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Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys

Published online by Cambridge University Press:  26 February 2018

Kate M. Scott
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
Sukanta Saha
Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
Carmen C.W. Lim
Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
Sergio Aguilar-Gaxiola
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
Ali Al-Hamzawi
College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
Jordi Alonso
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Corina Benjet
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
Evelyn J. Bromet
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
Ronny Bruffaerts
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
José Miguel Caldas-de-Almeida
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Giovanni de Girolamo
Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
Peter de Jonge
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
Louisa Degenhardt
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Silvia Florescu
Management and Development, National School of Public Health, Bucharest, Romania
Oye Gureje
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Josep M. Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Chiyi Hu
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
Elie G. Karam
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Viviane Kovess-Masfety
Ecole des Hautes Etudes en Santé Publique (EHESP), Paris Descartes University, Paris, EA 4057, France
Sing Lee
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Jean-Pierre Lepine
Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France
Zeina Mneimneh
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
Fernando Navarro-Mateu
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
Marina Piazza
Universidad Cayetano Heredia, Lima, Peru National Institute of Health, Lima, Peru
José Posada-Villa
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Nancy A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Juan Carlos Stagnaro
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
Ronald C. Kessler
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
John J. McGrath*
Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia National Centre for Register-based Research, Aarhus University, Aarhus, Aarhus BSS, Denmark
Author for correspondence: Prof John McGrath, E-mail:



Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.


In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.


After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).


PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.

Original Articles
Copyright © Cambridge University Press 2018 

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WHO World Mental Health Survey Collaborators are listed in the Appendix.

The WHO World Mental Health Survey collaborators are Sergio Aguilar-Gaxiola, MD, PhD, Ali Al-Hamzawi, MD, Mohammed Salih Al-Kaisy, MD, Jordi Alonso, MD, PhD, Laura Helena Andrade, MD, PhD, Corina Benjet, PhD, Guilherme Borges,ScD, Evelyn J. Bromet, PhD, Ronny Bruffaerts, PhD, Brendan Bunting, PhD, Jose Miguel Caldas de Almeida, MD, PhD, Graca Cardoso, MD, PhD, Somnath Chatterji, MD, Alfredo H. Cia, MD, Louisa Degenhardt, PhD, Koen Demyttenaere, MD, PhD, John Fayyad, MD, Silvia Florescu, MD, PhD, Giovanni de Girolamo, MD, Oye Gureje, MD, DSc, FRCPsych, Josep Maria Haro, MD, PhD, Yanling He, MD, Hristo Hinkov, MD, PhD, Chiyi Hu, MD, PhD, Yueqin Huang, MD, MPH, PhD, Peter de Jonge, PhD, Aimee Nasser Karam, PhD, Elie G. Karam, MD, Norito Kawakami, MD, DMSc, Ronald C. Kessler, PhD, Andrzej Kiejna, MD, PhD, Viviane Kovess-Masfety, MD, PhD, Sing Lee, MB,BS, Jean-Pierre Lepine, MD, Daphna Levinson, PhD, John J. McGrath, MD, PhD, Maria Elena Medina-Mora, PhD, Jacek Moskalewicz, PhD, Fernando Navarro-Mateu, MD, PhD, Beth-Ellen Pennell, MA, Marina Piazza, MPH, ScD, Jose Posada-Villa, MD, Kate M. Scott, PhD, Tim Slade, PhD, Juan Carlos Stagnaro, MD, PhD, Dan J. Stein, FRCPC, PhD, Margreet ten Have, PhD, Yolanda Torres, MPH, Dra.HC, Maria Carmen Viana, MD, PhD, Harvey Whiteford, MBBS, PhD, David R. Williams, MPH, PhD, Bogdan Wojtyniak, ScD.


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