Psychotic experiences (PEs) are not exclusive to psychotic disorders and highly correlated with mood episodes. In this representative general population-based study, longitudinal bidirectional associations between the extended psychosis phenotype and mood episodes were investigated, accounting for other possible causes.
Households were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011) and at 6-year follow-up (n = 2185). Participants were interviewed with the relevant sections of the composite international diagnostic interview both at baseline and at follow-up. Sociodemographic, familial and environmental risk factors associated with the extended psychosis phenotype and mood episodes were assessed. Logistic regression and cross-lagged panel correlation models were used for the associations between the extended psychosis phenotype and mood episodes.
PEs were associated with subsequent depressive and manic episodes. There was bidirectionality in that mood episodes were associated with subsequent PEs, and PEs were associated with subsequent mood episodes. The associations occurred in a sub-additive pattern. There were substantial synchronous and cross-lagged correlations between these psychopathology domains, with reciprocally similar cross-lagged correlations. Familial risk and adverse life events were associated with both psychopathology domains, whereas some sociodemographic risk factors and alcohol/cannabis use were associated with only one domain.
The sub-additive bidirectional associations between PEs and mood episodes over time and the similarity of cross-lagged correlations are suggestive of mutually causal connections between affective and psychotic domains of psychopathology.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39(2):179–195. https://doi.org/10.1017/S0033291708003814
Linscott RJ, van Os J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med 43(6):1133–1149. https://doi.org/10.1017/S0033291712001626
McGrath JJ, Saha S, Al-Hamzawi A, Alonso J, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, Chiu WT, de Jonge P, Fayyad J, Florescu S, Gureje O, Haro JM, Hu C, Kovess-Masfety V, Lepine JP, Lim CC, Mora ME, Navarro-Mateu F, Ochoa S, Sampson N, Scott K, Viana MC, Kessler RC (2015) Psychotic experiences in the general population: a cross-national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry 72(7):697–705. https://doi.org/10.1001/jamapsychiatry.2015.0575
Nuevo R, Chatterji S, Verdes E, Naidoo N, Arango C, Ayuso-Mateos JL (2012) The continuum of psychotic symptoms in the general population: a cross-national study. Schizophr Bull 38(3):475–485. https://doi.org/10.1093/schbul/sbq099
Varghese D, Scott J, Welham J, Bor W, Najman J, O’Callaghan M, Williams G, McGrath J (2011) Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophr Bull 37(2):389–393. https://doi.org/10.1093/schbul/sbp083
Saha S, Scott J, Varghese D, McGrath J (2012) Anxiety and depressive disorders are associated with delusional-like experiences: a replication study based on a National Survey of Mental Health and Wellbeing. BMJ Open 2 (3). https://doi.org/10.1136/bmjopen-2012-001001
Hanssen M, Peeters F, Krabbendam L, Radstake S, Verdoux H, van Os J (2003) How psychotic are individuals with non-psychotic disorders? Soc Psychiatry Psychiatr Epidemiol 38(3):149–154. https://doi.org/10.1007/s00127-003-0622-7
Kelleher I, Keeley H, Corcoran P, Lynch F, Fitzpatrick C, Devlin N, Molloy C, Roddy S, Clarke MC, Harley M, Arseneault L, Wasserman C, Carli V, Sarchiapone M, Hoven C, Wasserman D, Cannon M (2012) Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 201(1):26–32. https://doi.org/10.1192/bjp.bp.111.101543
Armando M, Nelson B, Yung AR, Ross M, Birchwood M, Girardi P, Fiori Nastro P (2010) Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophr Res 119(1–3):258–265. https://doi.org/10.1016/j.schres.2010.03.001
McGrath JJ, Saha S, Al-Hamzawi A, Andrade L, Benjet C, Bromet EJ, Browne MO, Caldas de Almeida JM, Chiu WT, Demyttenaere K, Fayyad J, Florescu S, de Girolamo G, Gureje O, Haro JM, Ten Have M, Hu C, Kovess-Masfety V, Lim CC, Navarro-Mateu F, Sampson N, Posada-Villa J, Kendler KS, Kessler RC (2016) The bidirectional associations between psychotic experiences and DSM-IV mental disorders. Am J Psychiatry. https://doi.org/10.1176/appi.ajp.2016.15101293
Stochl J, Khandaker GM, Lewis G, Perez J, Goodyer IM, Zammit S, Sullivan S, Croudace TJ, Jones PB (2015) Mood, anxiety and psychotic phenomena measure a common psychopathological factor. Psychol Med 45(7):1483–1493. https://doi.org/10.1017/S003329171400261X
