The Psychosis Continuum: Testing a Bifactor Model of Psychosis in a General Population Sample
Open accessAbstract
Although the factor structure of psychosis continues to be debated by taxonomists, recent studies have supported a bifactor model consisting of a general psychosis factor and 5 uncorrelated symptom-specific factors. While this model has received support in clinical samples, it has not been tested at the general population level. Analysis was conducted on Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34 653). Twenty-two psychotic symptoms were used as observed indicators of psychosis. These items were chosen based on their conceptual similarity to the items used in a similar study based on clinical samples. Confirmatory factor analysis and confirmatory bifactor modeling were used to test a variety of competing models. The best fitting model consisted of a general psychosis factor that was uncorrelated with 5 specific factors: positive, negative, disorganization, mania, and depression. These findings suggest that the bifactor model can be extended to general population samples, supporting the continuity between clinical and subclinical psychotic experiences. Theoretical and practical implications are discussed.
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Psychotic symptoms (e.g., delusions, hallucinations) exist in a continuum ranging from normality to pathology.
“The first one refers to the idea that psychotic symptoms (e.g., delusions, hallucinations) exist in a continuum ranging from normality to pathology (Carvalho, Pinto-Gouveia, Peixoto, & Motta, 2014;Johns & Van Os, 2001;Shevlin, McElroy, Bentall, Reininghaus, & Murphy, 2016;Van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2009).”
From Contextual Cognitive-Behavioral Therapies Across the Psychosis Continuum: A Review of Evidence for Schizophrenia, Schizoaffective and Bipolar Disorders (2017) · cites this paper as Shevlin, McElroy, Bentall, Reininghaus, & Murphy, 2016
Cites
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“recent DSM-5 field trials [6], the high level of comorbidity between different diagnostic”
BackgroundRuan, W. J., Goldstein, R. B., Chou, S. P., Smith, S. M., Saha, T. D., Pickering, R. P., Dawson, D. A., Huang, B., Stinson, F. S., & Grant, B. F. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.06.001 · Cited by 557 · see citing works
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Psychosis as a transdiagnostic and extended phenotype in the general population
van Os, J., & Reininghaus, U. (2016) · World Psychiatry · doi:10.1002/wps.20310 · Cited by 531 · see citing works
Self-citationBen-Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., Roberts, N. P., Lueger-Schuster, B., & Shevlin, M. (2018) · Depression and Anxiety · doi:10.1002/da.22723 · Cited by 241 · see citing works
Self-citationInvestigating the genetic architecture of general and specific psychopathology in adolescence
Jones, H. J., Heron, J., Hammerton, G., Stochl, J., Jones, P. B., Cannon, M., Smith, G. D., Holmans, P., Lewis, G., Linden, D. E. J., et al. (2018) · Translational Psychiatry · doi:10.1038/s41398-018-0204-9 · Cited by 59 · see citing works
Schick, A., Paetzold, I., Rauschenberg, C., Hirjak, D., Banaschewski, T., Meyer-Lindenberg, A., Boehnke, J. R., Boecking, B., & Reininghaus, U. (2021) · JMIR Research Protocols · doi:10.2196/27462 · Cited by 30 · see citing works
Self-citationMartins, M. J. R. V., Castilho, P., Carvalho, C. B., Pereira, A. T., Santos, V., Gumley, A., & de Macedo, A. F. (2017) · European Psychologist · doi:10.1027/1016-9040/a000283 · Cited by 11 · see citing works
- Authors
- Shevlin, M., McElroy, E., Bentall, R. P., Reininghaus, U., & Murphy, J.
- Affiliations
- University of Ulster (GB)
- University of Liverpool (GB)
- King's College London (GB)
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-05-24
- Volume
- 43
- Issue
- 1
- Pages
- 133-141
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC5216850
- OpenAlex
- W2400170440
- Cited by
- 70
- References
- 4
- Citations by year
- 2025: 6 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 7 · 2019: 8 · 2018: 15 · 2017: 12 · 2016: 2
- FWCI
- 9.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Ulster University Research Portal (Ulster University) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- psychosis continuum, bifactor model
- MeSH terms
- Adolescent, Adult, Factor Analysis, Statistical, Female, Humans, Male, Psychiatric Status Rating Scales, Psychotic Disorders, Models, Statistical, Young Adult
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