The DOI matches its Crossref record; 157 of the 158 references it cites were found in a registry or an index.
What causes psychosis? An umbrella review of risk and protective factors
Open accessAbstract
Psychosis is a heterogeneous psychiatric condition for which a multitude of risk and protective factors have been suggested. This umbrella review aimed to classify the strength of evidence for the associations between each factor and psychotic disorders whilst controlling for several biases. The Web of Knowledge database was searched to identify systematic reviews and meta‐analyses of observational studies which examined associations between socio‐demographic, parental, perinatal, later factors or antecedents and psychotic disorders, and which included a comparison group of healthy controls, published from 1965 to January 31, 2017. The literature search and data extraction followed PRISMA and MOOSE guidelines. The association between each factor and ICD or DSM diagnoses of non‐organic psychotic disorders was graded into convincing, highly suggestive, suggestive, weak, or non‐significant according to a standardized classification based on: number of psychotic cases, random‐effects p value, largest study 95% confidence interval, heterogeneity between studies, 95% prediction interval, small study effect, and excess significance bias. In order to assess evidence for temporality of association, we also conducted sensitivity analyses restricted to data from prospective studies. Fifty‐five meta‐analyses or systematic reviews were included in the umbrella review, corresponding to 683 individual studies and 170 putative risk or protective factors for psychotic disorders. Only the ultra‐high‐risk state for psychosis (odds ratio, OR=9.32, 95% CI: 4.91‐17.72) and Black‐Caribbean ethnicity in England (OR=4.87, 95% CI: 3.96‐6.00) showed convincing evidence of association. Six factors were highly suggestive (ethnic minority in low ethnic density area, second generation immigrants, trait anhedonia, premorbid IQ, minor physical anomalies, and olfactory identification ability), and nine were suggestive (urbanicity, ethnic minority in high ethnic density area, first generation immigrants, North‐African immigrants in Europe, winter/spring season of birth in Northern hemisphere, childhood social withdrawal, childhood trauma, Toxoplasma gondii IgG, and non‐right handedness). When only prospective studies were considered, the evidence was convincing for ultra‐high‐risk state and suggestive for urbanicity only. In summary, this umbrella review found several factors to be associated with psychotic disorders with different levels of evidence. These risk or protective factors represent a starting point for further etiopathological research and for the improvement of the prediction of psychosis.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“The CHR-P criteria are robustly associated with psychosis onset (Odds Ratio, OR=9.32) 44 within high-risk clinical samples (but not in the general population 84 )”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [44]
In the citing paper
“Transition to psychosis is associated with clinically meaningful real-world outcomes 89 and is modulated by baseline levels of attenuated positive psychotic (OR=2.56) and negative (OR=2.68) symptoms, while good functioning reduces the risk (OR=0.59) 44 .”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [44]
In the citing paper
“Psychotic disorders are infrequent before the age of 14 43 ; their risk peaks in the age group of 15-35 and declines after the age of 35 44 .”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [44]
In the citing paper
“Black - Caribbean ethnicity in England (OR=4.87) 44 ****”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [44]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,893
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,586
Meta-analysis of Observational Studies in Epidemiology<SUBTITLE>A Proposal for Reporting</SUBTITLE>
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575
Biological insights from 108 schizophrenia-associated genetic loci
Schizophrenia Working Group of the Psychiatric Genomics Consortium (2014) · Nature · doi:10.1038/nature13595 · Cited by 7,577
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60692-4 · Cited by 6,414
Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews
Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson, N., Hamel, C., Porter, A. C., Tugwell, P., Moher, D., & Bouter, L. M. (2007) · BMC Medical Research Methodology · doi:10.1186/1471-2288-7-10 · Cited by 4,374
Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P. (2015) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000055 · Cited by 2,587
Flagged first, then by citations
1 of the 158 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Higgins JPT, 2011, Cochrane handbook for systematic reviews of interventions version 5.1.0
- Schwarzer G., 2007, Meta: an R package for meta‐analysis, R News, 7, 40
Cited by
Sorted by citations
Items 501–554 of 554
Giné-Servén, E., Boix-Quintana, E., Daví-Loscos, E., Cepedello, S., Moreno-Sancho, L., Niubó, M., Hernández-Antón, R., Cuesta, M. J., & Labad, J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1398682
Epidemiology of Mental Health Disorders in Female Children and Adolescents
Leung, K., Alexander, L., Goicochea, S., & Cuffe, S. P. (2024) · Springer eBooks · doi:10.1007/978-3-031-58293-6_2
Exploring substance use in first episode psychoses, what can we do more?
