, that is, Overweight Preoccupation and Body Area Satisfaction, mediated the prospective association between baseline PEs and DE 12 months later. Direct effects were significant. After accounting for indirect effects through more severe body image concerns at 6 months, higher baseline PEs were significantly associated with greater DE at 12 months. Baseline PEs and 6-month body image explained a significant proportion of variance in 12-month DE. However, we did not find evidence of a direct prospective association between PEs and BMI.

CONCLUSION

This study is the first to assess the mediating role of body image between PEs and DE. Findings offer promising new avenues for early intervention to help mitigate the effects of PEs on DE in adolescents.

Youth Psychotic Experiences: Diagnostic Associations and Evaluation of the CAPE-16

Background

Adolescent self-reported psychotic experiences are associated with mental illness and could help guide prevention strategies. The Community Assessment of Psychic Experiences (CAPE) was developed over 20 years ago. In a rapidly changing society, where new generations of adolescents are growing up in an increasingly digital world, it is crucial to ensure high reliability and validity of the questionnaire.

Methods

In this observational validation study, we used unique transgenerational questionnaire and health registry data from the Norwegian Mother, Father, and Child Cohort, a population-based pregnancy cohort. Adolescents, aged ~14 years, responded to the CAPE-16 (n = 18,835) and fathers to the CAPE-9 questionnaire (n = 28,793). We investigated the psychometric properties of CAPE-16 through factor analyses, measurement invariance testing across biological sex, response before/ during the COVID-19 pandemic, and generations (comparison with fathers), and examined associations with later psychiatric diagnoses.

Outcomes

One third (33·4%) of adolescents reported lifetime psychotic experiences. We confirmed a three-factor structure (paranoia, bizarre thoughts, and hallucinations) of CAPE-16, and observed good scale reliability of the distress and frequency subscales (ω = ·86 and ·90). CAPE-16 measured psychotic experiences were invariant to biological sex and pandemic status. CAPE-9 was non-invariant across generations, with items related to understanding of the digital world (electrical influences) prone to bias. CAPE-16 sum scores were associated with a subsequent psychiatric diagnosis, particularly psychotic disorders (frequency: OR = 2·06; 97·5% CI = 1·70-2·46; distress: OR = 1·93; 97·5% CI = 1·63-2·26).

Interpretation

CAPE-16 showed robust psychometric properties across sex and pandemic status, and sum scores were associated with subsequent psychiatric diagnoses, particularly psychotic disorders. These findings suggest that with certain adjustments, CAPE-16 could have value as a screening tool for adolescents in the modern, digital world.

Funding

European Union's Horizon 2020 Programme, Research Council of Norway, South-Eastern Norway Regional Health Authority, NIMH, and the KG Jebsen Stiftelsen.

The mental and physical health correlates of psychotic experiences among US college students: Findings from the Healthy Mind Study 2020

BACKGROUND

Psychotic experiences have been framed as a marker of mental and physical health status; however, more research is needed to confirm these associations in university populations.

METHODS

We analyzed data from the Healthy Minds Survey (Fall Semester Cohort 2020), which is a non-probability sample of students attending one of 28 universities in the United States, who completed an online survey (September 2020-December 2020). We used multivariable logistic regression to examine the associations between several mental and physical health conditions and psychotic experiences, adjusting for age, gender, sexual orientation race/ethnicity, and international student status.

RESULTS

In terms of mental health, all conditions were associated with greater odds of having lifetime psychotic experiences. Having at least one mental health condition was associated with 2.18 times greater odds of having lifetime psychotic experiences (aOR: 2.18; 95% CI: 1.96-2.42). In terms of physical health, having at least one physical health condition was associated with 1.37 times greater odds of having lifetime psychotic experiences (aOR: 1.37; 95% CI: 1.22-1.53), but only four conditions were associated with greater odds of lifetime psychotic experiences, which were: asthma, gastrointestinal disease, HIV/AIDS, and other chronic disease. The counts of mental and physical health conditions were associated with greater odds of lifetime psychotic experiences in a dose-dependent fashion.

CONCLUSION

Psychotic experiences appear to be an indicator for mental health problems and some physical health problems. More research is needed to determine whether assessing for psychotic experiences broadly can help identify at-risk individuals in university settings who may benefit from targeted preventive interventions.

Do anxiety symptoms and coping motives serially mediate the association between psychotic-like experiences and cannabis-related problems in undergraduate recent cannabis users?

Many Canadian emerging adults (ages 18-25 years) use cannabis, with 60 % of past-three-month users experiencing one or more cannabis-related problems (i.e., adverse consequences of use). While psychotic-like experiences (PLEs) and cannabis problems overlap, little is known about the mechanisms explaining this link. One hypothesis is that PLEs are distressing and give rise to anxiety, with which emerging adults attempt to cope through increased cannabis use, in turn increasing their risk for cannabis-related problems. We tested a chained-mediational model to determine if anxiety and coping-with-anxiety motives for cannabis use sequentially mediated the link between PLEs and cannabis problems in emerging adult undergraduates; a conditional process model tested for moderation by sex. Emerging adult cannabis users (N = 413; mean [SD] age = 19.1 [1.5] years; 71.9 % female) from five Canadian universities provided cross-sectional, self-report survey data in fall 2021. Validated measures of PLEs, anxiety, cannabis coping-with-anxiety motives, and cannabis-related problems were administered. Path analyses supported the hypothesized chained mediational indirect effect (b = 0.027, 95 % bootstrap CI [0.012, 0.050]). No direct effect was found (p =.698), suggesting that the PLEs-to-cannabis problems association is fully explained by anxiety and cannabis coping-with-anxiety motives. Inconsistent with hypotheses, mediation did not depend on sex (95 % CIs crossed zero); therefore, anxiety and cannabis coping-with-anxiety motives explain the link between PLEs and cannabis problems in emerging adults regardless of their sex. Results highlight anxiety and cannabis coping-with-anxiety motives as potentially important intervention targets in cannabis-using emerging adults with PLEs, possibly preventing the development/worsening of cannabis-related problems.

Association between tuberculosis and psychotic experiences: Mediating factors and implications for patient care in low- and middle-income countries

Background

Tuberculosis may play a role in the aetiology of psychosis. However, little is known about the association between tuberculosis and psychotic experiences (PEs) or the mediating factors of this association.

Methods

We analysed cross-sectional data from 48 low- and middle-income countries of the World Health Survey (WHS). Tuberculosis assessment was based on past 12-month symptoms of active tuberculosis. We assessed four types of past 12-month PEs with the Composite International Diagnostic Interview. We performed multivariable multinomial logistic regression and mediation analysis.

Results

We analysed data on 224 842 individuals aged ≥18 years (mean age = 38.3 years, standard deviation = 16.0; 50.7% women). Tuberculosis was associated with 1.84 (95% confidence interval (CI) = 1.41-2.40), 2.18 (95%CI = 1.58-3.03), and 3.79 (95%CI = 2.88-4.98) times higher odds for 1, 2, and ≥3 PEs, respectively. The mediation analysis showed that the association between tuberculosis and at least one PE is mainly explained by anxiety (31.5%), sleep/energy (27.8%), and pain/discomfort (23.5%).