Perlis RH, Uher R, Ostacher M, Goldberg JF, Trivedi MH, Rush AJ, Fava M (2011) Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Arch Gen Psychiatry 68(4):351–360. https://doi.org/10.1001/archgenpsychiatry.2010.179
Wigman JT, van Nierop M, Vollebergh WA, Lieb R, Beesdo-Baum K, Wittchen HU, van Os J (2012) Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity–implications for diagnosis and ultra-high risk research. Schizophr Bull 38(2):247–257. https://doi.org/10.1093/schbul/sbr196
van Rossum I, Dominguez MD, Lieb R, Wittchen HU, van Os J (2011) Affective dysregulation and reality distortion: a 10-year prospective study of their association and clinical relevance. Schizophr Bull 37(3):561–571. https://doi.org/10.1093/schbul/sbp101
Guloksuz S, van Nierop M, Lieb R, van Winkel R, Wittchen HU, van Os J (2015) Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology. Psychol Med 45(11):2389–2401. https://doi.org/10.1017/S0033291715000380
De Loore E, Gunther N, Drukker M, Feron F, Sabbe B, Deboutte D, van Os J, Myin-Germeys I (2011) Persistence and outcome of auditory hallucinations in adolescence: a longitudinal general population study of 1800 individuals. Schizophr Res 127(1–3):252–256. https://doi.org/10.1016/j.schres.2011.01.015
Dhossche D, Ferdinand R, Van der Ende J, Hofstra MB, Verhulst F (2002) Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychol Med 32(4):619–627
Sullivan SA, Wiles N, Kounali D, Lewis G, Heron J, Cannon M, Mahedy L, Jones PB, Stochl J, Zammit S (2014) Longitudinal associations between adolescent psychotic experiences and depressive symptoms. PLoS One 9(8):e105758. https://doi.org/10.1371/journal.pone.0105758
Zavos HM, Eley TC, McGuire P, Plomin R, Cardno AG, Freeman D, Ronald A (2016) Shared etiology of psychotic experiences and depressive symptoms in adolescence: a longitudinal Twin Study. Schizophr Bull 42(5):1197–1206. https://doi.org/10.1093/schbul/sbw021
Rossler W, Hengartner MP, Ajdacic-Gross V, Haker H, Gamma A, Angst J (2011) Sub-clinical psychosis symptoms in young adults are risk factors for subsequent common mental disorders. Schizophr Res 131(1–3):18–23. https://doi.org/10.1016/j.schres.2011.06.019
Fowler D, Hodgekins J, Garety P, Freeman D, Kuipers E, Dunn G, Smith B, Bebbington PE (2012) Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophr Bull 38(5):1063–1073. https://doi.org/10.1093/schbul/sbr019
van Os J, Linscott RJ (2012) Introduction: the extended psychosis phenotype–relationship with schizophrenia and with ultrahigh risk status for psychosis. Schizophr Bull 38(2):227–230. https://doi.org/10.1093/schbul/sbr188
van Os J, Guloksuz S (2017) A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry 16(2):200–206. https://doi.org/10.1002/wps.20423
Binbay T, Elbi H, Alptekin K, Aksu Tanik F, Drukker M, Onay H, Ozkinay F, Zagli N, Van Os J (2011) Izmir mental health survey for gene-environment interaction in psychoses (TurkSch): objectives and methodology. Turk Psikiyatri Derg 22(2):65–76
Binbay T, Alptekin K, Elbi H, Zagli N, Drukker M, Aksu Tanik F, Ozkinay F, Onay H, Van Os J (2012) Lifetime prevalence and correlates of schizophrenia and disorders with psychotic symptoms in the general population of Izmir, Turkey. Turk Psikiyatri Derg 23(3):149–160
Binbay T, Drukker M, Alptekin K, Elbi H, Aksu Tanik F, Ozkinay F, Onay H, Zagli N, van Os J (2012) Evidence that the wider social environment moderates the association between familial liability and psychosis spectrum outcome. Psychol Med 42(12):2499–2510. https://doi.org/10.1017/S0033291712000700
TurkStat (2008) The results of address based population registration system. Turkish Statistical Institute, Ankara
Kish L (1949) A procedure for objective respondent selection within the household. J Am Stat Assoc 44:380–387
Andrews G, Peters L (1998) The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol 33(2):80–88
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA et al (1988) The Composite international diagnostic interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45(12):1069–1077
Alptekin K, Ulas H, Akdede BB, Tumuklu M, Akvardar Y (2009) Prevalence and risk factors of psychotic symptoms: in the city of Izmir, Turkey. Soc Psychiatry Psychiatr Epidemiol 44(11):905–910. https://doi.org/10.1007/s00127-009-0012-x
Deveci A, Taskin O, Dinc G, Yilmaz H, Demet MM, Erbay-Dundar P, Kaya E, Ozmen E (2007) Prevalence of pseudoneurologic conversion disorder in an urban community in Manisa, Turkey. Soc Psychiatry Psychiatr Epidemiol 42(11):857–864. https://doi.org/10.1007/s00127-007-0233-9
