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Am J Psychiatry. 2016 Oct 1;173(10):997-1006. Epub 2016 Mar 17.

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

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From the Queensland Centre for Mental Health Research, Park Centre for Mental Health, Wacol, Australia; the Discipline of Psychiatry and the Queensland Brain Institute, University of Queensland, St. Lucia, Australia; the College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq; the Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; the Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente, Mexico City; the Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, N.Y.; the Centre for Mental Health, University of Melbourne, Melbourne, Australia; the Chronic Diseases Research Center (CEDOC) and the Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; the Department of Health Care Policy, Harvard University, Boston; the Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; the Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), Beirut, Lebanon; the National School of Public Health, Management, and Professional Development, Bucharest, Romania; IRCCS St. John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; the Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Parc Sanitari Sant Joan de Deïu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht; the Shenzhen Insitute of Mental Health and Shenzhen Kanging Hospital, Shenzhen, China; Ecole des Hautes Etudes en Santé Publique (EHESP), Paris Descartes University, Paris; the Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand; IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain; Colegio Mayor de Cundinamarca University, Bogotá, Colombia; and the Department of Psychiatry, Virginia Commonwealth University, Richmond.



While it is now recognized that psychotic experiences are associated with an increased risk of later mental disorders, we lack a detailed understanding of the reciprocal time-lagged relationships between first onsets of psychotic experiences and mental disorders. Using data from World Health Organization World Mental Health (WMH) Surveys, the authors assessed the bidirectional temporal associations between psychotic experiences and mental disorders.


The WMH Surveys assessed lifetime prevalence and age at onset of psychotic experiences and 21 common DSM-IV mental disorders among 31,261 adult respondents from 18 countries. Discrete-time survival models were used to examine bivariate and multivariate associations between psychotic experiences and mental disorders.


Temporally primary psychotic experiences were significantly associated with subsequent first onset of eight of the 21 mental disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, adult separation anxiety disorder, bulimia nervosa, and alcohol abuse), with odds ratios ranging from 1.3 (95% CI=1.2-1.5) for major depressive disorder to 2.0 (95% CI=1.5-2.6) for bipolar disorder. In contrast, 18 of 21 primary mental disorders were significantly associated with subsequent first onset of psychotic experiences, with odds ratios ranging from 1.5 (95% CI=1.0-2.1) for childhood separation anxiety disorder to 2.8 (95% CI=1.0-7.8) for anorexia nervosa.


While temporally primary psychotic experiences are associated with an elevated risk of several subsequent mental disorders, these data show that most mental disorders are associated with an elevated risk of subsequent psychotic experiences. Further investigation of the underlying factors accounting for these time-order relationships may shed light on the etiology of psychotic experiences.

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