Background
Are associations between predictors and PEs confounded by depression?
Methods
Participants
Measures
PEs
Depression
Psychiatric diagnosis
Etiological risk factors
Statistical analysis
Results
Modelling PEs and depressive symptoms across the continuum
PEs level1 N = 13,978 (29·7%) | PEs level2 N = 23,567 (50·1%) | PEs level3 N = 6402 (13·6%) | PEs level4 N = 2118 (4·5%) | PEs level5 N = 939 (2·0%) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) | β | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | |
Psychotic Experiences (SCL90-R) 4·44 (SD 5·95) | 0 (0) | 0·00 (Ref) | 3·29 (1·92) | 3·29***$ (3·25–3·33) | 10·31 (1·94) | 10·31***$ (10·25–10·37) | 17·55 (2·15) | 17·55***$ (17·46–17·64) | 29·75 (7·26) | 29·75***$ (29·62–29·87) |
Depressive Symptoms (PHQ 9) 3·00 (SD 3·42) | 0·92 (1·83) | 0·00 (Ref) | 2·97 (2·52) | 1·88***$ (1·82–1·93) | 5·52 (3·42) | 4·61***$ (4·53–4·69) | 7·77 (4·23) | 6·86***$ (6·73–6·98) | 11·11 (5·66) | 10·19***$ (10·01–10·37) |
Rho (95%CI)a | – | 0·35**@ (0·34, 0·36) | 0·20*@ (0·18, 0·23) | 0·10* (0·06, 0·15) | 0·25* (0·19, 0·31) |
Categorical measures of psychosis, depression, and non-psychotic psychopathology
PEs level1 N = 13,978 (29·7%) | PEs level2 N = 23,567 (50·1%) | PEs level3 N = 6402 (13·6%) | PEs level4 N = 2118 (4·5%) | PEs level5 N = 939 (2·0%) | Deviation From Linearity | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N (%) | OR | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | βa | χ2 | P-value | |
Hallucinations and Delusions n = 324 (0·7%) | 0 (0·0) | – | 0 (0·0) | – | 23 (0·4) | 1·00 (Ref) | 87 (4·1) | 11·94***$ (7·52–18·96) | 214 (22·8) | 82·52***$ (53·29–127·77) | – | – | – |
– | – | 1·00 (Ref) | 12·98***$ (8·15–20·68) | 101·83***$ (64·49–160·77) | – | – | – | ||||||
Schizophrenia Nuclear Symptoms n = 360 (0·8%) | 0 (0·0) | – | 0 (0·0) | – | 10 (0·2) | 1·00 (Ref) | 48 (2·3) | 14·87***$ (7·51–29·44) | 302 (32·2) | 303·68***$ (160·88–573·21) | – | – | – |
– | – | 1·00 (Ref) | 7·10***$ (3·74–13·48) | 127·81***$ (72·28–225·98) | – | – | – | ||||||
Nuclear Symptoms and Depression n = 85 (0·2%) | 0 (0·0) | – | 0 (0·0) | – | 0 (0·0) | – | 3 (0·1) | 1·00 (Ref) | 82 (8·7) | 67·55***$ (21·28–214·37) | – | – | – |
– | – | – | 1·00 (Ref) | 26·56***$ (8·18–86·21) | – | – | – | ||||||
Depressive Disorder n = 567 (1·2%) | 24 (0·2) | 1·00 (Ref) | 50 (0·2) | 1·24 (0·76–2·01) | 103 (1·6) | 9·57***$ (6·13–14·94) | 144 (6·8) | 42·83***$ (27·73–66·16) | 246 (26·2) | 208·41***$ (136·07–319·20) | 0·58 | 166·12 | < 0·001$ |
Diagnosed Schizophrenia n = 63 (0·1%) | 10 (0·07) | 1·00 (Ref) | 19 (0·08) | 1·17 (0·54–2·52) | 12 (0·2) | 2·73* (1·18–6·32) | 8 (0·4) | 5·48***$ (2·16–13·90) | 14 (1·5) | 22·16***$ (9·80–50·10) | 0·43 | 22·06 | < 0·001$ |
1·00 (Ref) | 0·95 (0·44–2·06) | 1·59 (0·66–3·86) | 2·41 (0·86–6·74) | 6·19***$ (2·11–18·17) | 0·32 | 9·98 | 0·002$ | ||||||
Diagnosed Non-Psychotic Disorder n = 2321 (4·9%) | 258 (1·8) | 1·00 (Ref) | 907 (3·8) | 2·16***$ (1·88–2·48) | 604 (9·4) | 5·61***$ (4·83–6·51) | 332 (15·7) | 9·99***$ (8·43–11·85) | 220 (23·4) | 16·52***$ (13·59–20·08) | 0·14 | 51·13 | < 0·001$ |
1·00 (Ref) | 1·76***$ (1·52–2·03) | 3·37***$ (2·87–3·96) | 4·69***$ (3·87–5·68) | 5·36***$ (4·23–6·80) | 0·05 | 6·80 | 0·009 |
Etiology and psychosis continuity
PEs level1 N = 13,978 (29·7%) | PEs level2 N = 23,567 (50·1%) | PEs level3 N = 6402 (13·6%) | PEs level4 N = 2118 (4·5%) | PEs level5 N = 939 (2·0%) | Deviation From Linearity | ||||||||
Mean (SD) | β | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | Mean (SD) | β (95%CI) | βa | χ2 | P-value | |
Demography | |||||||||||||
Age 18·19 (SD 0·91) | 18·23 (0·95) | 0·00 (Ref) | 18·18 (0·90) | −0·05***$ (− 0·06−− 0·03) | 18·16 (0·88) | − 0·06***$ (− 0·09−− 0·04) | 18·16 (0·87) | −0·07**$ (− 0·11–0·02) | 18·17 (0·83) | −0·06 (− 0·12–0·00) | 0·01 | 4·30 | 0·03 |
0·00 (Ref) | −0·07 ***$ (− 0·09−− 0·05) | −0·12***$ (− 0·15−− 0·09) | -0·15***$ (− 0·19--0·10) | -0·18***$ (− 0·24--0·11) | 0·00 | 0·01 | 0·93 | ||||||
N (%) | OR | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | ||||
Male n = 23,444 (49·9%) | 7353 (52·6) | 1·00 (Ref) | 11,313 (48·0) | 0·83***$ (0·80–0·87) | 3213 (50·2) | 0·91**$ (0·86–0·96) | 1096 (51·7) | 0·97 (0·88–1·06) | 469 (49·9) | 0·90 (0·79–1·03) | 0·06 | 42·18 | < 0·001$ |
1·00 (Ref) | 0·91***$ (0·91–0·95) | 1·12***$ (1·05–1·20) | 1·32***$ (1·19–1·47) | 1·43***$ (1·23–1·66) | 0·10 | 98·30 | < 0·001$ | ||||||
Ethnic Minority n = 4777 (10·1%) | 1358 (9·7) | 1·00 (Ref) | 2375 (10·1) | 1·05 (0·98–1·13) | 693 (10·8) | 1·15** (1·04–1·26) | 248 (11·7) | 1·26**$ (1·09–1·45) | 103 (11·0) | 1·16 (0·94–1·44) | 0·02 | 1·69 | 0·19 |
1·00 (Ref) | 0·99 (0·92–1·07) | 0·99 (0·89–1·11) | 1·01 (0·86–1·19) | 0·84 (0·66–1·07) | 0·00 | 0·01 | 0·91 | ||||||
