The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R).
BACKGROUND
To estimate the prevalence and correlates of clinician-diagnosed DSM-IV nonaffective psychosis (NAP) in a national household survey.


METHODS
Data came from the United States National Comorbidity Survey Replication (NCS-R). A screen for NAP was followed by blinded sub-sample clinical reappraisal interviews. Logistic regression was used to impute clinical diagnoses to respondents who were not re-interviewed. The method of Multiple Imputation (MI) was used to estimate prevalence and correlates.


RESULTS
Clinician-diagnosed NAP was well predicted by the screen (area under the curve [AUC] = .80). The MI prevalence estimate of NAP (standard error in parentheses) is 5.0 (2.6) per 1000 population lifetime and 3.0 (2.2) per 1000 past 12 months. The vast majority (79.4%) of lifetime and 12-month (63.7%) cases met criteria for other DSM-IV hierarchy-free disorders. Fifty-eight percent of 12-month cases were in treatment, most in the mental health specialty sector.


CONCLUSIONS
The screen for NAP in the NCS-R greatly improved on previous epidemiological surveys in reducing false positives, but coding of open-ended screening scale responses was still needed to achieve accurate prediction. The lower prevalence estimate than in total-population incidence studies raises concerns that systematic nonresponse bias causes downward bias in survey prevalence estimates of NAP.
Kessler
Ronald C
RC
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
Birnbaum
Howard
H
Demler
Olga
O
Falloon
Ian R H
IR
Gagnon
Elizabeth
E
Guyer
Margaret
M
Howes
Mary J
MJ
Kendler
Kenneth S
KS
Shi
Lizheng
L
Walters
Ellen
E
Wu
Eric Q
EQ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006212:Hallucinations / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000453:epidemiology*; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology