Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries.
Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.
School of Social Work, University of Maryland, Baltimore, Baltimore, MD.
Jordan E
JE
DeVylder
Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
Ai
A
Koyanagi
School of Social Work, University of Maryland, Baltimore, Baltimore, MD.
Jay
J
Unick
School of Public Health, University of California Berkeley, Berkeley, CA.|Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA.
Hans
H
Oh
School of Social Work, University of Maryland, Baltimore, Baltimore, MD.
Boyoung
B
Nam
The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Stockholm, Sweden.
Andrew
A
Stickley
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D001208:Asia / Q000453:epidemiology; D003906:Developing Countries / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000209:etiology; D013020:South America / Q000453:epidemiology; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*; D014944:World Health Organization; D055815:Young Adult
World Health Survey; psychosis; schizophrenia; stress