Nogueira, G. N., Andrade, A. G. M., Guimarães, A. P. C., Gomes, S. P., Ferreira, T. C., Souza, F. G. D. M. E., & Bisol, L. W. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.06.011
Лежейко, Т. В., Mikhailova, V. A., Габаева, М. В., & Голимбет, В. Е. (2024) · Генетика · doi:10.31857/s0016675824030114
Лежейко, Т. В., Mikhailova, V. A., Габаева, М. В., NIu, K., & Голимбет, В. Е. (2024) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-024-01660-4
He, H., Yue, F., & Hu, M. (2024) · Cogent Psychology · doi:10.1080/23311908.2024.2432756 · Cited by 2
“Furthermore, a review found that the incidence of childhood trauma in people diagnosed with schizophrenia is high (Radua et al., 2018), and childhood trauma specifically relate to positive symptoms of schizophrenia (torregrossa et al., 2024). a study has found that individuals diagnosed with…”
MARRA, M., Reitano, M. R., Cirella, L., Pozzoli, S. M., & Videtta, G. (2025) · Minerva Psychiatry · doi:10.23736/s2724-6612.24.02557-0
Calderon, V., Vasquez, M. L., Uribe, C., Bearden, C. E., & Lopez, S. R. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02308-w · Cited by 1
Murden, R., Allan, S. M., Hodgekins, J., & Oduola, S. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02833-3
“Additionally, research suggests a higher incidence of women identified during ARMS [27] compared to higher incidence of men identified during FEP [28].”
Li, Y., Yang, S., Yu, C., Wu, M., Huang, S., Diao, Y., Wu, X., Yang, H., & Ma, Z. (2025) · PLoS ONE · doi:10.1371/journal.pone.0315436
“Egger’s regression asymmetry test and the comparison of random-effects summary effect size and that of the largest study will be applied to assess the small-study effect bias [17,28].”
Zhang, T., Xu, L., Wei, Y., Tang, X., Ju, M., Liu, X., Zhang, D., Liu, H., Wang, Z., Chen, T., et al. (2025) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2025.111356
Anhedonia and 24-hour movement behaviours in adulthood
Karppanen, A., Miettunen, J., Hurtig, T. M., Leinonen, A., Korpelainen, R., & Farrahi, V. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100911
Characterizing the Social Epigenome in Mexican Patients with Early-Onset Psychosis
Ruíz-Ramos, D., Martínez‐Magaña, J. J., Juárez-Rojop, I. E., Nolasco-Rosales, G. A., Sosa-Hernández, F., Cruz-Castillo, J. D., Cavazos, J., Callejas, A., Zavaleta-Ramírez, P., Zorrilla-Dosal, J. A., et al. (2025) · Genes · doi:10.3390/genes16050591
Occupational Therapy in the Treatment of Early Psychosis: a Scoping Review
Kramer, I., Zagorac, S., Hefron, N., Walker, L., Taylor, C., Thomas, E. C., & Read, H. (2025) · Community Mental Health Journal · doi:10.1007/s10597-025-01475-8
“Early psychosis often begins in adolescence or early adulthood, with a high-risk period occurring between the ages of 12 and 25 (Radua et al., 2018).”
