The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Samples
Procedures
Data Collection and Data Items
Psychotic experiences.
DSM-IV mental disorders.
Statistical Analysis
Results
Lifetime Prevalence of Mental Disorders Among Respondents With and Without Psychotic Experiences
Total Sample (N=31,261) | Respondents With Lifetime Psychotic Experiences (N=2,385) | Respondents Without Lifetime Psychotic Experiences (N=28,876) | Odds Ratio Between Lifetime Psychotic Experiences and Lifetime Mental Disorder | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mental Disorder | Na | %b | SE | Na | %b | SE | Na | %b | SE | Odds Ratioc | 95% CI |
Mood disorders | |||||||||||
Major depressive disorder with hierarchy | 6,824 | 11.8 | 0.2 | 897 | 25.4 | 1.2 | 5,927 | 10.9 | 0.2 | 2.3* | 2.0–2.6 |
Bipolar disorder (broad) | 1,212 | 2.3 | 0.1 | 196 | 6.5 | 0.6 | 1,016 | 2.1 | 0.1 | 2.8* | 2.2–3.5 |
Anxiety disorders | |||||||||||
Panic disorder | 1,019 | 1.8 | 0.1 | 181 | 4.8 | 0.5 | 838 | 1.6 | 0.1 | 2.7* | 2.2–3.4 |
Generalized anxiety disorder with hierarchy | 1,832 | 3.4 | 0.1 | 276 | 8.0 | 0.6 | 1,556 | 3.1 | 0.1 | 2.4* | 2.0–3.0 |
Social phobia | 2,495 | 4.7 | 0.1 | 382 | 12.1 | 0.8 | 2,113 | 4.3 | 0.1 | 2.4* | 2.0–2.8 |
Specific phobia | 4,108 | 8.4 | 0.2 | 630 | 20.5 | 1.1 | 3,478 | 7.6 | 0.2 | 2.6* | 2.3–3.0 |
Agoraphobia without panic | 557 | 1.0 | 0.1 | 102 | 3.1 | 0.4 | 455 | 0.9 | 0.1 | 2.8* | 2.0–3.9 |
Posttraumatic stress disorder | 1,811 | 3.7 | 0.1 | 328 | 10.2 | 0.7 | 1,483 | 3.3 | 0.1 | 3.0* | 2.5–3.6 |
Separation anxiety disorder (child) | 449 | 2.2 | 0.1 | 90 | 5.7 | 0.8 | 359 | 2.0 | 0.1 | 2.3* | 1.6–3.1 |
Separation anxiety disorder (adult) | 877 | 3.7 | 0.2 | 186 | 11.1 | 1.0 | 691 | 3.2 | 0.2 | 3.1* | 2.4–4.0 |
Impulse control disorders | |||||||||||
Intermittent explosive disorder with hierarchy | 1,023 | 3.3 | 0.1 | 153 | 8.4 | 0.7 | 870 | 3.0 | 0.1 | 2.1* | 1.7–2.6 |
Attention deficit hyperactivity disorder | 368 | 1.5 | 0.1 | 79 | 5.1 | 0.8 | 289 | 1.3 | 0.1 | 2.6* | 1.8–3.9 |
Oppositional defiant disorder with hierarchy | 311 | 2.2 | 0.2 | 68 | 5.8 | 0.9 | 243 | 1.9 | 0.2 | 2.7* | 1.8–4.1 |
Conduct disorder | 329 | 2.1 | 0.2 | 64 | 5.4 | 0.8 | 265 | 1.8 | 0.2 | 2.3* | 1.6–3.4 |
Eating disorders | |||||||||||
Anorexia nervosa | 69 | 0.4 | 0.1 | 13 | 0.7 | 0.3 | 56 | 0.3 | 0.1 | 1.8 | 0.7–4.4 |
