Skip to main content Accessibility help

Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence

  • D. Kounali (a1), S. Zammit (a1) (a2), N. Wiles (a1), S. Sullivan (a1), M. Cannon (a3), J. Stochl (a4), P. Jones (a4), L. Mahedy (a2), S. H. Gage (a1), J. Heron (a1) and G. Lewis (a1)...



An argument often used to support the view that psychotic experiences (PEs) in general population samples are a valid phenotype for studying the aetiology of schizophrenia is that risk factors for schizophrenia show similar patterns of association with PEs. However, PEs often co-occur with depression, and no study has explicitly tested whether risk factors for schizophrenia are shared between PEs and depression, or are psychopathology specific, while jointly modelling both outcomes.


We used data from 7030 subjects from a birth cohort study. Depression and PEs at age 18 years were assessed using self-report questionnaires and semi-structured interviews. We compared the extent to which risk factors for schizophrenia across sociodemographic, familial, neurodevelopmental, stress–adversity, emotional–behavioural and substance use domains showed different associations with PEs and depression within bivariate models that allowed for their correlation.


Most of the exposures examined were associated, to a similar degree, with an increased risk of both outcomes. However, whereas female sex and family history of depression showed some discrimination as potential risk factors for depression and PEs, with stronger associations in the former, markers of abnormal neurodevelopment showed stronger associations with PEs.


The argument that PEs are valid markers for studying the aetiology of schizophrenia, made simply on the basis that they share risk factors in common, is not well supported. PEs seem to be a weak index of genetic and environmental risk for schizophrenia; however, studies disentangling aetiological pathways to PEs from those impacting upon co-morbid psychopathology might provide important insights into the aetiology of psychotic disorders.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence
      Available formats


The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence

Corresponding author

* Address for correspondence: Dr S. Zammit, Department of Psychological Medicine and Neurology, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK. (Email:


