Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries

Caroline Wusten*, Bjorn Schlier, Edo S. Jaya, Behrooz Z. Alizadeh, Agna A. Bartels-Velthuis, Nico J. van Beveren, Richard Bruggeman, Wiepke Cahn, Lieuwe de Haan, Philippe Delespaul, Carin J. Meijer, Inez Myin-Germeys, Rene S. Kahn, Frederike Schirmbeck, Claudia J. P. Simons, Neeltje E. van Haren, Jim van Os, Ruud van Winkel, Eduardo Fonseca-Pedrero, Emmanuelle PetersHelene Verdoux, Todd S. Woodward, Tim B. Ziermans, Tania M. Lincoln, Genetic Risk and Outcome of Psychosis (GROUP) Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Psychotic experiences (PEs) are common in the general population but do not necessarily reflect a risk status if they occur in relative isolation or are not distressing. Emerging evidence suggests that PEs might be experienced as more benign for individuals from collectivistic low- and middle-income countries (LAMIC) compared with individualistic high-income countries (HIC). The aim of this study was to determine whether: (1) self-reported PEs are less distressing in community samples from LAMIC than from HIC; (2) the network of PEs is significantly less connected in a sample from LAMIC than from HIC. Adults from 8 HIC (n = 4669) and 5 LAMIC (n = 2472) were compared. The lifetime frequency of PEs and related distress were assessed with the Community Assessment of Psychic Experiences. We analyzed the associations of PEs with distress and country type. The interconnection of PEs was visualized by a network analysis and tested for differences in global connection strengths. The average endorsement rates of PEs were significantly higher in LAMIC than in HIC (chi(2) = 1772.87, P <.01, Phi(cramer) = 0.50). There was a universal positive correlation between higher frequency of PEs and more distress, but the distress levels controlled for frequency were significantly higher in HIC (R-2 = 0.11; b = 0.26; SE = 0.01; T = 17.68; P <.001). Moreover, the network of PEs was significantly less connected in LAMIC (S = 0.40, P <.05). The findings indicate that PEs are of less clinical relevance in LAMIC compared with HIC. The universal use of current high- risk criteria might thus not be adequate without consideration of associated distress and cultural values.

Original languageEnglish
Pages (from-to)1185-1194
Number of pages10
JournalSchizophrenia Bulletin
Issue number6
Publication statusPublished - Nov 2018


  • psychosis continuum
  • high-risk status
  • psychosis phenotype
  • culture
  • cross-cultural comparison
  • CAPE
  • network approach
  • epidemiology
  • schizophrenia
  • RISK


Dive into the research topics of 'Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries'. Together they form a unique fingerprint.

Cite this