Elsevier

Biological Psychiatry

Volume 58, Issue 8, 15 October 2005, Pages 668-676
Biological Psychiatry

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

https://doi.org/10.1016/j.biopsych.2005.04.034Get rights and content

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.

Section snippets

Sample

The NCS-R is a nationally representative, face-to-face household survey of adults (ages 18+) (Kessler et al 2003, Kessler et al 2004). A total of 9282 respondents participated in the survey (February 2001 - December 2003). The response rate was 70.9%. Participants received $50 for participation. Verbal rather than written consent was used in order to be consistent with the recruitment procedures in the baseline NCS (Kessler et al 1994). The Human Subjects Committees of Harvard Medical School

Screening Question Responses

NAP screening questions were endorsed by 9.1% of respondents (Table 1). The most commonly endorsed symptoms were visual (6.3%) and auditory (4.0%) hallucinations; the least commonly were thought control (.1%) and thought insertion (.4%). Clinical review of open-ended CIDI responses concluded that 16.8% of respondents who endorsed symptom questions were probable cases of NAP, which would yield a lifetime prevalence estimate of 1.5%. The proportions classified probable were much lower for visual

Discussion

The 1.5% lifetime prevalence estimate of probable NAP based on preliminary clinical review of CID open-ended responses is in the middle of the range of prevalence estimates in past community epidemiological surveys (Bland et al 1988, Canino et al 1987, Hwu et al 1989, Keith et al 1991, Kendler et al 1996, Lee et al 1990, Wells et al 1989, Wittchen et al 1992). This was achieved, though, using a much smaller set of screening questions than in previous surveys as well as with a much smaller

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