John J McGrath1, Sukanta Saha1, Ali Al-Hamzawi2, Jordi Alonso3, Evelyn J Bromet4, Ronny Bruffaerts5, José Miguel Caldas-de-Almeida6, Wai Tat Chiu7, Peter de Jonge8, John Fayyad9, Silvia Florescu10, Oye Gureje11, Josep Maria Haro12, Chiyi Hu13, Viviane Kovess-Masfety14, Jean Pierre Lepine15, Carmen C W Lim16, Maria Elena Medina Mora17, Fernando Navarro-Mateu18, Susana Ochoa12, Nancy Sampson7, Kate Scott16, Maria Carmen Viana19, Ronald C Kessler7. 1. Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia2Discipline of Psychiatry, University of Queensland, St Lucia, Australia3Queensland Brain Institute, University of Queensland, St Lucia, Australia. 2. College of Medicine, Al-Qadisiya University, Al Diwaniya City, Iraq. 3. Health Services Research Unit, Instituto Hospital del Mar de Investigaciones Médicas, Institut de Recerca Hospital del Mar, Barcelona, Spain6Centros de Investigación Biomédica en Red (CIBER) en Epidemiologõïa y Salud Puïblica, Barcelona, Spain. 4. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York. 5. Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium. 6. Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal. 7. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 8. Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation, University of Groningen, University Medical Center, Groningen, the Netherlands. 9. Institute for Development, Research, Advocacy, and Applied Care, Beirut, Lebanon. 10. National School of Public Health, Management and Professional Development, Bucharest, Romania. 11. Department of Psychiatry, University College Hospital, Ibadan, Nigeria. 12. Parc Sanitari Sant Joan de Déu, Centros de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain. 13. Shenzhen Insitute of Mental Health and Shenzhen Kanging Hospital, Shenzhen, China. 14. Ecole des Hautes Etudes en Santé Publique, EA 4057 Paris Descartes University, Paris, France. 15. Hôpital 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. 16. Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 17. National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico. 18. Subdirección 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. 19. Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil.
Abstract
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.
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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