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Original Investigation |

Psychotic Experiences in the General Population A Cross-National Analysis Based on 31 261 Respondents From 18 Countries

John J. McGrath, PhD, MD1,2,3; Sukanta Saha, PhD1,2,3; Ali Al-Hamzawi, MD4; Jordi Alonso, DrPH, MD5,6; Evelyn J. Bromet, PhD7; Ronny Bruffaerts, PhD8; José Miguel Caldas-de-Almeida, PhD, MD9; Wai Tat Chiu, AM10; Peter de Jonge, PhD11; John Fayyad, MD12; Silvia Florescu, PhD, MD13; Oye Gureje, MD14; Josep Maria Haro, PhD, MD15; Chiyi Hu, PhD, MD16; Viviane Kovess-Masfety, PhD, MD17; Jean Pierre Lepine, HDR, MD18; Carmen C. W. Lim, MSc19; Maria Elena Medina Mora, PhD20; Fernando Navarro-Mateu, PhD, MD21; Susana Ochoa, PhD15; Nancy Sampson, BA10; Kate Scott, PhD19; Maria Carmen Viana, PhD, MD22; Ronald C. Kessler, PhD10
[+] Author Affiliations
1Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
2Discipline of Psychiatry, University of Queensland, St Lucia, Australia
3Queensland Brain Institute, University of Queensland, St Lucia, Australia
4College of Medicine, Al-Qadisiya University, Al Diwaniya City, Iraq
5Health Services Research Unit, Instituto Hospital del Mar de Investigaciones Médicas, Institut de Recerca Hospital del Mar, Barcelona, Spain
6Centros de Investigación Biomédica en Red (CIBER) en Epidemiologõïa y Salud Puïblica, Barcelona, Spain
7Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
8Universitair Psychiatrisch Centrum–Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
9Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
10Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
11Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation, University of Groningen, University Medical Center, Groningen, the Netherlands
12Institute for Development, Research, Advocacy, and Applied Care, Beirut, Lebanon
13National School of Public Health, Management and Professional Development, Bucharest, Romania
14Department of Psychiatry, University College Hospital, Ibadan, Nigeria
15Parc Sanitari Sant Joan de Déu, Centros de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain
16Shenzhen Insitute of Mental Health and Shenzhen Kanging Hospital, Shenzhen, China
17Ecole des Hautes Etudes en Santé Publique, EA 4057 Paris Descartes University, Paris, France
18Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, l’Unité Mixte de Recherche S 1144, University Paris Diderot and Paris Descartes, Paris, France
19Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
20National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
21Subdirección General de Salud Mental, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Murcia, Spain
22Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil
JAMA Psychiatry. 2015;72(7):697-705. doi:10.1001/jamapsychiatry.2015.0575.
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Importance  Community-based surveys find that many otherwise healthy individuals report histories of hallucinations and delusions. To date, most studies have focused on the overall lifetime prevalence of any of these psychotic experiences (PEs), which might mask important features related to the types and frequencies of PEs.

Objective  To explore detailed epidemiologic information about PEs in a large multinational sample.

Design, Setting, and Participants  We obtained data from the World Health Organization World Mental Health Surveys, a coordinated set of community epidemiologic surveys of the prevalence and correlates of mental disorders in representative household samples from 18 countries throughout the world, from 2001 through 2009. Respondents included 31 261 adults (18 years and older) who were asked about lifetime and 12-month prevalence and frequency of 6 types of PEs (2 hallucinatory experiences and 4 delusional experiences). We analyzed the data from March 2014 through January 2015.

Main Outcomes and Measures  Prevalence, frequency, and correlates of PEs.

Results  Mean lifetime prevalence (SE) of ever having a PE was 5.8% (0.2%), with hallucinatory experiences (5.2% [0.2%]) much more common than delusional experiences (1.3% [0.1%]). More than two-thirds (72.0%) of respondents with lifetime PEs reported experiencing only 1 type. Psychotic experiences were typically infrequent, with 32.2% of respondents with lifetime PEs reporting only 1 occurrence and 31.8% reporting only 2 to 5 occurrences. We found a significant relationship between having more than 1 type of PE and having more frequent PE episodes (Cochran-Armitage z = −10.0; P < .001). Lifetime prevalence estimates (SEs) were significantly higher among respondents in middle- and high-income countries than among those in low-income countries (7.2% [0.4%], 6.8% [0.3%], and 3.2% [0.3%], respectively; χ22 range, 7.1-58.2; P < .001 for each) and among women than among men (6.6% [0.2%] vs 5.0% [0.3%]; χ21 = 16.0; P < .001). We found significant associations with lifetime prevalence of PEs in the multivariate model among nonmarried compared with married respondents (χ22 = 23.2; P < .001) and among respondents who were not employed (χ24 = 10.6; P < .001) and who had low family incomes (χ23 = 16.9; P < .001).

Conclusions and Relevance  The epidemiologic features of PEs are more nuanced than previously thought. Research is needed that focuses on similarities and differences in the predictors of the onset, course, and consequences of distinct PEs.

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Submit a Comment
Cultural Factors Related to Surveys of Psychological Symptoms
Posted on May 27, 2015
George Dyck, MD
University of Kansas, Professor Emeritus
Conflict of Interest: None Declared
I find it troubling that there is relatively little discussion in this article about the cultural and psychological factors that influence how individuals report psychotic symptoms, to say nothing about how language differences play a role in whether a person gives an affirmative response to the questions posed. The degree to which a person will consciously or unconsciously decide to report a symptom is greatly dependent upon how negatively it is perceived, and also on how much the individual is concerned about the perception, even when the answers are anonymous. Furthermore, a delusion is by definition not perceived as a delusion by the person experiencing it. The same could be said about a hallucination in many cases.
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