Conclusions

Tuberculosis was associated with increased odds of PEs. Factors such as affect, sleep, and pain should be considered in tuberculosis patients to target those who might be particularly vulnerable to PEs, and consequently, to psychotic disorders and other adverse effects of PE.

The genetic epidemiology of schizotypal personality disorder

BACKGROUND

The concept of schizotypal personality disorder (SPD) emerged from observations of personality characteristics common in relatives of schizophrenic patients. While often studied in family designs, few studies and none with genetic measures, have examined SPD in epidemiological samples.

METHODS

We studied individuals born in Sweden 1940-2000 with an ICD-10 diagnosis of SPD with no prior schizophrenia (SZ) diagnosis (n = 2292). Demographic features, patterns of comorbidity, and Family Genetic Risk Scores (FGRS) were assessed from multiple Swedish registries. Prediction of progression to SZ was assessed by Cox models.

RESULTS

SPD was rare, with a prevalence of 0.044%, and had high levels of comorbidity with autism spectrum disorder (ASD), OCD, ADHD, and major depression (MD), and increased rates of being single, unemployed and in receipt of welfare. Affected individuals had elevated levels of FGRS for SZ (+0.42), ASD (+0.30), MD (+0.29), and ADHD (+0.20). Compared to cases of schizophrenia, they had significantly lower rates of FGRSSZ, but significantly elevated rates of genetic risk for ASD, MD, and ADHD. Over a mean follow-up of 8.7 years, 14.6% of SPD cases received a first diagnosis of SZ, the risk for which was significantly increased by levels of FGRSSZ, male sex, young age at SPD diagnosis and an in-patient SPD diagnosis and significantly decreased by comorbidity with MD, ASD, and ADHD.

CONCLUSIONS

Our results not only support the designation of SPD as a schizophrenia spectrum disorder but also suggest potentially important etiologic links between SPD and ASD and, to a lesser extent, ADHD, OCD, and MD.

The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends

BACKGROUND

Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents.

METHODS

Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends.

RESULTS

Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted β = 0.05; 95% CI: 0.01-0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted β = -0.02; 95% CI: -0.04 to <-0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted β = 0.07; 95% CI: 0.03-0.11). However, among those with more close friends, the association was non-significant (adjusted β = 0.03; 95% CI: -0.01 to 0.07).

CONCLUSIONS

Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels.

Identifying prior signals of bipolar disorder using primary care electronic health records: a nested case-control study

BACKGROUND

Bipolar disorders are serious mental illnesses, yet evidence suggests that the diagnosis and treatment of bipolar disorder can be delayed by around 6 years.

AIM

To identify signals of undiagnosed bipolar disorder using routinely collected electronic health records.

DESIGN AND SETTING

A nested case-control study conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. 'Cases' were adult patients with incident bipolar disorder diagnoses between 1 January 2010 and 31 July 2017.

METHOD

The patients with bipolar disorder (the bipolar disorder group) were matched by age, sex, and registered general practice to 20 'controls' without recorded bipolar disorder (the control group). Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events before the index (diagnosis) date.

RESULTS

There were 2366 patients with incident bipolar disorder diagnoses and 47 138 matched control patients (median age 40 years and 60.4% female: n = 1430/2366 with bipolar disorder and n = 28 471/47 138 without). Compared with the control group, the bipolar disorder group had a higher incidence of diagnosed depressive, psychotic, anxiety, and personality disorders and escalating self-harm up to 10 years before a bipolar disorder diagnosis. Sleep disturbance, substance misuse, and mood swings were more frequent among the bipolar disorder group than the control group. The bipolar disorder group had more frequent face-to-face consultations, and were more likely to miss multiple scheduled appointments and to be prescribed ≥3 different psychotropic medication classes in a given year.

CONCLUSION

Psychiatric diagnoses, psychotropic prescriptions, and health service use patterns might be signals of unreported bipolar disorder. Recognising these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment, and initiation of appropriate treatments.

Prevalence, risk factors, and comorbidities of psychotic experiences in Afghanistan: a highly stressful environment

OBJECTIVES

To estimate the prevalence and demographic, psychiatric, and trauma-focused correlates of psychotic experiences (PEs) in the Afghan general population.

METHODS

Data were drawn from a cross-sectional household survey implemented in eight regions of Afghanistan (N = 4445). The CIDI structured instrument was administered to adults to assess psychiatric disorders and psychotic experiences; life events and PTSD were assessed using validated instruments. Weighted multivariate models integrated socio-demographics, regions, traumas as determinants of PE.

RESULTS

PEs were frequently reported in the Afghan population: 27.50% of the population reported a lifetime PE. PEs were more common among specific ethnic groups, and were associated with lower income in adjusted regression models. PEs were associated with mental health problems including major depressive disorders (OR = 3.43), PTSD (OR = 5.08), generalized anxiety (OR = 4.2); lifetime suicidal attempts (OR 6.04), lifetime suicidal thoughts (OR = 3.42), addiction (OR = 2.18); and psychological distress and impairment due to mental health (OR = 2.95 and 2.46, respectively).

CONCLUSION

Psychotic experiences in the Afghan general population confirm general population findings in other countries, that psychotic experiences are common and associated with economic and social marginalization, and part of a continuum of mental health problems experienced in populations. Efforts to reduce and treat psychotic experiences within a broad array of psychiatric conditions are needed.

Associations between digital media use and psychotic experiences in young adults of Quebec, Canada: a longitudinal study

PURPOSE

Digital media use has been associated with psychotic experiences in youth from the community, but the direction of association remains unclear. We aimed to examine between- and within-person associations of digital media use and psychotic experiences in youth.

METHODS

The sample included 425 participants aged 18-25 years (82.5% female) from the community, followed between May 2021 and January 2022 over 3 time points-of which 263 participants (61.9%) completed at least 2. Digital media use was self-reported as time spent daily on TV and streaming platforms, social media, and video games over the past 3 months. Psychotic experiences in the past 3 months were measured with the 15-item Community Assessment of Psychic Experiences. Associations between digital media use and psychotic experiences were estimated using a random-intercept cross-lagged panel model.

RESULTS

On average, individuals who reported greater digital media use also reported higher levels of psychotic experiences (r = 0.34, 95% CI 0.15, 0.53). However, a person's variation in digital media use, relative to their personal average, was not significantly associated with subsequent variations in their levels of psychotic experiences, or vice-versa. Results were similar across TV/streaming, social media and video game use, and after adjusting for age, sex, education, sleep, physical activity, and cannabis use.

CONCLUSION

Individuals with a tendency for higher levels of digital media use also had a tendency for higher levels of psychotic experiences. Understanding this association may help personalize mental health interventions for people with psychotic experiences, which may be offered digitally to promote their accessibility.

Psychosis screening questionnaire: Exploring its factor structure among South African adults

Background

Early detection of psychosis improves treatment outcomes, but there is limited research evaluating the validity of psychosis screening instruments, particularly in low-resourced countries.

Aim

This study aims to assess the construct validity and psychometric properties of the psychosis screening questionnaire (PSQ) in South Africa.

Setting

This study was conducted at several health centres in the Western and Eastern Cape provinces in South Africa.

Methods

The sample consisted of 2591 South African adults participating as controls in a multi-country case-control study of psychiatric genetics. Using confirmatory factor analysis and item response theory, we evaluated the psychometric properties of the PSQ.

Results

Approximately 11% of the participants endorsed at least one psychotic experience on the PSQ, and almost half of them (49%) occurred within the last 12 months. A unidimensional model demonstrated good fit (root mean square error of approximation [RMSEA] = 0.023, comparative fit index [CFI] = 0.977 and Tucker-Lewis Index [TLI] = 0.954). The mania item had the weakest association with a single latent factor (standardised factor loading = 0.14). Model fit improved after removing the mania item (RMSEA = 0.025, CFI = 0.991 and TLI = 0.972). With item response theory analysis, the PSQ provided more information at higher latent trait levels.

Conclusion

Consistent with prior literature, the PSQ demonstrated a unidimensional factor structure among South Africans. In our study, the PSQ in screening for psychosis performed better without the mania item, but future criterion validity studies are warranted.

Contribution

This study highlights that PSQ can be used to screen for early psychosis.

Regional Vulnerability Indices in Youth With Persistent and Distressing Psychoticlike Experiences

Importance

Distressing and persistent psychoticlike experiences (PLEs) in youth are associated with greater odds of developing psychiatric conditions in adulthood. Despite this risk, it is unclear whether early PLEs show similar brain patterns compared with adults with psychiatric and neurologic conditions.

Objective

To examine the degree to which persistent and distressing PLEs exhibit neural metrics that show similarity to adults with chronic psychiatric and neurologic conditions.

Design, Setting, and Participants

This cohort study used Adolescent Brain Cognitive Development (ABCD) Study examining the persistence and distress associated with PLEs across the first 3 waves of data with baseline structural magnetic resonance imaging data. Analyzed data were collected between September 1, 2016, and September 27, 2021. Children were recruited from 21 research sites across the US.

Exposures

Psychoticlike experiences were assessed using the Prodromal Questionnaire-Brief Child Version, and participants were categorized into groups based on the persistence and distress associated with PLEs.

Main Outcomes and Measures

Cortical and subcortical regional vulnerability indices (RVIs) were created by quantifying the similarity of participants' baseline neuroimaging measures to the expected patterns found in adult neuropsychiatric samples. The PLE groups were compared on the following RVI cortical and subcortical metrics: schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, Parkinson disease, Alzheimer disease, and metabolic diseases.

Results

Analyses examined PLE groups created from 8242 children in the ABCD sample (52.5% male; mean [SD] age, 9.93 [0.63] years; and 56.3% White), including persistent distressing PLEs (n = 329), transient distressing PLEs (n = 396), persistent nondistressing PLEs (n = 234), transient nondistressing PLEs (n = 390), and low distressing PLEs (n = 6893) groups. Participants with persistent or transient distressing PLEs broadly showed increased subcortical RVI scores across most RVI metrics, with persistent distressing PLEs additionally showing increased scores for cortical RVI metrics. The greatest effect sizes were found for persistent distressing PLEs with cortical RVI-schizophrenia spectrum disorders (β estimate, 1.055; 95% CI, 0.326-1.786) and RVI-Alzheimer disease (β estimate, 2.473; 95% CI, 0.930-4.018).

Conclusions and Relevance

In this cohort study of ABCD participants, the findings suggest that especially the persistent distressing PLEs in children were associated with neural metrics resembling those observed in adults with severe psychiatric and neurologic conditions. These findings support the potential use of brain-based risk scores for early identification and precision medicine approaches in the assessment of PLEs.

Do Anxiety Symptoms Mediate the Association Between Cannabis Use Frequency and Psychotic-Like Experiences in Emerging Adult Undergraduates?

OBJECTIVE

Cannabis is commonly used by Canadian emerging adults (ages 18-25 years), many of whom attend post-secondary institutions. Frequent cannabis use is linked with psychotic-like experiences (PLEs); however, the exact nature of this association remains unclear. Anxiety symptoms may mediate this association, as they are prevalent in emerging adults and have been independently linked with both cannabis use and PLEs. Past work found that anxiety mediated the association between cannabis use frequency and attenuated positive psychotic symptoms (further along the psychosis continuum than PLEs), however this research had yet to be validated in the Canadian population, and trait rather than state anxiety (frequency of anxiety symptoms) was studied. Thus, our primary objective was to examine if anxiety symptoms mediated the association between cannabis use frequency and PLEs in Canadian emerging adult undergraduates. Despite known sex differences in cannabis use, expression of anxiety, and PLEs, past work did not evaluate the potential impact of biological sex on the anxiety-mediated model, and thus is the secondary objective of the present study.

METHODS

1,266 first-/second-year emerging adult undergraduates from five Canadian universities provided cross-sectional, self-report survey data in fall 2021 semester. Validated measures of cannabis use frequency, anxiety, and PLEs were administered.

RESULTS

Path analyses supported mediation from cannabis use to PLEs through anxiety (b  =  0.07, P < 0.001, 95% bootstrap CI [0.03, 0.10]). No direct effect was found (P  =  0.457), suggesting that the cannabis-to-PLEs association was mediated by anxiety. Mediation did not depend on biological sex (i.e., bootstrapped 95% CIs crossed zero).

CONCLUSIONS

Anxiety symptoms mediated the association between cannabis use and PLEs in emerging adults regardless of their biological sex. Assuming replication in prospective research, results highlight anxiety as an important intervention target in frequent cannabis-using emerging adults, to potentially prevent development/worsening of PLEs, and in turn psychotic illness.

Psychotic experiences, perceived stress, and suicidal ideation among the general population during the COVID-19 pandemic: Findings from Japan

BACKGROUND

Psychotic experiences (PEs) have been linked to suicidality. However, little is known about the mechanisms underlying this association. This cross-sectional study examined the role of perceived stress in the association between PEs and suicidal ideation in the general population during the COVID-19 pandemic, which has been linked to high levels of stress and an increase in suicidal behavior.

METHODS

Data were analyzed from an online sample of 1452 Japanese individuals aged 18 to 89 that were collected in February 2021. Information was obtained on past-year suicidal ideation and PEs, which were assessed with the PRIME Screen-Revised (PS-R). Perceived stress was measured with the Perceived Stress Scale (PSS-14). Logistic regression was used to examine associations.

