Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey.

BACKGROUND We seek to estimate lifetime prevalence and demographic correlates of nonaffective psychosis in the US population assessed by a computer-analyzed structured interview and a senior clinician. METHODS In the National Comorbidity Survey, a probability subsample of 5877 respondents were administered a screen for psychotic symptoms. Based on the response to this screening, detailed follow-up interviews were conducted by mental health professionals (n = 454). The initial screen and clinical reinterview were reviewed by a senior clinician. Results are presented for narrowly (schizophrenia or schizophreniform disorder) and broadly (all nonaffective psychoses) defined psychotic illness. RESULTS One or more psychosis screening questions were endorsed by 28.4% of individuals. By computer algorithm, lifetime prevalences of narrowly and broadly defined psychotic illness were 1.3% and 2.2%, respectively. Of those assigned a narrow diagnosis by the computer, the senior clinician assigned narrow and broad diagnoses to 10% and 37%, respectively. By clinician diagnosis, lifetime prevalence rates of narrowly and broadly defined psychosis were 0.2% and 0.7%, respectively. A clinician diagnosis of nonaffective psychosis was significantly associated with low income; unemployment a marital status of single, divorced, or separated; and urban residence Clinician confirmation of a computer diagnosis was predicted by hospitalization, neuroleptic treatment, duration of illness, enduring impairment, and thought disorder. CONCLUSIONS Lifetime prevalence estimates of psychosis in community samples are strongly influenced by methods of assessment and diagnosis. Although results using computer algorithms were similar in the National Comorbidity Survey and Epidemiologic Catchment Area studies, diagnoses so obtained agreed poorly with clinical diagnoses. Accurate assessment of psychotic illness in epidemiologic samples may require collection of extensive contextual information for clinician review.

[1]  P. Bebbington,et al.  Psychosis Screening Questionnaire , 2014 .

[2]  R M Groves,et al.  Advances in strategies for minimizing and adjusting for survey nonresponse. , 1995, Epidemiologic reviews.

[3]  K. Kendler,et al.  Independent diagnoses of adoptees and relatives as defined by DSM-III in the provincial and national samples of the Danish Adoption Study of Schizophrenia. , 1994, Archives of general psychiatry.

[4]  H Freeman,et al.  Schizophrenia and City Residence , 1994, British Journal of Psychiatry.

[5]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[6]  K. Kendler,et al.  The Roscommon Family Study. I. Methods, diagnosis of probands, and risk of schizophrenia in relatives. , 1993, Archives of general psychiatry.

[7]  C. Maclean,et al.  Exclusion of linkage between schizophrenia and the D2 dopamine receptor gene region of chromosome 11q in 112 Irish multiplex families. , 1993, Archives of general psychiatry.

[8]  A. David,et al.  Schizophrenia and city life , 1992, The Lancet.

[9]  C. Ross,et al.  Schneiderian symptoms and childhood trauma in the general population. , 1992, Comprehensive psychiatry.

[10]  P. J. Fischer,et al.  The epidemiology of alcohol, drug, and mental disorders among homeless persons. , 1991, The American psychologist.

[11]  G. Nestadt,et al.  Screening for Psychosis in the General Population with a Self‐Report Interview , 1991, The Journal of nervous and mental disease.

[12]  J. Yamamoto,et al.  Psychiatric Epidemiology in Korea: Part I: Gender and Age Differences in Seoul , 1990, The Journal of nervous and mental disease.

[13]  P. Joyce,et al.  Christchurch Psychiatric Epidemiology Study, Part I: Methodology and Lifetime Prevalence for Specific Psychiatric Disorders , 1989, The Australian and New Zealand journal of psychiatry.

[14]  H. Hwu,et al.  Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule , 1989, Acta psychiatrica Scandinavica.

[15]  H. Wittchen,et al.  Procedural validity of standardized symptom questions for the assessment of psychotic symptoms--a comparison of the DIS with two clinical methods. , 1988, Comprehensive psychiatry.

[16]  R. Bland,et al.  LIFETIME PREVALENCE OF PSYCHIATRIC DISORDERS IN EDMONTON , 1988, Acta psychiatrica Scandinavica. Supplementum.

[17]  P. Shrout,et al.  The prevalence of specific psychiatric disorders in Puerto Rico. , 1987, Archives of general psychiatry.

[18]  P. Shrout,et al.  The Spanish Diagnostic Interview Schedule. Reliability and concordance with clinical diagnoses in Puerto Rico. , 1987, Archives of general psychiatry.

[19]  E. Torrey,et al.  Prevalence Studies in Schizophrenia , 1987, British Journal of Psychiatry.

[20]  K. Kendler,et al.  Psychiatric illness in first-degree relatives of schizophrenic and surgical control patients. A family study using DSM-III criteria. , 1985, Archives of general psychiatry.

[21]  A. Farmer,et al.  A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. , 1985, Archives of general psychiatry.

[22]  D von Zerssen,et al.  A comparison of two diagnostic methods. Clinical ICD diagnoses vs DSM-III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (version 2). , 1985, Archives of general psychiatry.

[23]  M. Folstein,et al.  Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Experience in eastern Baltimore. , 1985, Archives of general psychiatry.

[24]  W. Eaton.  Epidemiology of schizophrenia. , 1985, Epidemiologic reviews.

[25]  L. George,et al.  Exclusion criteria of DSM-III. A study of co-occurrence of hierarchy-free syndromes. , 1984, Archives of general psychiatry.

[26]  E. Torrey,et al.  Endemic psychosis in western Ireland. , 1984, The American journal of psychiatry.

[27]  K. Kendler,et al.  An independent analysis of the Danish Adoption Study of Schizophrenia. VI. The relationship between psychiatric disorders as defined by DSM-III in the relatives and adoptees. , 1984, Archives of general psychiatry.

[28]  W. Carpenter,et al.  Lifetime psychotic symptoms assessed with the DIS. , 1983, Schizophrenia bulletin.

[29]  M. Tsuang,et al.  Subtypes of drug abuse with psychosis. Demographic characteristics, clinical features, and family history. , 1982, Archives of general psychiatry.

[30]  D. A. Johnson,et al.  Studies of Depressive Symptoms in Schizophrenia , 1981, British Journal of Psychiatry.

[31]  Americal Psychiatric Press.  Diagnostic and Statistical Manual of Mental Disorders, Third Edition , 1980 .

[32]  Beverley D. Causey,et al.  Computerized Method for Approximating the Variance of a Complicated Estimate , 1976 .

[33]  E. X. Freed.  Alcoholism and schizophrenia: the search for perspectives. A review. , 1975, Journal of studies on alcohol.

[34]  G. Koch,et al.  An Application of Multivariate Analysis to Complex Sample Survey Data , 1972 .

[35]  Leslie Kish,et al.  Balanced Repeated Replications for Standard Errors , 1970 .

[36]  E. Mishler,et al.  SOCIOCULTURAL FACTORS IN THE EPIDEMIOLOGY OF SCHIZOPHRENIA; A REVIEW. , 1963, Psychiatry.

[37]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[38]  T. Larsson,et al.  A methodological, psychiatric and statistical study of a large Swedish rural population. , 1955, Acta psychiatrica et neurologica Scandinavica. Supplementum.

[39]  J. Böök.  A GENETIC AND NEUROPSYCHIATRIC INVESTIGATION OF A NORTH-SWEDISH POPULATION , 1953 .

[40]  W. Mayer-Gross,et al.  Genetic-statistical and psychiatric investigations of a west Swedish population , 1949 .