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Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology

  • S. Guloksuz (a1) (a2), M. van Nierop (a1), R. Lieb (a3), R. van Winkel (a1) (a4), H.-U. Wittchen (a5) (a6) and J. van Os (a1) (a7)...



Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity.


In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology.


The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use.


In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.


Corresponding author

* Address for correspondence: J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, EURON, PO Box 616, 6200 MD Maastricht, The Netherlands. (Email:


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Aas, M, Etain, B, Bellivier, F, Henry, C, Lagerberg, T, Ringen, A, Agartz, I, Gard, S, Kahn, JP, Leboyer, M, Andreassen, OA, Melle, I (2014). Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders. Psychological Medicine 44, 16531662.
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.
Armando, M, Lin, A, Girardi, P, Righetti, V, Dario, C, Saba, R, Decrescenzo, F, Mazzone, L, Vicari, S, Birchwood, M, Fiori Nastro, P (2013). Prevalence of psychotic-like experiences in young adults with social anxiety disorder and correlation with affective dysregulation. Journal of Nervous and Mental Disease 201, 10531059.
Baliki, MN, Petre, B, Torbey, S, Herrmann, KM, Huang, L, Schnitzer, TJ, Fields, HL, Apkarian, AV (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience 15, 11171119.
Bentall, RP, Wickham, S, Shevlin, M, Varese, F (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734740.
Borsboom, D, Cramer, AO (2013). Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9, 91121.
Bovasso, GB (2001). Cannabis abuse as a risk factor for depressive symptoms. American Journal of Psychiatry 158, 20332037.
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.
Cougnard, A, Marcelis, M, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, C, Spauwen, J, Van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model. Psychological Medicine 37, 513527.
Craddock, N, Owen, MJ (2010). The Kraepelinian dichotomy – going, going … but still not gone. British Journal of Psychiatry 196, 9295.
Cross-Disorder Group of the Psychiatric Genomics Consortium (2013). Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet 381, 13711379.
Darroch, J (1997). Biologic synergism and parallelism. American Journal of Epidemiology 145, 661668.
Derogatis, LR, Cleary, PA (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology 33, 981989.
DeVylder, JE, Burnette, D, Yang, LH (2014). Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples. Psychological Medicine 44, 35033513.
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, Jones, PB, Fearon, P, Craig, TK, Dazzan, P, Morgan, K, Hutchinson, G, Doody, GA, McGuffin, P, Leff, J, Murray, RM, Morgan, C (2010). The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychological Medicine 40, 19671978.
Freeman, D, Dunn, G, Fowler, D, Bebbington, P, Kuipers, E, Emsley, R, Jolley, S, Garety, P (2013 a). Current paranoid thinking in patients with delusions: the presence of cognitive–affective biases. Schizophrenia Bulletin 39, 12811287.
Freeman, D, Fowler, D (2009). Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Research 169, 107112.
Freeman, D, Startup, H, Dunn, G, Cernis, E, Wingham, G, Pugh, K, Cordwell, J, Kingdon, D (2013 b). The interaction of affective with psychotic processes: a test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions. Journal of Psychiatric Research 47, 18371842.
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR, McGuire, PK (2014). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120131.
Gracie, A, Freeman, D, Green, S, Garety, PA, Kuipers, E, Hardy, A, Ray, K, Dunn, G, Bebbington, P, Fowler, D (2007). The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatrica Scandinavica 116, 280289.
Hammersley, P, Dias, A, Todd, G, Bowen-Jones, K, Reilly, B, Bentall, RP (2003). Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. British Journal of Psychiatry 182, 543547.