Binge eating disorder with hierarchy | 563 | 2.1 | 0.1 | 128 | 5.0 | 0.5 | 435 | 1.9 | 0.1 | 2.0* | 1.5–2.6 |
Bulimia nervosa with hierarchy | 364 | 1.1 | 0.1 | 89 | 3.8 | 0.5 | 275 | 0.9 | 0.1 | 3.6* | 2.6–5.0 |
Substance use disorders | |||||||||||
Alcohol abuse with hierarchy | 1,908 | 5.1 | 0.2 | 232 | 9.8 | 0.9 | 1,676 | 4.8 | 0.2 | 1.7* | 1.4–2.0 |
Alcohol dependence | 1,170 | 2.4 | 0.1 | 205 | 6.3 | 0.6 | 965 | 2.1 | 0.1 | 2.3* | 1.8–2.8 |
Drug abuse with hierarchy | 644 | 1.8 | 0.1 | 83 | 3.6 | 0.5 | 561 | 1.7 | 0.1 | 1.6* | 1.2–2.1 |
Drug dependence | 481 | 1.2 | 0.1 | 104 | 3.8 | 0.5 | 377 | 1.0 | 0.1 | 2.7* | 1.9–3.6 |
Temporal Priorities Between Onset Ages for Psychotic Experiences and Mental Disorders
Mental Disorder | Respondents With Psychotic Experience and Mental Disorder | Respondents With Both Lifetime Mental Disorder of Interest and Lifetime Psychotic Experiences | |||||||
---|---|---|---|---|---|---|---|---|---|
Psychotic Experience Onset Prior to Disorder Onset | Psychotic Experience Onset and Disorder Onset in the Same Year | Psychotic Experience Onset After Disorder Onset | Goodness-of-Fit Test for Equal Proportiona | ||||||
N | %b | SE | %b | SE | %b | SE | χ2 | p | |
Mood disorders | |||||||||
Major depressive disorder with hierarchy | 897 | 44.5 | 2.0 | 10.2 | 1.2 | 45.4 | 2.2 | 0.1 | 0.767 |
Bipolar disorder (broad) | 196 | 53.7 | 5.0 | 7.2 | 2.5 | 39.1 | 5.0 | 6.0 | 0.024 |
Anxiety disorders | |||||||||
Panic disorder | 181 | 42.2 | 5.3 | 10.9 | 3.9 | 46.9 | 5.3 | 1.0 | 0.343 |
Generalized anxiety disorder with hierarchy | 276 | 46.1 | 4.2 | 6.8 | 1.9 | 47.1 | 4.3 | 0.0 | 0.839 |
Social phobia | 382 | 22.6 | 2.8 | 6.7 | 2.2 | 70.7 | 3.3 | 113.0 | <0.001 |
Specific phobia | 630 | 6.7 | 1.2 | 4.5 | 0.9 | 88.9 | 1.5 | 549.8 | <0.001 |
Agoraphobia without panic | 102 | 28.4 | 5.8 | 3.7 | 1.9 | 68.0 | 5.9 | 38.2 | <0.001 |
Posttraumatic stress disorder | 328 | 40.0 | 3.9 | 11.2 | 2.3 | 48.8 | 3.6 | 4.2 | 0.047 |
Separation anxiety disorder (child) | 90 | 9.1 | 2.8 | 3.8 | 2.0 | 87.1 | 3.4 | 163.5 | <0.001 |
Separation anxiety disorder (adult) | 186 | 46.7 | 5.0 | 7.5 | 1.9 | 45.8 | 5.0 | 0.0 | 0.893 |
Impulse control disorders | |||||||||
Intermittent explosive disorder with hierarchy | 153 | 25.4 | 3.3 | 5.3 | 2.3 | 69.4 | 3.9 | 105.0 | <0.001 |
Attention deficit hyperactivity disorder | 79 | 9.4 | 4.9 | 2.9 | 2.7 | 87.6 | 6.1 | 3,145.0 | <0.001 |