Cilli AS, Kaya N (2003) [Nicotine dependence and psychiatric comorbidity among university students]. Turk Psikiyatri Derg 14(1):42–49
Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D (1991) Cross-cultural feasibility, reliability and sources of variance of the composite international diagnostic interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry 159:645–653, 658
Cooper L, Peters L, Andrews G (1998) Validity of the composite international diagnostic interview (CIDI) psychosis module in a psychiatric setting. J Psychiatr Res 32(6):361–368
Binbay T, Drukker M, Elbi H, Tanik FA, Ozkinay F, Onay H, Zagli N, van Os J, Alptekin K (2012) Testing the psychosis continuum: differential impact of genetic and nongenetic risk factors and comorbid psychopathology across the entire spectrum of psychosis. Schizophr Bull 38(5):992–1002. https://doi.org/10.1093/schbul/sbr003
Goldthorpe J (1987) Social mobility and class structure in modern Britain. Clarendon Press, New York
NIMH.Genetics.Initiative (1992) Family interview for genetic studies (FIGS). MD National Institute of Mental Health, Rockville
Mortensen PB, Pedersen MG, Pedersen CB (2010) Psychiatric family history and schizophrenia risk in Denmark: which mental disorders are relevant? Psychol Med 40(2):201–210. https://doi.org/10.1017/S0033291709990419
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J (2005) Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. Bmj 330(7481):11. https://doi.org/10.1136/bmj.38267.664086.63
Ulas H, Binbay T, Kirli U, Elbi H, Alptekin K (2017) The epidemiology of alcohol use in Izmir, Turkey: drinking pattern, impairment and help-seeking. Soc Psychiatry Psychiatr Epidemiol. https://doi.org/10.1007/s00127-017-1345-5
Brugha TS, Cragg D (1990) The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatr Scand 82(1):77–81
Knol MJ, van der Tweel I, Grobbee DE, Numans ME, Geerlings MI (2007) Estimating interaction on an additive scale between continuous determinants in a logistic regression model. Int J Epidemiol 36(5):1111–1118. https://doi.org/10.1093/ije/dym157
Stata Statistical Software (2013) Release 13. StataCorp LP, College station
van Os J, Reininghaus U (2016) Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 15(2):118–124. https://doi.org/10.1002/wps.20310
Anderson T, Kida T (1982) The cross-lagged research approach: description and illustration. J Acc Res 20(2):403–414. https://doi.org/10.2307/2490748
Regier DA, Boyd JH, Burke JD Jr, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ (1988) One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Arch Gen Psychiatry 45(11):977–986
van Os J, Hanssen M, Bijl RV, Ravelli A (2000) Strauss (1969) revisited: a psychosis continuum in the general population? Schizophr Res 45(1–2):11–20
Verdoux H, van Os J (2002) Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr Res 54(1–2):59–65
Bijl RV, Ravelli A, van Zessen G (1998) Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 33(12):587–595
van Os J, Gilvarry C, Bale R, van Horn E, Tattan T, White I, Murray R (2000) Diagnostic value of the DSM and ICD categories of psychosis: an evidence-based approach. UK700 Group. Soc Psychiatry Psychiatr Epidemiol 35(7):305–311
Reininghaus U, Bohnke JR, Hosang G, Farmer A, Burns T, McGuffin P, Bentall RP (2016) Evaluation of the validity and utility of a transdiagnostic psychosis dimension encompassing schizophrenia and bipolar disorder. Br J Psychiatry 209(2):107–113. https://doi.org/10.1192/bjp.bp.115.167882
Kelleher I, Cannon M (2014) Whither the psychosis-neurosis borderline. Schizophr Bull 40(2):266–268. https://doi.org/10.1093/schbul/sbt230
Linscott RJ, van Os J (2010) Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annu Rev Clin Psychol 6:391–419. https://doi.org/10.1146/annurev.clinpsy.032408.153506
Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J, Lloyd T, Holloway J, Hutchinson G, Leff JP, Mallett RM, Harrison GL, Murray RM, Jones PB (2006) Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 63(3):250–258. https://doi.org/10.1001/archpsyc.63.3.250
This work is part of the TürkSch project and is funded by the Scientific and Technological Council of Turkey 1001 programme, project nos: 107S053 and 112S476.
About this article
Cite this article
Kırlı, U., Binbay, T., Drukker, M. et al. Psychotic experiences and mood episodes predict each other bidirectionally: a 6-year follow-up study in a community-based population. Soc Psychiatry Psychiatr Epidemiol 54, 331–341 (2019). https://doi.org/10.1007/s00127-018-1641-8
- Psychotic experiences