Low Family Income n = 6986 (14·9%) | 2047 (14·6) | 1·00 (Ref) | 3446 (14·6) | 1·02 (0·96–1·08) | 970 (15·1) | 1·06 (0·98–1·16) | 339 (16·0) | 1·14* (1·00–1·29) | 184 (19·6) | 1·46***$ (1·23–1·73) | 0·04 | 8·72 | 0·003 |
1·00 (Ref) | 0·95 (0·89–1·01) | 0·89* (0·81–0·98) | 0·87 (0·75–1·00) | 0·98 (0·80–1·19) | 0·01 | 0·36 | 0·55 | ||||||
Urban Birth n = 6791 (14·4%) | 2292 (16·4) | 1·00 (Ref) | 3221 (13·7) | 0·80***$ (0·75–0·85) | 835 (13·0) | 0·76***$ (0·69–0·82) | 318 (15·0) | 0·89 (0·79–1·01) | 125 (13·3) | 0·78* (0·64–0·94) | 0·06 | 16·68 | < 0·001$ |
1·00 (Ref) | 0·87***$ (0·81–0·92) | 0·92 (0·84–1·01) | 1·19* (1·03–1·38) | 1·19 (0·96–1·48) | 0·09 | 37·27 | < 0·001$ | ||||||
PEs level1 N = 13,978 (29·7%) | PEs level2 N = 23,567 (50·1%) | PEs level3 N = 6402 (13·6%) | PEs level4 N = 2118 (4·5%) | PEs level5 N = 939 (2·0%) | Deviation From Linearity | ||||||||
N (%) | OR | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | N (%) | OR (95%CI) | βa | χ2 | P-value | |
Family History | |||||||||||||
Family History (psychosis) n = 338 (0·7%) | 67 (0·5) | 1·00 (Ref) | 159 (0·7) | 1·40* (1·05–1·86) | 69 (1·1) | 2·25***$ (1·60–3·15) | 27 (1·3) | 2·67***$ (1·70–4·18) | 16 (1·7) | 3·58***$ (2·06–6·19) | 0·05 | 1·10 | 0·29 |
1·00 (Ref) | 1·26 (0·94–1·69) | 1·74** (1·20–2·54) | 1·82* (1·09–3·05) | 2·02* (1·03–3·94) | 0·10 | 0·03 | 0·86 | ||||||
Family History (non-psychosis) n = 440 (0·9%) | 79 (0·6) | 1·00 (Ref) | 214 (0·9) | 1·58***$ (1·22–2·05) | 87 (1·4) | 2·39***$ (1·76–3·25) | 50 (2·3) | 4·22***$ (2·95–6·03) | 10 (1·1) | 1·87 (0·97–3·62) | -0·01 | 0·01 | 0·91 |
1·00 (Ref) | 1·42** (1·09–1·85) | 1·82***$ (1·29–2·55) | 2·79***$ (1·83–4·25) | 1·00 (0·48–2·11) | -0·05 | 1·06 | 0·30 | ||||||
Adverse Childhood Experiences | |||||||||||||
Loss of Parent (Divorce) n = 1102 (2·3%) | 191 (1·3) | 1·00 (Ref) | 546 (2·3) | 1·71***$ (1·45–2·02) | 219 (3·4) | 2·57***$ (2·11–3·12) | 85 (4·0) | 3·03***$ (2·34–3·94) | 61 (6·0) | 5·03***$ (3·74–6·77) | 0·03 | 0·93 | 0·34 |
1·00 (Ref) | 1·61***$ (1·36–1·91) | 2·21***$ (1·78–2·74) | 2·42***$ (1·80–3·25) | 3·59***$ (2·50–5·16) | 0·00 | 0·01 | 0·92 | ||||||
Loss of Parent (Death) n = 632 (1·3%) | 145 (1·0) | 1·00 (Ref) | 304 (1·3) | 1·25* (1·02–1·53) | 114 (1·8) | 1·74***$ (1·36–2·23) | 48 (2·2) | 2·23***$ (1·60–3·10) | 21 (2·2) | 2·19***$ (1·38–3·49) | 0·06 | 2·41 | 0·12 |