Hanssen, M, Peeters, F, Krabbendam, L, Radstake, S, Verdoux, H, van Os, J (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149154.
Harley, M, Kelleher, I, Clarke, M, Lynch, F, Arseneault, L, Connor, D, Fitzpatrick, C, Cannon, M (2010). Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychological Medicine 40, 16271634.
Hartley, S, Barrowclough, C, Haddock, G (2013). Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms. Acta Psychiatrica Scandinavica 128, 327346.
Heins, M, Simons, C, Lataster, T, Pfeifer, S, Versmissen, D, Lardinois, M, Marcelis, M, Delespaul, P, Krabbendam, L, van Os, J, Myin-Germeys, I (2011). Childhood trauma and psychosis: a case–control and case–sibling comparison across different levels of genetic liability, psychopathology, and type of trauma. American Journal of Psychiatry 168, 12861294.
Henquet, C, Krabbendam, L, Spauwen, J, Kaplan, C, Lieb, R, Wittchen, HU, van Os, J (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 330, 11.
Houston, JE, Murphy, J, Adamson, G, Stringer, M, Shevlin, M (2008). Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophrenia Bulletin 34, 580585.
Hovens, JG, Giltay, EJ, Wiersma, JE, Spinhoven, P, Penninx, BW, Zitman, FG (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica 126, 198207.
Hovens, JG, Wiersma, JE, Giltay, EJ, van Oppen, P, Spinhoven, P, Penninx, BW, Zitman, FG (2010). Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Acta Psychiatrica Scandinavica 122, 6674.
Karlson, KB, Holm, A (2011). Decomposing primary and secondary effects: a new decomposition method. Research in Social Stratification and Mobility 29, 221237.
Kaymaz, N, Drukker, M, Lieb, R, Wittchen, HU, Werbeloff, N, Weiser, M, Lataster, T, van Os, J (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine 42, 22392253.
Kaymaz, N, Krabbendam, L, de Graaf, R, Nolen, W, Ten Have, M, van Os, J (2006). Evidence that the urban environment specifically impacts on the psychotic but not the affective dimension of bipolar disorder. Social Psychiatry and Psychiatric Epidemiology 41, 679685.
Kaymaz, N, van Os, J, de Graaf, R, Ten Have, M, Nolen, W, Krabbendam, L (2007). The impact of subclinical psychosis on the transition from subclinicial mania to bipolar disorder. Journal of Affective Disorders 98, 5564.
Kedzior, KK, Laeber, LT (2014). A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population – a meta-analysis of 31 studies. BMC Psychiatry 14, 136.
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, Murtagh, A, Molloy, C, Roddy, S, Clarke, MC, Harley, M, Cannon, M (2012 b). Identification and characterization of prodromal risk syndromes in young adolescents in the community: a population-based clinical interview study. Schizophrenia Bulletin 38, 239246.
Kendler, KS, Gardner, CO (2010). Interpretation of interactions: guide for the perplexed. British Journal of Psychiatry 197, 170171.
Knol, MJ, van der Tweel, I, Grobbee, DE, Numans, ME, Geerlings, MI (2007). Estimating interaction on an additive scale between continuous determinants in a logistic regression model. International Journal of Epidemiology 36, 11111118.
Kohler, U, Karlson, KB, Holm, A (2011). Comparing coefficients of nested nonlinear probability models. Stata Journal 11, 420438.
Konings, M, Stefanis, N, Kuepper, R, de Graaf, R, ten Have, M, van Os, J, Bakoula, C, Henquet, C (2012). Replication in two independent population-based samples that childhood maltreatment and cannabis use synergistically impact on psychosis risk. Psychological Medicine 42, 149159.
Kuepper, R, Henquet, C, Lieb, R, Wittchen, HU, van Os, J (2011 a). Non-replication of interaction between cannabis use and trauma in predicting psychosis. Schizophrenia Research 131, 262263.
Kuepper, R, van Os, J, Lieb, R, Wittchen, HU, Henquet, C (2011 b). Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study. Psychological Medicine 41, 21212129.
Kuepper, R, van Os, J, Lieb, R, Wittchen, HU, Hofler, M, Henquet, C (2011 c). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ 342, d738.
