The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R)

Biol Psychiatry. 2005 Oct 15;58(8):668-76. doi: 10.1016/j.biopsych.2005.04.034. Epub 2005 Jul 14.


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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Comorbidity
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Hallucinations / epidemiology
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Male
  • Mental Disorders / classification
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Population Surveillance*
  • Prevalence
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / epidemiology*
  • Risk Factors
  • United States / epidemiology