Oppositional defiant disorder with hierarchy | 68 | 17.6 | 5.8 | 1.1 | 1.1 | 81.3 | 5.9 | 401.3 | <0.001 |
Conduct disorder | 64 | 17.7 | 5.9 | 4.9 | 3.4 | 77.5 | 7.2 | 54.0 | <0.001 |
Eating disorders | |||||||||
Anorexia nervosa | 13 | 23.6 | 13.6 | — | — | 76.4 | 13.6 | —c | — |
Binge eating disorder with hierarchy | 128 | 44.7 | 5.9 | 6.9 | 2.9 | 48.3 | 5.9 | 0.2 | 0.656 |
Bulimia nervosa with hierarchy | 89 | 49.8 | 6.3 | 8.4 | 4.0 | 41.8 | 6.4 | 1.4 | 0.266 |
Substance use disorders | |||||||||
Alcohol abuse with hierarchy | 232 | 50.1 | 4.6 | 2.6 | 1.2 | 47.3 | 4.6 | 0.5 | 0.494 |
Alcohol dependence | 205 | 43.3 | 4.4 | 6.3 | 2.6 | 50.4 | 4.8 | 2.8 | 0.109 |
Drug abuse with hierarchy | 83 | 55.0 | 6.9 | 3.2 | 2.0 | 41.8 | 6.8 | 36.6 | 0.026 |
Drug dependence | 104 | 48.2 | 6.3 | 7.6 | 3.8 | 44.2 | 6.2 | 2.5 | 0.192 |
Time-Lagged Associations Between Lifetime Psychotic Experiences and Subsequent Onset of Mental Disorders
Bivariate Modelsa | Multivariate Modelsb | |||
---|---|---|---|---|
Mental Disorder | Odds Ratio | 95% CI | Odds Ratio | 95% CI |
Mood disorders | ||||
Major depressive disorder with hierarchy | 1.6* | 1.4–1.9 | 1.3* | 1.2–1.5 |
Bipolar disorder (broad) | 2.7* | 2.0–3.5 | 2.0* | 1.5–2.6 |
Anxiety disorders | ||||
Panic disorder | 2.0* | 1.5–2.8 | 1.3 | 0.9–1.8 |
Generalized anxiety disorder with hierarchy | 1.9* | 1.5–2.4 | 1.4* | 1.1–1.8 |
Social phobia | 2.0* | 1.5–2.7 | 1.4* | 1.0–1.8 |
Specific phobia | 1.0 | 0.7–1.5 | 0.9 | 0.6–1.3 |
Agoraphobia without panic | 2.0* | 1.2–3.4 | 1.2 | 0.7–2.1 |
Posttraumatic stress disorder | 2.0* | 1.6–2.6 | 1.3* | 1.1–1.7 |
Separation anxiety disorder (child) | 1.7 | 0.9–3.2 | 1.2 | 0.6–2.3 |
Separation anxiety disorder (adult) | 2.7* | 1.9–3.6 | 1.6* | 1.2–2.2 |
Impulse control disorders | ||||
Intermittent explosive disorder with hierarchy | 1.5* | 1.1–2.1 | 1.2 | 0.9–1.6 |
Attention deficit hyperactivity disorder | 2.5 | 0.8–7.4 | 1.8 | 0.6–5.6 |
Oppositional defiant disorder with hierarchy | 2.6* | 1.2–5.7 | 2.1 | 0.9–5.0 |
Conduct disorder | 1.9 | 0.9–4.1 | 1.2 | 0.5–3.0 |
Eating disorders | ||||
Anorexia nervosa | 0.9 | 0.3–2.8 | 0.7 | 0.2–2.0 |
Binge eating disorder with hierarchy | 1.7* | 1.1–2.5 | 1.0 | 0.7–1.6 |
Bulimia nervosa with hierarchy | 3.2* | 2.2–4.8 | 1.9* | 1.2–3.1 |
Substance use disorders | ||||
Alcohol abuse with hierarchy | 1.7* | 1.3–2.3 | 1.4* | 1.1–1.9 |
Alcohol dependence | 1.9* | 1.4–2.7 | 1.1 | 0.8–1.7 |