Sloan, A. F., & Schaefer, J. D. (2025) · Springer eBooks · doi:10.1007/978-3-031-87990-6_18
Multimodal Prediction of Psychosis in the Prospective MoBa Birth CohortPreprint
Birkenæs, V., Parekh, P., Shadrin, A. A., Jaholkowski, P. P., Ystaas, L., Makowski, C., Bakken, N. R., Hagen, E., Frei, E., Oliver, D., et al. (2025) · Research Square · doi:10.21203/rs.3.rs-6783339/v1
Self-citationPhysical activity and brain health: a systematic review of Mendelian Randomization studiesPreprint
Túnez, A., van de Weijer, M. P., Firth, J., Verweij, K. J. H., & Treur, J. L. (2025) · medRxiv · doi:10.1101/2025.06.23.25330111
Ojagbemi, A., Idowu, O., Olley, B., Esponda, G. M., Roberts, T., John, S., Raghavan, V., Pow, J. L., Donald, C., Ayinde, O. O., et al. (2025) · Schizophrenia Research · doi:10.1016/j.schres.2025.07.027
Self-citationGago, E., Montalvo, I., Tost, M., Pérez, S., Miñano, M. J., Blasco, B., Barbero, J. D., Estrada, F., Palao, D. J., Nadal, R. A., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.08.018
Xavier, S. M., Jongsma, H. E., Gayer-Anderson, C. E., Quattrone, D., Blackmore, S. J., Tarricone, I., Llorca, P., Velthorst, E., Murray, R. M., Jones, P. B., et al. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100530
Self-citationDETECÇÃO DE SINAIS DE PROBLEMAS EMOCIONAIS EM ESTUDANTES DO ENSINO MÉDIO E SUAS POTENCIAIS CAUSAS
Cruz, M. S. S. (2025) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v6i9.6447
Cano, J. F., Bernal‐Valencia, M. A., Vargas-Acevedo, P., Mejía‐Salgado, G., Sánchez, A., Correa-Jiménez, Ó., Múnera, M., & de‐la‐Torre, A. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262110321
Primärpräventiver Nutzen körperlicher Aktivität und strukturierten Trainings
Samitz, G. (2025) · Springer eBooks · doi:10.1007/978-3-662-68883-0_2
Mascayano, F., Burgos, J., Hernández, V., Casanueva, R., Yang, X., Li, Z., Sampat, P., Muñoz-Quezada, M. T., Navarro, S. R., Rodriguez, K. M., et al. (2025) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2025.101282
Mentis, A.-F. A., Dardiotis, E., Efthymiou, V., & Chrousos, G. P. (2021) · Figshare · doi:10.6084/m9.figshare.13565684
Mensi, M. M., Orlandi, M., Casini, E., Catalan, A., de Pablo, G. S., Fusar‐Poli, P., & Borgatti, R. (2024) · Figshare · doi:10.6084/m9.figshare.26567372
Self-citationMentis, A.-F. A., Dardiotis, E., Efthymiou, V., & Chrousos, G. P. (2021) · Figshare · doi:10.6084/m9.figshare.13565687
Trott, M., Driscoll, R., & Pardhan, S. (2023) · Figshare · doi:10.6084/m9.figshare.22613428
Abate, B. B., Tilahun, B. D., & Yayeh, B. M. (2024) · Figshare · doi:10.6084/m9.figshare.24934602
Gao, X., Zhao, Y., Wang, N., & Yang, L. (2022) · Figshare · doi:10.6084/m9.figshare.20064349
Abate, B. B., Tilahun, B. D., & Yayeh, B. M. (2024) · Figshare · doi:10.6084/m9.figshare.24934315
Mensi, M. M., Orlandi, M., Casini, E., Catalan, A., de Pablo, G. S., Fusar‐Poli, P., & Borgatti, R. (2024) · Figshare · doi:10.6084/m9.figshare.26567369
Self-citationMentis, A.-F. A., Dardiotis, E., Efthymiou, V., & Chrousos, G. P. (2021) · Figshare · doi:10.6084/m9.figshare.13565690
Mlay, J. P., Ntlantsana, V., Gcabashe, N., Jamieson, L., Naidu, T., Bhengu, B. S., Thela, L. T., Paruk, S., Burns, J. K., Chiliza, B., et al. (2026) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v32i0.2455
Transition from Illness Anxiety Disorder to Delusional Disorder: A Case Series
Bhattacharjee, D., & Chowdhury, A. (2026) · Consortium Psychiatricum · doi:10.17816/cp15643
“Moreover, a family history of psychosis, as seen in Case 2, is a known risk factor for developing psychotic disorders [9].”
Shields, G., Farragher, T. M., Davies, L. M., Verma, A., Kirkham, J. J., Makara, D., & Clarkson, P. (2026) · Journal of Mental Health · doi:10.1080/09638237.2026.2645543
“With variation in the people diagnosed and a wide range of symptoms and disease trajectories, heterogeneity in the population with SMI is a very relevant issue (Di Michele & Bolino, 2004; Patel et al., 2014; Radua et al., 2018; Rowland & Marwaha, 2018).”
Gao, Y., Yu, J., Lui, S. S. Y., Yang, T., & Chan, R. C. K. (2026) · PsyCh Journal · doi:10.1002/pchj.70094
“Anhedonia is a risk factor for the onset of depression (Morgan et al. 2013), schizophrenia (Gooding et al. 2005; Kwapil 1998), and other psychotic disorders (Radua et al. 2018).”
