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A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder
Open accessAbstract
OBJECTIVE: The authors investigated the incidence, course, and outcome of psychotic experiences from childhood through early adulthood in the general population and examined prediction of psychotic disorder. METHODS: This was a population-based cohort study using the semistructured Psychosis-Like Symptoms Interview at ages 12, 18, and 24 (N=7,900 with any data). Incidence rates were estimated using flexible parametric modeling, and positive predictive values (PPVs), sensitivity, specificity, and area under the curve were estimated for prediction. RESULTS: The incidence rate of psychotic experiences increased between ages 13 and 24, peaking during late adolescence. Of 3,866 participants interviewed at age 24, 313 (8.1%, 95% CI=7.2, 9.0) had a definite psychotic experience since age 12. A total of 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%), by both self-report and interviewer-rated measures of psychotic experiences at age 18 (PPVs, 2.9% and 10.0%, respectively), was improved by incorporating information on frequency and distress (PPVs, 13.3% and 20.0%, respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder at ages 18-24 was 21.1% (95% CI=6.1, 45.6) (sensitivity, 14.3%, 95% CI=4.0, 32.7). CONCLUSIONS: The study results show a peak in incidence of psychotic experiences during late adolescence as well as an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cutoff thresholds will likely have little impact on population levels of first-episode psychosis.
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Metadata
- Authors
- Sullivan, S. A., Kounali, D., Cannon, M., David, A. S., Fletcher, P. C., Holmans, P., Jones, H., Jones, P. B., Linden, D. E. J., Lewis, G., Owen, M. J., O’Donovan, M., Rammos, A., Thompson, A., Wolke, D., Heron, J., & Zammit, S.
- Affiliations
- Royal College of Surgeons in Ireland (IE)
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke’s Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K...
- Corresponding author
- Sullivan, Sarah A.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2020-04-01
- Volume
- 177
- Issue
- 4
- Pages
- 308-317
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2986902715
- Cited by
- 176
- References
- 47
- Citations by year
- 2026: 21 · 2025: 26 · 2024: 41 · 2023: 24 · 2022: 23 · 2021: 29 · 2020: 12
- FWCI
- 15.96
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Explore Bristol Research (acceptedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Wellcome Trust (095844/Z/11/Z, 206368/Z/17/Z)
- Medical Research Council (MR/P005748/1, MR/L010305/1, MR/M006727/1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- psychotic experiences, psychosis, incidence, clinical high risk for psychosis, first-episode psychosis, psychosis prediction, late adolescence, symptom distress, help-seeking, unmet mental health needs, childhood to adulthood
- MeSH terms
- Adolescent, Child, Delusions, Female, United Kingdom, Hallucinations, Humans, Male, Predictive Value of Tests, Prospective Studies, Psychotic Disorders, Cohort Studies, Incidence, Young Adult
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 ›
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