Drug abuse with hierarchy | 1.9* | 1.2–2.8 | 1.4 | 0.9–2.1 |
Drug dependence | 2.3* | 1.5–3.4 | 1.4 | 0.9–2.0 |
Time-Lagged Associations Between Lifetime Mental Disorders and Subsequent Onset of Psychotic Experiences
Mental Disorder | Bivariate Modelsa | Multivariate Modelb | ||
---|---|---|---|---|
Odds Ratio | 95% CI | Odds Ratio | 95% CI | |
Mood disorders | ||||
Major depressive disorder with hierarchy | 2.5* | 2.1–3.0 | 2.2* | 1.8–2.7 |
Bipolar disorder (broad) | 2.6* | 1.9–3.7 | 1.9* | 1.3–2.9 |
Anxiety disorders | ||||
Panic disorder | 2.5* | 1.8–3.4 | 1.6* | 1.2–2.3 |
Generalized anxiety disorder with hierarchy | 2.4* | 1.8–3.1 | 1.7* | 1.2–2.3 |
Social phobia | 2.2* | 1.8–2.6 | 1.5* | 1.2–2.0 |
Specific phobia | 2.6* | 2.2–2.9 | 2.2* | 1.8–2.7 |
Agoraphobia without panic | 2.5* | 1.8–3.6 | 1.9* | 1.3–2.7 |
Posttraumatic stress disorder | 2.5* | 1.9–3.2 | 1.8* | 1.3–2.4 |
Separation anxiety disorder (child) | 2.1* | 1.5–3.0 | 1.5* | 1.0–2.1 |
Separation anxiety disorder (adult) | 2.8* | 2.1–3.9 | 1.9* | 1.3–2.8 |
Impulse control disorders | ||||
Intermittent explosive disorder with hierarchy | 2.4* | 1.9–3.0 | 1.9* | 1.5–2.5 |
Attention deficit hyperactivity disorder | 2.7* | 2.0–3.8 | 1.7* | 1.2–2.4 |
Oppositional defiant disorder with hierarchy | 3.0* | 2.1–4.3 | 2.0* | 1.3–3.1 |
Conduct disorder | 2.5* | 1.7–3.7 | 1.4 | 0.9–2.3 |
Eating disorders | ||||
Anorexia nervosa | 2.9* | 1.1–8.1 | 2.8* | 1.0–7.8 |
Binge eating disorder with hierarchy | 2.2* | 1.6–3.2 | 1.8* | 1.2–2.6 |
Bulimia nervosa with hierarchy | 2.7* | 1.8–4.2 | 1.8* | 1.2–3.0 |
Substance use disorders | ||||
Alcohol abuse with hierarchy | 1.8* | 1.4–2.5 | 1.8* | 1.3–2.5 |
Alcohol dependence | 2.4* | 1.8–3.3 | 2.0* | 1.3–2.9 |
Drug abuse with hierarchy | 1.5 | 1.0–2.3 | 1.1 | 0.7–1.8 |
Drug dependence | 2.6* | 1.7–3.9 | 1.3 | 0.8–2.3 |
χ2 | p | |||
Joint effect of all types of disorders (df=21) | 130.4 | <0.001 | ||
Difference between types of disorders (df=20) | 27.9 | 0.111 | ||
Odds Ratio | 95% CI | |||
Number of disorders | ||||
2 disorders | 1.0 | 0.7–1.3 | ||
3 disorders | 0.5* | 0.4–0.8 | ||
4 disorders | 0.4* | 0.2–0.8 | ||
5+ disorders | 0.2* | 0.1–0.4 | ||
χ2 | p | |||
Joint effect of all number of disorders (df=4) | 31.1 | <0.001 |
Discussion
Future Directions
Conclusions
Acknowledgments
Footnotes
Supplementary Material
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