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Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys

  • Kate M. Scott (a1), Sukanta Saha (a2), Carmen C.W. Lim (a2), Sergio Aguilar-Gaxiola (a3), Ali Al-Hamzawi (a4), Jordi Alonso (a5) (a6) (a7), Corina Benjet (a8), Evelyn J. Bromet (a9), Ronny Bruffaerts (a10), José Miguel Caldas-de-Almeida (a11), Giovanni de Girolamo (a12), Peter de Jonge (a13) (a14), Louisa Degenhardt (a15), Silvia Florescu (a16), Oye Gureje (a17), Josep M. Haro (a18), Chiyi Hu (a19), Elie G. Karam (a20) (a21) (a22), Viviane Kovess-Masfety (a23), Sing Lee (a24), Jean-Pierre Lepine (a25), Zeina Mneimneh (a26), Fernando Navarro-Mateu (a27), Marina Piazza (a28) (a29), José Posada-Villa (a30), Nancy A. Sampson (a31), Juan Carlos Stagnaro (a32), Ronald C. Kessler (a31) and John J. McGrath (a2) (a33)...



Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.


In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.


After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).


PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.


Corresponding author

Author for correspondence: Prof John McGrath, E-mail:


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WHO World Mental Health Survey Collaborators are listed in the Appendix.

The WHO World Mental Health Survey collaborators are Sergio Aguilar-Gaxiola, MD, PhD, Ali Al-Hamzawi, MD, Mohammed Salih Al-Kaisy, MD, Jordi Alonso, MD, PhD, Laura Helena Andrade, MD, PhD, Corina Benjet, PhD, Guilherme Borges,ScD, Evelyn J. Bromet, PhD, Ronny Bruffaerts, PhD, Brendan Bunting, PhD, Jose Miguel Caldas de Almeida, MD, PhD, Graca Cardoso, MD, PhD, Somnath Chatterji, MD, Alfredo H. Cia, MD, Louisa Degenhardt, PhD, Koen Demyttenaere, MD, PhD, John Fayyad, MD, Silvia Florescu, MD, PhD, Giovanni de Girolamo, MD, Oye Gureje, MD, DSc, FRCPsych, Josep Maria Haro, MD, PhD, Yanling He, MD, Hristo Hinkov, MD, PhD, Chiyi Hu, MD, PhD, Yueqin Huang, MD, MPH, PhD, Peter de Jonge, PhD, Aimee Nasser Karam, PhD, Elie G. Karam, MD, Norito Kawakami, MD, DMSc, Ronald C. Kessler, PhD, Andrzej Kiejna, MD, PhD, Viviane Kovess-Masfety, MD, PhD, Sing Lee, MB,BS, Jean-Pierre Lepine, MD, Daphna Levinson, PhD, John J. McGrath, MD, PhD, Maria Elena Medina-Mora, PhD, Jacek Moskalewicz, PhD, Fernando Navarro-Mateu, MD, PhD, Beth-Ellen Pennell, MA, Marina Piazza, MPH, ScD, Jose Posada-Villa, MD, Kate M. Scott, PhD, Tim Slade, PhD, Juan Carlos Stagnaro, MD, PhD, Dan J. Stein, FRCPC, PhD, Margreet ten Have, PhD, Yolanda Torres, MPH, Dra.HC, Maria Carmen Viana, MD, PhD, Harvey Whiteford, MBBS, PhD, David R. Williams, MPH, PhD, Bogdan Wojtyniak, ScD.



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