Hide All
Amemiya, T (1981). Quantitative response models: a survey. Journal of Economics Literature 19, 14831586.
Armando, M, Nelson, B, Yung, AR, Ross, M, Birchwood, M, Girardi, P, Fiori Nastro, P (2010). Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophrenia Research 119, 258265.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Bartels-Velthuis, AA, Jenner, JA, van de Willige, G, van Os, J, Wiersma, D (2010). Prevalence and correlates of auditory vocal hallucinations in middle childhood. British Journal of Psychiatry 196, 4146.
Bell, T, Watson, M, Sharp, D, Lyons, I, Lewis, G (2005). Factors associated with being a false positive on the General Health Questionnaire. Social Psychiatry and Psychiatric Epidemiology 40, 402407.
Bevan Jones, R, Thapar, A, Lewis, G, Zammit, S (2012). The association between early autistic traits and psychotic experiences in adolescence. Schizophrenia Research 135, 164169.
Binbay, T, Drukker, M, Elbi, H, Tanik, FA, Ozkinay, F, Onay, H, Zagli, N, van Os, J, Alptekin, K (2012). Testing the psychosis continuum: differential impact of genetic and nongenetic risk factors and comorbid psychopathology across the entire spectrum of psychosis. Schizophrenia Bulletin 38, 9921002.
Boyd, A, Golding, J, Macleod, J, Lawlor, DA, Fraser, A, Henderson, J, Molloy, L, Ness, A, Ring, S, Davey Smith, G (2012). Cohort Profile: the ‘children of the 90s’ – the index offspring of the Avon Longitudinal Study of Parents and Children. International Journal of Epidemiology 42, 111127.
Breetvelt, EJ, Boks, MP, Numans, ME, Selten, JP, Sommer, IE, Grobbee, DE, Kahn, RS, Geerlings, MI (2010). Schizophrenia risk factors constitute general risk factors for psychiatric symptoms in the population. Schizophrenia Research 120, 184190.
Cannon, M, Caspi, A, Moffitt, TE, Harrington, H, Taylor, A, Murray, RM, Poulton, R (2002 a). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449456.
Cannon, M, Jones, PB, Murray, RM (2002 b). Obstetric complications and schizophrenia: historical and meta-analytic review. American Journal of Psychiatry 159, 10801092.
David, AS (2010). Why we need more debate on whether psychotic symptoms lie on a continuum with normality. Psychological Medicine 40, 19351942.
Dhossche, D, Ferdinand, R, Van der Ende, J, Hofstra, MB, Verhulst, F (2002). Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychological Medicine 32, 619627.
Dickson, H, Laurens, KR, Cullen, AE, Hodgins, S (2012). Meta-analyses of cognitive and motor function in youth aged 16 years and younger who subsequently develop schizophrenia. Psychological Medicine 42, 743755.
Doherty, JL, O'Donovan, MC, Owen, MJ (2012). Recent genomic advances in schizophrenia. Clinical Genetics 81, 103109.
Dominguez, MD, Saka, MC, Lieb, R, Wittchen, HU, van Os, J (2010). Early expression of negative/disorganized symptoms predicting psychotic experiences and subsequent clinical psychosis: a 10-year study. American Journal of Psychiatry 167, 10751082.
Dominguez, MD, Wichers, M, Lieb, R, Wittchen, HU, van Os, J (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin 37, 8493.
Fisher, HL, Caspi, A, Poulton, R, Meier, MH, Houts, R, Harrington, H, Arseneault, L, Moffitt, TE (2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychological Medicine 43, 20772086.
Gale, CR, Batty, GD, Cooper, C, Deary, IJ (2009). Psychomotor coordination and intelligence in childhood and health in adulthood – testing the system integrity hypothesis. Psychosomatic Medicine 71, 675681.
Gale, CR, Deary, IJ, Boyle, SH, Barefoot, J, Mortensen, LH, Batty, GD (2008). Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the Vietnam experience study. Archives of General Psychiatry 65, 14101418.
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Harell, FE (2001). Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression and Survival Analysis. Springer: New York.
Horwood, J, Salvi, G, Thomas, K, Duffy, L, Gunnell, D, Hollis, C, Lewis, G, Menezes, P, Thompson, A, Wolke, D, Zammit, S, Harrison, G (2008). IQ and non-clinical psychotic symptoms in 12-year-olds: results from the ALSPAC birth cohort. British Journal of Psychiatry 193, 185191.
Kaymaz, N, van Os, J (2010). Extended psychosis phenotype – yes: single continuum – unlikely. Psychological Medicine 40, 19631966.
Kelleher, I, Keeley, H, Corcoran, P, Lynch, F, Fitzpatrick, C, Devlin, N, Molloy, C, Roddy, S, Clarke, MC, Harley, M, Arseneault, L, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2012 a). Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. British Journal of Psychiatry 201, 2632.
Kelleher, I, Lynch, F, Harley, M, Molloy, C, Roddy, S, Fitzpatrick, C, Cannon, M (2012 b). Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Archives of General Psychiatry 69, 12771283.
Khandaker, GM, Barnett, JH, White, IR, Jones, PB (2011). A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophrenia Research 132, 220227.
Krabbendam, L, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Nolen, WA, Iedema, J, van Os, J (2004). Dimensions of depression, mania and psychosis in the general population. Psychological Medicine 34, 11771186.
Lewis, G (1994). Assessing psychiatric disorder with a human interviewer or a computer. Journal of Epidemiology and Community Health 48, 207210.
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.
Linscott, RJ, van Os, J (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 11331149.
Little, RJA, Rubin, DB (2002). Statistical Analysis with Missing Data. Wiley: New York.
Lorant, V, Deliege, D, Eaton, W, Robert, A, Philippot, P, Ansseau, M (2003). Socioeconomic inequalities in depression: a meta-analysis. American Journal of Epidemiology 157, 98112.
Lundstrom, S, Chang, Z, Kerekes, N, Gumpert, CH, Rastam, M, Gillberg, C, Lichtenstein, P, Anckarsater, H (2011). Autistic-like traits and their association with mental health problems in two nationwide twin cohorts of children and adults. Psychological Medicine 41, 24232433.
Malmberg, A, Lewis, G, David, A, Allebeck, P (1998). Premorbid adjustment and personality in people with schizophrenia. British Journal of Psychiatry 172, 308313; discussion 314–315.
McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.
Moore, TH, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.
Mortensen, PB, Pedersen, CB, Westergaard, T, Wohlfahrt, J, Ewald, H, Mors, O, Andersen, PK, Melbye, M (1999). Effects of family history and place and season of birth on the risk of schizophrenia. New England Journal of Medicine 340, 603608.
Nosarti, C, Reichenberg, A, Murray, RM, Cnattingius, S, Lambe, MP, Yin, L, MacCabe, J, Rifkin, L, Hultman, CM (2012). Preterm birth and psychiatric disorders in young adult life. Archives of General Psychiatry 69, 610617.
Ntzoufras, I, Dellaportas, P, Forster, J (2003). Bayesian variable and link determination for generalized linear models. Journal of Planning and Inference 111, 165180.
Nuevo, R, Chatterji, S, Verdes, E, Naidoo, N, Arango, C, Ayuso-Mateos, JL (2012). The continuum of psychotic symptoms in the general population: a cross-national study. Schizophrenia Bulletin 38, 475485.
Patton, GC, Coffey, C, Posterino, M, Carlin, JB, Wolfe, R, Bowes, G (1999). A computerised screening instrument for adolescent depression: population-based validation and application to a two-phase case-control study. Social Psychiatry and Psychiatric Epidemiology 34, 166172.
Polanczyk, G, Moffitt, TE, Arseneault, L, Cannon, M, Ambler, A, Keefe, RS, Houts, R, Odgers, CL, Caspi, A (2010). Etiological and clinical features of childhood psychotic symptoms: results from a birth cohort. Archives of General Psychiatry 67, 328338.
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Rossler, W, Riecher-Rossler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J, Gross, VA (2007). Psychotic experiences in the general population: a twenty-year prospective community study. Schizophrenia Research 92, 114.
Schreier, A, Wolke, D, Thomas, K, Horwood, J, Hollis, C, Gunnell, D, Lewis, G, Thompson, A, Zammit, S, Duffy, L, Salvi, G, Harrison, G (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Scott, J, Martin, G, Bor, W, Sawyer, M, Clark, J, McGrath, J (2009). The prevalence and correlates of hallucinations in Australian adolescents: results from a national survey. Schizophrenia Research 107, 179185.
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347358.
Thapar, A, Collishaw, S, Pine, DS, Thapar, AK (2012). Depression in adolescence. Lancet 379, 10561067.
van Buuren, S, Brand, JPL, Groothuis-Oudshoorn, CGM, Rubin, DB (2006). Fully conditional specifications in multivariate imputation. Journal of Statistical Computation and Simulation 72, 10491064.
van Os, J, Hanssen, M, Bijl, RV, Ravelli, A (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 1120.
van Os, J, Jones, P, Lewis, G, Wadsworth, M, Murray, R (1997). Developmental precursors of affective illness in a general population birth cohort. Archives of General Psychiatry 54, 625631.
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635645.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
van Rossum, I, Dominguez, MD, Lieb, R, Wittchen, HU, van Os, J (2011). Affective dysregulation and reality distortion: a 10-year prospective study of their association and clinical relevance. Schizophrenia Bulletin 37, 561571.
Varghese, D, Scott, J, Welham, J, Bor, W, Najman, J, O'Callaghan, M, Williams, G, McGrath, J (2011). Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophrenia Bulletin 37, 389393.
Welham, J, Isohanni, M, Jones, P, McGrath, J (2009 a). The antecedents of schizophrenia: a review of birth cohort studies. Schizophrenia Bulletin 35, 603623.
Welham, J, Scott, J, Williams, G, Najman, J, Bor, W, O'Callaghan, M, McGrath, J (2009 b). Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychological Medicine 39, 625634.
Werbeloff, N, Drukker, M, Dohrenwend, BP, Levav, I, Yoffe, R, van Os, J, Davidson, M, Weiser, M (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 69, 467475.
Wicks, S, Hjern, A, Gunnell, D, Lewis, G, Dalman, C (2005). Social adversity in childhood and the risk of developing psychosis: a national cohort study. American Journal of Psychiatry 162, 16521657.
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519526.
Williams, NM, Zaharieva, I, Martin, A, Langley, K, Mantripragada, K, Fossdal, R, Stefansson, H, Stefansson, K, Magnusson, P, Gudmundsson, OO, Gustafsson, O, Holmans, P, Owen, MJ, O'Donovan, M, Thapar, A (2010). Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet 376, 14011408.
Zammit, S, Allebeck, P, David, AS, Dalman, C, Hemmingson, T, Lundberg, I, Lewis, G (2004). A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of General Psychiatry 61, 354360.
Zammit, S, Hamshere, M, Dwyer, S, Georgiva, L, Timpson, N, Moskvina, V, Richards, A, Evans, DM, Lewis, G, Jones, PB, Owen, MJ, O'Donovan, MC (2013 a). A population-based study of genetic variation and psychotic experiences in adolescents. Schizophrenia Bulletin. Published online: 30 October 2013 . doi: 10.1093/schbul/sbt146.
Zammit, S, Horwood, J, Thompson, A, Thomas, K, Menezes, P, Gunnell, D, Hollis, C, Wolke, D, Lewis, G, Harrison, G (2008). Investigating if psychosis-like symptoms (PLIKS) are associated with family history of schizophrenia or paternal age in the ALSPAC birth cohort. Schizophrenia Research 104, 279286.
Zammit, S, Kounali, D, Cannon, M, David, AS, Gunnell, D, Heron, J, Jones, PB, Lewis, S, Sullivan, S, Wolke, D, Lewis, G (2013 b). Psychotic experiences and psychotic disorders at age 18 in relation to psychotic experiences at age 12 in a longitudinal population-based cohort study. American Journal of Psychiatry 170, 742750.
Zammit, S, Odd, D, Horwood, J, Thompson, A, Thomas, K, Menezes, P, Gunnell, D, Hollis, C, Wolke, D, Lewis, G, Harrison, G (2009). Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort. Psychological Medicine 39, 14571467.


Type Description Title
Supplementary materials

Kounali Supplementary Material
Appendix 1

 Word (32 KB)
32 KB
Supplementary materials

Kounali Supplementary Material

 Word (114 KB)
114 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed