Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries

Abstract

Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

“…The perceived stress scale is a widely used to measure stress sensitivity. The two questions from the scale have been validated and applied in many settings worldwide, including LMICs (26). The questions asked in the scale include: "How often have you felt that you were unable to control the important things in your life?…”

“…Of the remaining LMICs, Brazil, Hungary, Turkey, and Zimbabwe were omitted as information on perceived stress was not collected. Furthermore, Georgia was also excluded due to a negative correlation between the two questions on perceived stress (26) Information on perceived stress was missing from 7.2% of the sample while data on chronic conditions was missing from 5.6% (angina) to 18.4% (tuberculosis). We conducted multiple imputation of missing values using the mi commands in Stata using chained equations (20 imputations).…”

Terminology and assessment tools of psychosis: A systematic narrative review

“…Many defined psychotic experiences as not reaching the threshold of psychotic disorders, such as ‘hallucination‐ and delusion‐like experiences that resemble the symptoms of psychotic disorders but are typically of less intensity, persistence, or impairment’ . This was akin to ‘hallucination‐like or delusion‐like symptoms that do not meet diagnosable criteria due to insufficient intensity, persistence, or associated impairment’ . Psychotic experiences are also ‘delusions and hallucinations’ which are ‘in the general population at levels that do not reach clinical thresholds’ and ‘the occurrence of hallucinations and delusions among ‘normal’ and ‘healthy’ individuals.’…”

“…Psychotic experiences are in the general population, [2][3][4]11,[13][14][15][16][17][18][19][20] transient, 21 and risk factors for psychotic disorders 3,4,13,15,18,[20][21][22][23][24][25] and other mental disorders 2,21 alongside impaired functioning. 2,15,21 Many regarded psychotic experiences as on the continuum of psychosis or psychotic symptoms, 3,21,23,[25][26][27][28] and included hallucinations, 28,29 or both hallucinations and delusions, 2,15,16,[30][31][32][33][34] alongside thought interference. 15,32 A sleep deprivation study listed them as 'paranoia, hallucinations, grandiosity, and cognitive disorganization'.…”

“…36 This was akin to 'hallucination-like or delusion-like symptoms that do not meet diagnosable criteria due to insufficient intensity, persistence, or associated impairment'. 26 Psychotic experiences are also 'delusions and hallucinations' which are 'in the general population at levels that do not reach clinical thresholds' 25 and 'the occurrence of hallucinations and delusions among 'normal' and 'healthy' individuals.' 3…”