Les traumatismes infantiles dans la schizophrénie : apports de l'imagerie cérébrale
Cancel, A. (2018) · theses.fr (ABES) · doi:10.70675/9b56cfcdz08ffz4c9dzbebaz8cc9c383a672
Cui, Y., Sun, Y., Liu, S., Song, J., Wang, X., & Li, N. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121800
Chen, S., Zheng, X., Deng, J., Li, Z., & Zhang, X. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02242-w
“Among these environmental influences, childhood trauma has been identified as a particularly significant contributor, greatly increasing the risk of developing schizophrenia later in life [ 8 , 9 ].”
Hostalet, N., Martínez‐Abadías, N., & Fatjó‐Vilas, M. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106753
Nobile, F., Pistollato, A., Forastiere, A., Michelozzi, P., Forastiere, F., & Stafoggia, M. (2026) · Environmental Research · doi:10.1016/j.envres.2026.124911
Chapter 5. Cannabis and Psychosis
Sideli, L., Spinazzola, E., Murray, R. M., & Colizzi, M. (2024) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9798894550749.lg05
Self-citationPersonal Recovery of People with Schizophrenia in Martinique: A Qualitative Study
Bourzeix, C., Salvetax, M., Samot, C., de la Londe, J. G., Cadwallader, J., Koenig, M., & Piot, M. (2026) · Transcultural Psychiatry · doi:10.1177/13634615261446908
“Several environmental factors have also been reported to increase the risk of developing schizophrenia, including: childhood trauma, cannabis use, living in urban areas, and being a fi rst-generation migrant (McCutcheon et al., 2020; Radua et al., 2018).”
Wang, H., Ran, S., Lu, D., Li, Z., & Zhang, X. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02300-3
Psychological Stress and Cancer Risk and Outcome: An Umbrella Review With Quantitative Synthesis
Petrelli, F., Abeni, C., Ceruti, E., Ghidini, A., Regonesi, M., Savelli, G., & Zaniboni, A. (2026) · Asia-Pacific Journal of Clinical Oncology · doi:10.1111/ajco.70144
Schizophrenie und andere primäre psychotische Störungen
Nickl-Jockschat, T., Steiner, J. H., Hasan, A., & Schneider, F. W. (2026) · Springer eBooks · doi:10.1007/978-3-662-70668-8_20
Melillo, A., Micheli, A. D., Nandha, S., Gadelrab, R., Jauhar, S., Young, A. H., Azis, M., Manchia, M., Pfennig, A., Mucci, A., et al. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1773189
Self-citationForte, M. F., Rabelo-da-Ponte, F. D., Clougher, D., Segura, À. G., Mas, S., Garriga, M., Rapado‐Castro, M., García‐Rizo, C., Vieta, E., Panadero, R., et al. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117428
Sleep disturbances as an early indicator of psychotic disorders in adolescents and young adults
Jaromirska, J., Strzelecki, D., Kotlicka‐Antczak, M., Białasiewicz, P., & Gabryelska, A. (2026) · Frontiers in Synaptic Neuroscience · doi:10.3389/fnsyn.2026.1949833
“While a first psychotic episode may signal underlying mental illness, it can also be triggered by environmental factors, such as substance use, psychological distress, or physical illness (Radua et al., 2018).”
The exposome in schizophrenia: A systematic review of environmental risk indices
Parás, C., Nicolás, C. G.-S., López‐Díaz, Á., Setién‐Suero, E., & Ayesa‐Arriola, R. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.10.002
Metadata
- Authors
- Radua, J., Ramella‐Cravaro, V., Ioannidis, J. P. A., Reichenberg, A., Phiphopthatsanee, N., Amir, T., Yenn Thoo, H., Oliver, D., Davies, C., Morgan, C., McGuire, P., Murray, R. M., & Fusar‐Poli, P.
- Affiliations
- Early Psychosis: Interventions & Clinical‐detection (EPIC) Lab, Department of Psychosis Studies Institute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- King's College London (GB)
- Stanford Medicine (US)
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2018-01-19
- Volume
- 17
- Issue
- 1
- Pages
- 49-66
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC5775150
- OpenAlex
- W2768338105
- Cited by
- 553
- References
- 158
- Citations by year
- 2026: 33 · 2025: 55 · 2024: 67 · 2023: 70 · 2022: 73 · 2021: 92 · 2020: 82 · 2019: 66 · 2018: 15
- FWCI
- 49.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Medical Research Council
- Instituto de Salud Carlos III (CP14/00041 and PI14/00292)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- psychosis, risk factors, protective factors, ethnic minorities, urbanicity, immigrant status, childhood trauma, season of birth, Toxoplasma gondii, handedness, anhedonia, premorbid intelligence, birth order
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