RESULTS

In an analysis adjusted for sociodemographic factors, PEs were associated with 2.4 times higher odds for past-year suicidal ideation. However, further adjusting the analysis for mental health (depressive symptoms) attenuated the association (OR: 1.49, 95%CI: 0.76-2.93). In an analysis adjusted for mental health, individuals with PEs and perceived stress had significantly higher odds for suicidal ideation (OR: 4.77, 95%CI: 1.83-12.44), while PEs without perceived stress were not linked to suicidal thoughts (OR: 0.47, 95%Cl: 0.13-1.77). A further analysis showed that stress mediated the PEs-suicidal ideation association.

CONCLUSIONS

Self-perceived stress plays an important role in the association between PEs and suicidal ideation. The detection and management of stress in people with PEs may help prevent negative outcomes such as suicidal thoughts and behaviors in this population.

Psychometric Properties and Diagnostic Associations of the Short-Form Community Assessment of Psychic Experiences in a Population-Based Sample of 29 021 Adult Men

BACKGROUND AND HYPOTHESIS

Around 5%-7% of the adult population are estimated to have lifetime psychotic experiences (PEs), which are associated with psychosis risk. PEs assessed with Community Assessment of Psychic Experiences (CAPE) are associated with psychosis but also non-psychotic disorders, which could be partly explained by CAPE indirectly capturing emotional symptoms. We investigated the psychometric properties of a shorter version, CAPE-9, and whether CAPE-9 scores are associated with lifetime psychotic or non-psychotic mental disorders after controlling for current anxiety and depressive symptoms.

DESIGN

CAPE-9 questionnaire data were obtained from 29 021 men (42.4 ± 5.6 yrs.) from the Norwegian Mother, Father, and Child Cohort Study. We investigated CAPE-9 reliability and factor structure. Logistic regression was used to test effects of current anxiety and depressive symptoms (SCL-12) on associations between CAPE-9 scores and psychiatric diagnoses.

RESULTS

CAPE-9 fit a previously reported 3-factor structure and showed good reliability. Twenty-six percent reported at least one lifetime PE. CAPE-9 scores were significantly associated with most psychiatric disorders (schizophrenia, depression, bipolar disorder, substance abuse, anxiety, trauma-related disorders, and ADHD). After controlling for concurrent emotional symptoms, only associations with schizophrenia (OR = 1.29; 95% CI = 1.18-1.38) and trauma-related disorders (OR = 1.09; CI = 1.02-1.15) remained significant.

CONCLUSIONS

CAPE-9 showed good psychometric properties in this large population-based adult male sample, and PEs were more clearly associated with psychotic disorders after controlling for current emotional symptoms. These results support the use of the short CAPE-9 as a cost-effective tool for informing public health initiatives and advancing our understanding of the dimensionality of psychosis.

Psychotic experiences and negative symptoms from adolescence to emerging adulthood: developmental trajectories and associations with polygenic scores and childhood characteristics

BACKGROUND

Psychotic experiences and negative symptoms (PENS) are common in non-clinical populations. PENS are associated with adverse outcomes, particularly when they persist. Little is known about the trajectories of PENS dimensions in young people, nor about the precursory factors associated with these trajectories.

METHODS

We conducted growth mixture modelling of paranoia, hallucinations, and negative symptoms across ages 16, 17, and 22 in a community sample (N = 12 049-12 652). We then described the emergent trajectory classes through their associations with genome-wide polygenic scores (GPS) for psychiatric and educational phenotypes, and earlier childhood characteristics.

RESULTS

Three trajectory classes emerged for paranoia, two for hallucinations, and two for negative symptoms. Across PENS, GPS for clinical help-seeking, major depressive disorder, and attention deficit hyperactivity disorder were associated with increased odds of being in the most elevated trajectory class (OR 1.07-1.23). Lower education GPS was associated with the most elevated trajectory class for hallucinations and negative symptoms (OR 0.77-0.91). Conversely for paranoia, higher education GPS was associated with the most elevated trajectory class (OR 1.25). Trajectory class associations were not significant for schizophrenia, obsessive-compulsive disorder, bipolar disorder, or anorexia GPS. Emotional/behaviour problems and life events in childhood were associated with increased odds of being in the most elevated trajectory class across PENS.

CONCLUSIONS

Our results suggest latent heterogeneity in the development of paranoia, hallucinations, and negative symptoms in young people that is associated with specific polygenic scores and childhood characteristics.

Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts

BACKGROUND

Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI).

METHODS

We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14 years (N = 3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15 years (N = 910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems.

RESULTS

Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage.

CONCLUSION

Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.

Prevalence, incidence, and persistence of psychotic experiences in the general population: results of a 9-year follow-up study

BACKGROUND

Psychotic experiences (PEs) frequently occur and are associated with a range of negative health outcomes. Prospective studies on PEs are scarce, and to date no study investigated PE prevalence, incidence, persistence, their risk indicators, and psychiatric comorbidity, in one dataset. Furthermore, most studies are based on self-report, and it is unclear how this compares to clinical interviews.

METHODS

Data are used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric cohort study among a representative sample of adults (baseline characteristics: N = 6646; 49.6% female; 18-64 years). Results are presented for self-reported and clinically validated PEs. Associations are assessed for mental disorders, socio-demographic, vulnerability, physical health, and substance use factors.

RESULTS

Based on self-report, at baseline 16.5% of respondents had at least one PE in their lifetime, of those, 30.1% also reported a PE at 3-year follow-up. 4.8% had a first PE at 3-year follow up. The 3-year prevalence of PE was associated with almost all studied risk indicators. Generally, the strongest associations were found for mental health disorders. Prevalence and incidence rates were two to three times higher in self-report than in clinical interview but results on associated factors were similar.

CONCLUSIONS

Validated prevalence and incidence estimates of PE are substantially lower than self-reported figures but results on associated factors were similar. Therefore, future studies on associations of PEs can rely on relatively inexpensive self-reports of PEs. The associations between PE and mental disorders underline the importance of assessment of PE in general practice.

Distress related to psychotic experiences: Enhancing the world health organization composite international diagnostic interview psychosis screen

BACKGROUND

The abbreviated version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) psychosis screen tends to yield high prevalence in online samples. Psychotic Experiences (PE) may not necessarily indicate current or imminent psychopathology; however, distressing PE appear to be more clinically informative.

METHODS

We analyzed data collected from an online survey administered to a Qualtrics panel (N = 2522 adults). Using multivariable logistic regression, we examined the association between PE (with and without associated distress) and several mental health outcomes, adjusting for age, gender, and race/ethnicity.

RESULTS

Individuals with distressing PE had greater odds of most mental health outcomes when compared with individuals with non-distressing PE. This was true for being in mental health treatment, loneliness, probable mental illness, suicidal ideation, and suicide attempt, adjusting for age, gender, race/ethnicity, and education level. The only exception was for hazardous alcohol use, for which there was no significant association with distressing PE.

CONCLUSION

As screening for PE gains traction in public health and preventive medicine, using an abbreviated version of the WHO CIDI psychosis screen may be clinically informative, especially when eliciting the distressful nature of PE.