Leverich, GS, McElroy, SL, Suppes, T, Keck, PE Jr, Denicoff, KD, Nolen, WA, Altshuler, LL, Rush, AJ, Kupka, R, Frye, MA, Autio, KA, Post, RM (2002). Early physical and sexual abuse associated with an adverse course of bipolar illness. Biological Psychiatry 51, 288297.
Lieb, R, Isensee, B, von Sydow, K, Wittchen, HU (2000). The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. European Addiction Research 6, 170182.
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.
Manrique-Garcia, E, Zammit, S, Dalman, C, Hemmingsson, T, Andreasson, S, Allebeck, P (2012). Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort. Psychological Medicine 42, 13211328.
Minozzi, S, Davoli, M, Bargagli, AM, Amato, L, Vecchi, S, Perucci, CA (2010). An overview of systematic reviews on cannabis and psychosis: discussing apparently conflicting results. Drug Alcohol Review 29, 304317.
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TRE, 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, Reininghaus, U, Reichenberg, A, Frissa, S, SELCoH study team, Hotopf, M, Hatch, SL (2014). Adversity, cannabis use and psychotic experiences: evidence of cumulative and synergistic effects. British Journal of Psychiatry 204, 346353.
Nanni, V, Uher, R, Danese, A (2012). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. American Journal of Psychiatry 169, 141151.
Perlis, RH, Uher, R, Ostacher, M, Goldberg, JF, Trivedi, MH, Rush, AJ, Fava, M (2011). Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Archives of General Psychiatry 68, 351360.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Reed, V, Gander, F, Pfister, H, Steiger, A, Sonntag, H, Trenkwalder, C, Hundt, W, Wittchen, H-U (1998). To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 7, 142155.
Reeves, LE, Anglin, DM, Heimberg, RG, Gibson, LE, Fineberg, AM, Maxwell, SD, Kerns, CM, Ellman, LM (2014). Anxiety mediates the association between cannabis use and attenuated positive psychotic symptoms. Psychiatry Research 218, 180186.
Rietdijk, J, Hogerzeil, SJ, van Hemert, AM, Cuijpers, P, Linszen, DH, van der Gaag, M (2011). Pathways to psychosis: help-seeking behavior in the prodromal phase. Schizophrenia Research 132, 213219.
Rossler, W, Hengartner, MP, Ajdacic-Gross, V, Haker, H, Gamma, A, Angst, J (2011). Sub-clinical psychosis symptoms in young adults are risk factors for subsequent common mental disorders. Schizophrenia Research 131, 1823.
Rothman, KJ, Greenland, S, Walker, AM (1980). Concepts of interaction. American Journal of Epidemiology 112, 467470.
Schwartz, S, Susser, E (2006). Relationships among causes. In Psychiatric Epidemiology: Searching for the Causes of Mental Disorders (ed. Susser, E., Schwartz, S., Morabia, A. and Bromet, E.). Oxford and New York: Oxford University Press.
Smeets, F, Lataster, T, Dominguez, MD, Hommes, J, Lieb, R, Wittchen, HU, van Os, J (2012). Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions. Schizophrenia Bulletin 38, 531542.
Smeets, F, Lataster, T, Viechtbauer, W, Delespaul, P, G.R.O.U.P. (2014). Evidence that environmental and genetic risks for psychotic disorder may operate by impacting on connections between core symptoms of perceptual alteration and delusional ideation. Schizophrenia Bulletin. Published online 12 09 2014 . doi:10.1093/schbul/sbu122.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2004). Does urbanicity shift the population expression of psychosis? Journal of Psychiatric Research 38, 613618.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. British Journal of Psychiatry 188, 527533.
StataCorp (2013). Stata/SE Statistical Software, Release 13.1. StataCorp LP: College Station, TX.
Sundquist, K, Frank, G, Sundquist, J (2004). Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden. British Journal of Psychiatry 184, 293298.
Treserras, S, Boulanouar, K, Conchou, F, Simonetta-Moreau, M, Berry, I, Celsis, P, Chollet, F, Loubinoux, I (2009). Transition from rest to movement: brain correlates revealed by functional connectivity. NeuroImage 48, 207216.
van Dam, DS, van Nierop, M, Viechtbauer, W, Velthorst, E, van Winkel, R, Genetic, Risk and Outcome of Psychosis (GROUP) investigators, Bruggeman, R, Cahn, W, de Haan, L, Kahn, RS, Meijer, CJ, Myin-Germeys, I, van Os, J, Wiersma, D (2014). Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology. Psychological Medicine. Published online 17 07 2014 . doi:10.1017/S0033291714001561.
Van Nierop, M, Viechtbauer, W, Gunther, N, van Zelst, C, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, G.R.O.U.P. Investigators, van Winkel R (in press). Childhood trauma is associated with a specific admixture of affective, anxiety, and psychotic symptoms cutting across traditional diagnostic boundaries. Psychological Medicine.
van Os, J (2013). The dynamics of subthreshold psychopathology: implications for diagnosis and treatment. American Journal of Psychiatry 170, 695698.
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203212.
van Os, J, Lataster, T, Delespaul, P, Wichers, M, Myin-Germeys, I (2014). Evidence that a psychopathology interactome has diagnostic value, predicting clinical needs: an experience sampling study. PLOS ONE 9, e86652.
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.
van Winkel, R, Kuepper, R (2014). Epidemiological, neurobiological, and genetic clues to the mechanisms linking cannabis use to risk for nonaffective psychosis. Annual Review of Clinical Psychology 10, 767791.
van Winkel, R, van Nierop, M, Myin-Germeys, I, van Os, J (2013). Childhood trauma as a cause of psychosis: linking genes, psychology, and biology. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 58, 4451.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient–control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
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.
Varotto, G, Visani, E, Canafoglia, L, Franceschetti, S, Avanzini, G, Panzica, F (2012). Enhanced frontocentral EEG connectivity in photosensitive generalized epilepsies: a partial directed coherence study. Epilepsia 53, 359367.
Vassos, E, Pedersen, CB, Murray, RM, Collier, DA, Lewis, CM (2012). Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 38, 11181123.
Wigman, JT, van Nierop, M, Vollebergh, WA, Lieb, R, Beesdo-Baum, K, Wittchen, HU, van Os, J (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity – implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin 38, 247257.
Wigman, JT, van Os, J, Thiery, E, Derom, C, Collip, D, Jacobs, N, Wichers, M (2013). Psychiatric diagnosis revisited: towards a system of staging and profiling combining nomothetic and idiographic parameters of momentary mental States. PLOS ONE 8, e59559.
Wigman, JT, van Winkel, R, Raaijmakers, QA, Ormel, J, Verhulst, FC, Reijneveld, SA, van Os, J, Vollebergh, WA (2011 a). Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychological Medicine 41, 23172329.
Wigman, JT, Vollebergh, WA, Raaijmakers, QA, Iedema, J, van Dorsselaer, S, Ormel, J, Verhulst, FC, van Os, J (2011 b). The structure of the extended psychosis phenotype in early adolescence – a cross-sample replication. Schizophrenia Bulletin 37, 850860.
Wittchen, HU, Lachner, G, Wunderlich, U, Pfister, H (1998 a). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.
Wittchen, HU, Perkonigg, A, Lachner, G, Nelson, CB (1998 b). Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. European Addiction Research 4, 1827.
Wittchen, HU, Pfister, H (1997). DIA-X-Interviews: Manual fur Screening-Verfahren und Interview; Interviewheft Langsschnittuntersuchung (DIA-X-Lifetime); Enganzungsheft (DIA-X-Lifetime); Interviewheft Querschnittsuntersuchung (DIA-X-Monatsversion); Erganzungsheft (DIA-X-12 Monatsversion); PC-Programm zur Durchfuhrung der Interviews (Langsund Querschnittsuntersuchung). Ausertungsprogramm. Swets & Zeiltinger: Frankfurt, Germany.
Zimmermann, P, Bruckl, T, Lieb, R, Nocon, A, Ising, M, Beesdo, K, Wittchen, HU (2008). The interplay of familial depression liability and adverse events in predicting the first onset of depression during a 10-year follow-up. Biological Psychiatry 63, 406414.



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