The Prevalence and Correlates of Nonaffective Psychosis in the National Comorbidity Survey Replication (NCS-R)

• Published in: Biological psychiatry (1969) Vol. 58; no. 8; pp. 668 - 676
• Main Authors: Kessler, Ronald C., Birnbaum, Howard, Demler, Olga, Falloon, Ian R.H., Gagnon, Elizabeth, Guyer, Margaret, Howes, Mary J., Kendler, Kenneth S., Shi, Lizheng, Walters, Ellen, Wu, Eric Q.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.10.2005; Elsevier Science
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Age Factors; Aged; Aged, 80 and over; Area Under Curve; Biological and medical sciences; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; epidemiology; Female; Hallucinations - epidemiology; Humans; Interviews as Topic; Logistic Models; Male; Medical sciences; Mental Disorders - classification; Mental Disorders - epidemiology; Middle Aged; Nonaffective psychosis; Other psychotic disorders; Population Surveillance; Prevalence; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - epidemiology; Risk Factors; United States - epidemiology; United States; Nonaffective psychosis; prevalence; epidemiology; Human; Psychosis; Concomitant disease; Survey; Prevalence; Epidemiology; Public health
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2005.04.034

To estimate the prevalence and correlates of clinician-diagnosed DSM-IV nonaffective psychosis (NAP) in a national household survey. 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. 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. 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.