Early Childhood Neurocognition in Relation to Middle Childhood Psychotic Experiences in Children at Familial High Risk of Schizophrenia or Bipolar Disorder and Population-Based Controls: The Danish High Risk and Resilience Study

BACKGROUND AND HYPOTHESIS

Familial high-risk (FHR) studies examining longitudinal associations between neurocognition and psychotic experiences are currently lacking. We hypothesized neurocognitive impairments at age 7 to be associated with increased risk of psychotic experiences from age 7 to 11 in children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and population-based controls (PBC), and further, impaired functioning in some neurocognitive functions to be associated with greater risk of psychotic experiences in children at FHR-SZ or FHR-BP relative to PBC.

STUDY DESIGN

Neurocognition was assessed at age 7 (early childhood) and psychotic experiences from age 7 to 11 (middle childhood) in 449 children from the Danish High Risk and Resilience Study. The neurocognitive assessment covered intelligence, processing speed, attention, visuospatial and verbal memory, working memory, and set-shifting. Psychotic experiences were assessed through face-to-face interviews with the primary caregiver and the child.

STUDY RESULTS

Set-shifting impairments at age 7 were associated with greater risk of psychotic experiences from age 7 to 11 in children at FHR-SZ. Children at FHR-BP and PBC showed no differential associations. Working memory and visuospatial memory impairments were related to increased risk of psychotic experiences across the cohort. However, adjusting for concurrent psychopathology attenuated these findings.

CONCLUSIONS

Early childhood neurocognitive impairments are risk markers of middle childhood psychotic experiences, of which impaired set-shifting appears to further increase the risk of psychotic experiences in children at FHR-SZ. More research is needed to examine longitudinal associations between neurocognitive impairments and psychotic experiences in FHR samples.

Risk for alcohol use problems in severe mental illness: Interactions with sex and racial/ethnic minority status

BACKGROUND

Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia and bipolar disorder.

METHODS

Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed "probable" alcohol use disorder (pAUD) risk score.

RESULTS

This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001).

LIMITATIONS

Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models.

CONCLUSIONS

SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.

Genetic and Geographical Associations With Six Dimensions of Psychotic Experiences in Adolesence

BACKGROUND AND HYPOTHESIS

Large-scale epidemiological and genetic research have shown that psychotic experiences in the community are risk factors for adverse physical and psychiatric outcomes. We investigated the associations of six types of specific psychotic experiences and negative symptoms assessed in mid-adolescence with well-established environmental and genetic risk factors for psychosis.

STUDY DESIGN

Fourteen polygenic risk scores (PRS) and nine geographical environmental variables from 3590 participants of the Twins Early Development Study (mean age 16) were associated with paranoia, hallucinations, cognitive disorganization, grandiosity, anhedonia, and negative symptoms scales. The predictors were modeled using LASSO regularization separately (Genetic and Environmental models) and jointly (GE model).

STUDY RESULTS

In joint GE models, we found significant genetic associations of negative symptoms with educational attainment PRS (β = -.07; 95% CI = -0.12 to -0.04); cognitive disorganization with neuroticism PRS (β = .05; 95% CI = 0.03-0.08); paranoia with MDD (β = .07; 95% CI = 0.04-0.1), BMI (β = .05; 95% CI = 0.02-0.08), and neuroticism PRS (β = .05; 95% CI = 0.02-0.08). From the environmental measures only family SES (β = -.07, 95% CI = -0.10 to -0.03) and regional education levels (β = -.06; 95% CI = -0.09 to -0.02) were associated with negative symptoms.

CONCLUSIONS

Our findings advance understanding of how genetic propensity for psychiatric, cognitive, and anthropometric traits, as well as environmental factors, together play a role in creating vulnerability for specific psychotic experiences and negative symptoms in mid-adolescence.

Exploring the relation between psychosis-like experiences and suicidal ideation, plans, and attempts among college students in the United States

AIM

The suicide rate among college students is particularly high, with evidence that psychosis-like experiences (PLEs) put these individuals at greater risk. The current study explored whether there are differential relations between four subtypes of PLEs and three suicide outcomes.

METHODS

We analysed a large sample of college students from the Fall semester cohort of the 2020 Healthy Minds Study (HMS) (weighted N = 36727). PLEs and suicide outcomes were assessed using binary variables from the World Health Organization Composite International Diagnostic Interview.

RESULTS

Findings revealed that reporting any of the subtypes of PLEs was associated with greater odds of suicidal ideation (SI), a suicide plan (SP) and a suicide attempt (SA) (signficant a ORs ranging from 1.30 to 3.30). For college students who endorsed SI or a SP in the past year, experiencing delusional mood (aOR [95% CI] = 1.30 [1.02-1.65]), suspiciousness (aOR [95% CI] = 1.31 [1.00-1.71]) and hallucinatory experiences (aOR [95% CI] = 2.76 [2.05-3.71]) in their lifetime increased their odds of reporting a SA in the past year. There was also evidence of a dose-dependent relation between the number of PLEs endorsed and all three suicide outcomes.

CONCLUSIONS

Certain subtypes of PLEs including delusional mood, suspiciousness and hallucinatory experiences may contribute to an elevated risk of suicide outcomes in college students. Moreover, the odds of reporting suicide outcomes were greater for individuals who endorsed a greater number of PLEs. It may be helpful to assess for indicated subtypes when determining suicide risk among college students and to be particularly mindful of those who report three or more PLEs.

Investigating the effectiveness of three school based interventions for preventing psychotic experiences over a year period - a secondary data analysis study of a randomized control trial

INTRODUCTION

Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up.

METHODS

The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling.

RESULTS

At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention.

CONCLUSIONS

This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.

Psychotic-like experiences are associated with physical disorders in general population: A cross-sectional study from the NESARC II

BACKGROUND

Psychotic-like experiences (PLEs) constitute subthreshold symptoms of psychotic disorders, and belong to five distinct dimensions: Positive, Negative, Depressive, Mania and Disorganization. PLEs are associated with various psychiatric disorders. However, few studies examined their association with physical disorders.

OBJECTIVE

Our aims were (1) to assess the associations between various physical disorders and PLEs in a U.S. representative sample, and (2) to examine these associations according to the five dimensions of PLEs.

METHOD

We used data from the wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II), a large national sample representative of the US population (N = 34,653). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule 4. Twenty-two PLEs were examined. Lifetime prevalence and adjusted Odds-Ratio (aOR) reflecting the association of sixteen physical disorders (including notably metabolic conditions and heart diseases) with PLEs were calculated.

RESULTS

All studied physical disorders were associated with the presence of PLEs. Particularly the presence of any physical condition, any heart disease and diabetes were more frequent in participants with at least one PLE compared with the group without any PLE (aOR = 1.74, 95% CI = 1.62-1.87, aOR = 1.44, 95% CI = 1.33-1.55 and aOR = 1.38, 95% CI = 1.24-1.54, respectively). Almost all physical disorders were associated with the five dimensions of PLEs.

CONCLUSIONS

PLEs were associated with a large range of physical disorders, with a gradual dose effect. To assess PLEs in the general population could help with the screening of subjects with physical disorders.

Association of Psychotic Experiences and Incident Depression in a Longitudinal Population-Based Community Survey

Objective

The present study aims to determine if psychotic experiences in a general population sample are a risk factor for depressive disorders at a 15-year follow-up visit.

Method

A longitudinal population cohort of adults over age 18 from East Baltimore were followed from 1981 to 1996 with 1409 participants included in analyses. Delusions and hallucinations and depressive disorders were assessed using DSM-III criteria. Odds ratios were obtained using logistic regression with psychotic experiences modeled both dichotomously and as count variables as predictors of major and minor depressive disorders at wave three. Age, race, and sex were included as covariates in the model.

Results

Both delusions and hallucinations were associated with an increased odds of incident depressive disorders. Delusions, but not hallucinations, were associated with increased odds of major depressive disorder (adjusted odds ratio, 3.04 [95% CI = 1.29-7.13]) and both delusions and hallucinations were associated with increased odds of minor depressive disorder (adjusted odds ratios, 4.6 [95% CI = 2.11-10.04] and 3.93 [95% CI = 2.11-7.32]). There was a dose-response relationship in number of psychotic experiences reported and odds of depressive disorders.

Conclusions

Lifetime psychotic experiences, particularly delusions, in the absence of mental disorders, are associated with later depressive disorders. Results persist in a dose-response manner. Future research should determine whether transitory versus persistent psychotic experiences have a differential effect on later depression.

Are attention-deficit/hyperactivity disorder symptoms associated with negative health outcomes in individuals with psychotic experiences? Findings from a cross-sectional study in Japan

Objective

Although research has indicated that the prevalence of attention-deficit/hyperactivity disorder (ADHD) may be elevated in individuals with psychotic disorders, as yet, there has been comparatively little research on this association and its effects among adults at the subclinical level. To address this deficit, the current study examined the association between psychotic experiences (PE) and ADHD symptoms in Japanese individuals and whether the presence of ADHD symptoms increases the risk for negative health outcomes in people with PE.

Method

Data were analyzed from an online sample of 1,452 individuals (age 18-89; 51.5% female) collected in 2021. Information on PE was obtained with the PRIME Screen-Revised (PS-R), while the Adult ADHD Self-Report Scale (ASRS) Screener was used to measure ADHD symptoms. Information was also obtained on a number of health outcomes including anxiety and depressive symptoms and suicidal ideation. Logistic regression was used to assess associations.

Results

In a fully adjusted analysis PE were associated with almost three times higher odds for ADHD symptoms (OR: 2.92, 95%CI: 1.19-7.17). In an analysis that was restricted to individuals with PE, ADHD symptoms were associated with significantly increased odds for depressive symptoms, lifetime suicidal ideation, perceived stress and severe sleep problems.

Conclusion

ADHD symptoms are present in some individuals with PE and increase the odds for several detrimental health outcomes in this population. Identifying co-occurring PE and ADHD/ADHD symptoms may facilitate treatment options and help prevent negative health outcomes in individuals with these conditions.

Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey

PURPOSE

Psychotic-like experiences (PLEs) are prevalent among adolescents and are the most significant predictor of future mental disorders. This study aims to examine the cross-sectional and longitudinal associations between sleep disturbance and PLEs in a large cohort of adolescents.

METHODS

The 17,722 adolescents in our study were assessed from April 21 to May 12, 2021 (Time 1, T1) and again 6 months later from December 17 to 26, 2021 (Time 2, T2). The Youth Self Rating Insomnia Scale and 8-item Positive Subscale of the Community Assessment of Psychic Experiences were used to assess sleep and PLEs, respectively. Sample characteristics and depression were also evaluated at T1, and negative life events were measured at T2. Sleep duration ≤6 h per night was considered as sleep deprivation, and sleep disturbance was defined as having insomnia or poor sleep quality.

RESULTS

The prevalence of sleep disturbance and frequent PLEs at T1 were 14.1% and 14.5%, respectively. Sleep disturbance and sleep deprivation at T1 were significantly associated with increased risk for PLEs at T2 after adjusting for sample characteristics, depression, and negative life events. Furthermore, sleep disturbance and sleep deprivation also predicted the new onset and persistence of PLEs.

CONCLUSION

Sleep disturbance predicts the development and persistence of PLEs. Early assessment and treatment of sleep disturbance may therefore contribute to a comprehensive strategy for the successful prevention and treatment of PLEs in adolescents.

Prevalence and risk factors of self-reported psychotic experiences among high school and college students: A systematic review, meta-analysis, and meta-regression

BACKGROUND

Adolescents are at high risk of incident psychopathology. Fleeting psychotic experiences (PEs) that emerge in young people in response to stress may be warning signs that are missed by research that fails to study stressed populations, such as late high school and college/university students. Our aim in this systematic review was to conduct a meta-analysis that estimates prevalence rates of PEs in students, and to assess whether these rates differ by gender, age, culture, and COVID-19 exposure.

METHOD

We searched nine electronic databases, from their inception until January 31, 2022 for relevant studies. We pooled the estimates using the DerSimonian-Laird technique and random-effects meta-analysis. Our main outcome was the prevalence of self-reported PEs in high school and college/university students. We subsequently analyzed our data by age, gender, population, country, culture, evaluation tool, and COVID-19 exposure.

RESULTS

Out of 486 studies retrieved, a total of 59 independent studies met inclusion criteria reporting 210' 024 students from 21 different countries. Nearly one in four students (23.31%; 95% CI 18.41%-29.05%), reported having experienced PEs (heterogeneity [Q = 22,698.23 (62), p = 0.001] τ²  = 1.4418 [1.0415-2.1391], τ = 1.2007 [1.0205-1.4626], I²  = 99.7%, H = 19.13 [18.59-19.69]). The 95% prediction intervals were 04.01%-68.85%. Subgroup analyses showed that the pooled prevalence differed significantly by population, culture, and COVID-19 exposure.

CONCLUSION

This meta-analysis revealed high prevalence rates of self-reported PEs among teen and young adult students, which may have significance for mental health screening in school settings. An important realization is that PEs may have very different mental health meaning in different cultures.

Testosterone Replacement Therapy in the Treatment of Depression

BACKGROUND

Depression is a common disorder that affects millions globally and is linked to reduced quality of life and mortality. Its pathophysiology is complex and there are several forms of treatment proposed in the literature with differing side effect profiles. Many patients do not respond to treatment which warrants augmentation with other treatments and the investigation of novel treatments. One of these treatments includes testosterone therapy which evidence suggests might improve depressed mood in older patients with low levels of testosterone and helps restore physical impairments caused by age-related hormonal changes.

OBJECTIVE

The objective of this review is to synthesize information regarding clinical depression, its treatment options, and the efficacy and safety of testosterone treatment for the treatment of depression.

METHODS

This review utilized comprehensive secondary and tertiary data analysis across many academic databases and published work pertaining to the topic of interest.

RESULTS

Within some subpopulations such as men with dysthymic disorder, treatment resistant depression, or low testosterone levels, testosterone administration yielded positive results in the treatment of depression. Additionally, rodent models have shown that administering testosterone to gonadectomized male animals reduces symptoms of depression. Conversely, some studies have found no difference in depressive symptoms after treatment with testosterone when compared with placebo. It was also noted that over administration of testosterone is associated with multiple adverse effects and complications.

CONCLUSION

The current evidence provides mixed conclusions on the effectiveness of testosterone therapy for treating depression. More research is needed in adult men to see if declining testosterone levels directly influence the development of depression.

Aggressive behaviors and associated factors in Chinese left-behind adolescents: a cross-sectional study

BACKGROUND

To examine whether the levels of aggressive behaviors and other individual and contextual variables differ between left-behind adolescents (LBA) and not left-behind adolescents (NLBA) and explore associations between aggression and other constructs among them.

METHODS

A cross-sectional study was conducted and 4530 school adolescents aged 9-18 years in north and south of China were randomly selected. The levels of aggressive behavior, personality and family and classroom environment were compared between LBA and NLBA and also the associated factors of aggression.

RESULTS

The total scores of aggressive behaviors were 6.33 ± 6.35 (Mean ± SD) in LBA and 5.78 ± 6.16 (Mean ± SD) in NLBA. Multiple linear regression models revealed that neuroticism and psychoticism were positively associated with aggressive behaviors for LBA with similar results of NLBA. Cohesion was negatively associated with aggressive behaviors, and conflict and achievement had positive effects in NLBA. Organization had a negative effect in LBA. Uncertainty and dissatisfaction had positive effects on aggression both in LBA and NLBA.

CONCLUSION

This study found a slightly higher level of aggressive behaviors in LBA comparing with NLBA. Personality was the mainly associated factor of aggression, but class-based interventions were more practical for aggressive behaviors in Chinese LBA.

Religiousness and psychotic experiences among young adult college students in the United States

BACKGROUND

Religiousness and psychotic experiences have been related, though findings have been mixed, with little attention paid to specific religious affiliations and religious importance.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021), which was an online survey administered at 140 college campuses across the United States. We used multivariable logistic regression to examine the associations between religiousness (affiliation and importance) and 12-month psychotic experiences, adjusting for age, gender, and race/ethnicity.

RESULTS

Only Christian religious affiliation was associated with lower odds of psychotic experiences (aOR: 0.79; 95% CI: 0.75, 0.84), while Non-Christian religious affiliation (aOR: 1.34; 95% CI: 1.19, 1.50) and Multiple religious affiliation s were associated with greater odds (aOR: 1.28; 95% CI: 1.15, 1.42). Overall, increased religious importance was associated with lower odds of psychotic experiences (aOR: 0.96; 95% CI: 0.94-0.99). After stratifying by affiliation, religious importance was only associated with lower odds of psychotic experiences among people who identified as Other Christian, Mormon, and Other World Religion. Religious importance was associated with greater odds of psychotic experiences among Atheists, Agnostics, Buddhists, Nothing in Particular, and Multiple Religions.

CONCLUSION

Religious affiliation and importance had varying associations with psychotic experiences, depending on type of religious affiliation. More research is needed to explore the modifying effects of religiousness. Responsiveness to religious beliefs and practices may be critical when assessing risk for psychosis.

Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood

OBJECTIVE

The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences.

METHOD

In a sample of 9- to 10-year-olds (N = 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association.

RESULTS

Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support.

CONCLUSION

This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.

Psychotic experiences among Black college students in the United States: The role of socioeconomic factors and discrimination

BACKGROUND

Psychosis is more prevalent among Black individuals compared with White individuals. However, it is unknown whether this disparity exists among college populations in the United States, and if so, what factors contribute to the disparity.

METHODS

We analyzed data from Black and White young adult students using the Health Minds Study (2020-2021), which is a survey administered at 140 colleges in the U.S. Using mediation analysis, we examined the extent to which the relation between race and psychotic experiences was mediated by socioeconomic factors (past and current financial distress, food insecurity, parental education) and discrimination.

RESULTS

Approximately 38 % of Black students and 30 % of White students reported lifetime psychotic experiences. Including all socioeconomic factors together in the same model accounted for just over half (50.2 %) the association between race and psychotic experiences. We then conducted additional analyses examining discrimination, all the socioeconomic factors plus discrimination accounted for 81.5 % of the association between race and psychotic experiences. When disentangling the mediators, food insecurity and discrimination accounted for the largest percentages of the association. The effects of past financial distress and parental education were modified by race.

CONCLUSION

Black college students were more likely to report lifetime psychotic experiences than their White counterparts. Moreover, socioeconomic factors and discrimination made significant contributions to this racial difference.

Childhood adversity increases risk of psychotic experiences in patients with substance use disorder

INTRODUCTION

Adverse childhood experiences (ACEs) increase the risk of psychotic experiences (PE), but little is known about heterogeneities of this association in different developmental stages, dimensions, or whether they are affected by substance use disorder (SUD). This study examines the association between different types of ACEs at various developmental stages and lifetime PE in patients with SUD in Chile.

METHODS

We included 399 consenting adults in outpatient or residential SUD treatment programs. Sociodemographic data and information about PE and ACEs were obtained by trained clinical psychologists.

RESULTS

Patients reporting PE experienced more ACEs compared to patients without PE (4.2 versus 3.4). They also experienced more complex adversities (41.8% versus 25.1%), had more psychiatric comorbidities (85% versus 70.4%), and reported using more substances (mean 4.5 versus 3.9). Adjusted association between ACEs and PE showed the highest OR for arrests (1.88), sexual abuse (1.81), alcohol abuse by parents (1.48), school exclusion (1.39), foster or residential care (18.3).

CONCLUSION

Early exposure to ACEs is a risk factor for later PE among patients with SUD. Type of ACE and the period when they occurred is important, suggesting the existence of critical periods where the individual is more susceptible to adverse environmental stimuli.

A functional neuroimaging study of self-other processing alterations in atypical developmental trajectories of psychotic-like experiences

Self-disturbances constitute a hallmark of psychosis, but it remains unclear whether these alterations are present in at-risk populations, and therefore their role in the development of psychosis has yet to be confirmed. The present study addressed this question by measuring neural correlates of self-other processing in youth belonging to three developmental trajectories of psychotic experiences. Eighty-six youths were recruited from a longitudinal cohort of over 3800 adolescents based on their trajectories of Psychotic-Like Experiences from 12 to 16 years of age. Participants underwent neuroimaging at 17 years of age (mean). A functional neuroimaging task evaluating self- and other-related trait judgments was used to measure whole-brain activation and connectivity. Youth who showed an increasing trajectory displayed hypoactivation of the dorsomedial prefrontal cortex and hypoconnectivity with the cerebellum. By contrast, youth who showed a decreasing trajectory displayed decreased activation of the superior temporal gyrus, the inferior frontal gyrus, and the middle occipital gyrus. These findings suggest that the increasing trajectory is associated with alterations that might erode distinctions between self and other, influencing the emergence of symptoms such as hallucinations. The decreasing trajectory, in comparison, was associated with hypoactivations in areas influencing attention and basic information processing more generally. These alterations might affect the trajectories’ susceptibilities to positive vs. negative symptoms, respectively.

Nongenetic Factors Associated With Psychotic Experiences Among UK Biobank Participants: Exposome-Wide Analysis and Mendelian Randomization Analysis

Importance

Although hypothesis-driven research has identified several factors associated with psychosis, this one-exposure-to-one-outcome approach fails to embrace the multiplicity of exposures. Systematic approaches, similar to agnostic genome-wide analyses, are needed to identify genuine signals.

Objective

To systematically investigate nongenetic correlates of psychotic experiences through data-driven agnostic analyses and genetically informed approaches to evaluate associations.

Design, Setting, Participants

This cohort study analyzed data from the UK Biobank Mental Health Survey from January 1 to June 1, 2021. An exposome-wide association study was performed in 2 equal-sized split discovery and replication data sets. Variables associated with psychotic experiences in the exposome-wide analysis were tested in a multivariable model. For the variables associated with psychotic experiences in the final multivariable model, the single-nucleotide variant-based heritability and genetic overlap with psychotic experiences using linkage disequilibrium score regression were estimated, and mendelian randomization (MR) approaches were applied to test potential causality. The significant associations observed in 1-sample MR analyses were further tested in multiple sensitivity tests, including collider-correction MR, 2-sample MR, and multivariable MR analyses.

Exposures

After quality control based on a priori criteria, 247 environmental, lifestyle, behavioral, and economic variables.

Main Outcomes and Measures

Psychotic experiences.

Results

The study included 155 247 participants (87 896 [57%] female; mean [SD] age, 55.94 [7.74] years). In the discovery data set, 162 variables (66%) were associated with psychotic experiences. Of these, 148 (91%) were replicated. The multivariable analysis identified 36 variables that were associated with psychotic experiences. Of these, 28 had significant genetic overlap with psychotic experiences. One-sample MR analyses revealed forward associations with 3 variables and reverse associations with 3. Forward associations with ever having experienced sexual assault and pleiotropy of risk-taking behavior and reverse associations without pleiotropy of experiencing a physically violent crime as well as cannabis use and the reverse association with pleiotropy of worrying too long after embarrassment were confirmed in sensitivity tests. Thus, associations with psychotic experiences were found with both well-studied and unexplored multiple correlated variables. For several variables, the direction of the association was reversed in the final multivariable and MR analyses.

Conclusions and Relevance

The findings of this study underscore the need for systematic approaches and triangulation of evidence to build a knowledge base from ever-growing observational data to guide population-level prevention strategies for psychosis.

Heritability of Psychotic Experiences in Adolescents and Interaction With Environmental Risk

IMPORTANCE

Genetic risk factors are known to play a role in the etiology of psychotic experiences in the general population. Little is known about whether these risk factors interact with environmental risks for psychotic experiences.

OBJECTIVE

To assess etiological heterogeneity and exposure to environmental risks associated with psychotic experiences in adolescence using the twin design.

DESIGN, SETTING, AND PARTICIPANTS

This twin study, conducted from December 1, 2014, to August 31, 2020, included a UK-based sample of twin pairs aged 16 years. This investigation evaluated the extent to which the genetic variance underlying psychotic experiences and the magnitude of the heritability of psychotic experiences was moderated by exposure to 5 environmental risk factors (bullying, dependent life events, cannabis use, tobacco use, and low birth weight). Psychotic experiences were assessed by 5 self-reported measures and 1 parent-reported measure. Participants' exposure to environmental risks was assessed at birth and age 12 to 16 years. Structural equation models were used to assess differences in the variance in and heritability of psychotic experiences across these exposures, while controlling for gene-environment correlation effects. Analyses were repeated in an independent Swedish sample. Data analyses were performed from September 1, 2018, to August 31, 2020.

MAIN OUTCOMES AND MEASURES

Primary outcome measures were exposure to environmental factors, as measured by a composite score, and psychotic experiences.

RESULTS

A total of 4855 twin pairs (1926 female same-sex pairs, 1397 male same-sex pairs, and 1532 opposite-sex pairs) were included from the Twins Early Development Study (TEDS), and 6435 twin pairs (2358 female same-sex pairs, 1861 male same-sex pairs, and 2216 opposite-sex pairs) were included from the Child and Adolescent Twin Study in Sweden (CATSS). Mean age of twins from TEDS was 16.5 years. Mean age of twins from CATSS was 18.6 years. More exposure to environmental risk factors was associated with having more psychotic experiences. The relative contribution of genetic influences to psychotic experiences was lower with increasing environmental exposure for paranoia (44%; 95% CI, 33%-53% to 38%; 95% CI, 14%-58%), cognitive disorganization (47%; 95% CI, 38%-51% to 32%; 95% CI, 11%-45%), grandiosity (41%; 95% CI, 29%-52% to 32%; 95% CI, 9%-48%), and anhedonia (49%; 95% CI, 42%-53% to 37%; 95% CI, 15%-54%). This pattern was replicated for the measure of psychotic experiences in the independent Swedish replication sample. The heritability of hallucinations and parent-rated negative symptoms remained relatively constant.

CONCLUSIONS AND RELEVANCE

Findings of this twin study suggest that environmental factors play a greater role in the etiology of psychotic experiences than genetic factors. The relative importance of environmental factors is even higher among individuals exposed to environmental risks for psychotic experiences, highlighting the importance of a diathesis-stress or bioecological framework for understanding adolescent psychotic experiences.

Psychotic-like experiences of young adults in the general population predict mental disorders

Psychotic-like experiences (PLEs) have been identified as risk markers for psychotic disorders and may indicate an individual's susceptibility to mental disorders in general. We examined whether 23 PLEs (assessed with M-CIDI questionnaire) reported in young adulthood (n = 1313) predict subsequent psychotic or any mental disorders in the general population. We also investigated whether these possible associations are explained by general psychological distress assessed with the General Health Questionnaire-12 (GHQ-12). The register follow-up period spanned 10-12 years. In Cox regression models, PLEs predicted subsequent psychotic disorders (n = 12) when the effects of age, sex, education, and marital status were adjusted for, but not when general psychological distress was added to the model. Having any mental disorders during follow-up (n = 91) was predicted by PLEs reported at a younger age, when controlling for age, sex, education, marital status, and general psychological distress. In line with earlier results in other age groups, PLEs can be seen as a sign of vulnerability to not just psychotic but all mental disorders during the following years also among young adults in the general population. PLEs were a predictive marker of general psychopathology independently from general psychological distress.

Comparing psychotic experiences in low-and-middle-income-countries and high-income-countries with a focus on measurement invariance

BACKGROUND

The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias.

METHODS

A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses.

RESULTS

MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = -0.42) and underestimation (e.g. magical thinking, d = -0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition.

CONCLUSION

Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.