1·00 (Ref) | 1·16 (0·94–1·42) | 1·44** (1·09–1·90) | 1·68** (1·15–2·45) | 1·43 (0·83–2·46) | 0·03 | 0·55 | 0·46 | ||||||
Physical Abuse n = 14,785 (31·5%) | 3829 (27·4) | 1·00 (Ref) | 6773 (28·7) | 1·09***$ (1·04–1·14) | 2625 (41·0) | 1·88***$ (1·76–2·00) | 1019 (48·1) | 2·49***$ (2·27–2·74) | 539 (57·4) | 3·66***$ (3·20–4·19) | 0·17 | 253·88 | < 0·001$ |
1·00 (Ref) | 1·01 (0·96–1·06) | 1·55***$ (1·44–1·66) | 1·87***$ (1·68–2·08) | 2·40***$ (2·06–2·80) | 0·14 | 171·46 | < 0·001$ | ||||||
Sexual Abuse n = 1360 (2·9%) | 311 (2·2) | 1·00 (Ref) | 666 (2·8) | 1·25**$ (1·09–1·43) | 208 (3·2) | 1·46***$ (1·22–1·75) | 102 (4·8) | 2·22***$ (1·77–2·79) | 73 (7·8) | 3·67***$ (2·82–4·78) | 0·13 | 25·67 | < 0·001$ |
1·00 (Ref) | 1·12 (0·97–1·29) | 1·11 (0·91–1·35) | 1·46** (1·13–1·90) | 1·97***$ (1·42–2·74) | 0·08 | 9·50 | 0·002$ | ||||||
Neglect n = 16,056 (34·2%) | 3511 (25·1) | 1·00 (Ref) | 7707 (32·7) | 1·46***$ (1·39–1·53) | 3042 (45·7) | 2·72***$ (2·55–2·89) | 1198 (56·6) | 3·90***$ (3·55–4·29) | 598 (63·9) | 5·27***$ (4·59–6·05) | 0·12 | 128·09 | < 0·001$ |
1·00 (Ref) | 1·32***$ (1·25–1·38) | 2·11***$ (1·97–2·27) | 2·69***$ (2·42–2·99) | 3·06***$ (2·62–3·57) | 0·09 | 64·77 | < 0·001$ | ||||||
> =2 maltreatment n = 10,567 (22.5%) | 2991 (21.4) | 1.00 (Ref) | 4531 (19.2) | 0.88***$ (0.84–0.93) | 1811 (28.3) | 1.46***$ (1.36–1.56) | 790 (37.3) | 2.20***$ (1.99–2.42) | 444 (47.3) | 3.33***$ (2.91–3.81) | 0.24 | 434 | < 0·001$ |
1.00 (Ref) | 0.82***$ (0.77–0.86) | 1.20***$ (1.11–1.29) | 1.64***$ (1.47–1.83) | 2.17***$ (1.85–2.53) | 0.21 | 315.23 | < 0·001$ |
Latent classes
Number of classes | Log Likelihood | Number of parameters | AIC | BIC | AdjBIC | LMRT P-value | Entropy | BLRT P-value | No. classes with n < 5% study sample |
---|---|---|---|---|---|---|---|---|---|
Level 1–5 | |||||||||
2 | − 156,499 | 51 | 313,100 | 313,547 | 313,385 | 0.33 | 0.94 | 0.00 | 0 |
3 | −151,298 | 77 | 302,751 | 303,425 | 303,180 | 0.00 | 0.90 | 0.00 | 1 |
4 | −148,819 | 103 | 297,844 | 298,746 | 298,419 | 0.00 | 0.91 | 0.00 | 1 |
5 | − 147,881 | 129 | 296,016 | 297,146 | 296,736 | 0.68 | 0.90 | 0.00 | 2 |
6 | −147,078 | 155 | 294,467 | 295,824 | 295,332 | 0.00 | 0.89 | 0.00 | 4 |
Level 1–4 | |||||||||
2 | −133,617 | 51 | 267,337 | 267,783 | 267,620 | 0.00 | 0.90 | 0.00 | 0 |
3 | −130,798 | 77 | 261,750 | 262,423 | 262,178 | 0.00 | 0.89 | 0.00 | 1 |
4 | − 129,473 | 103 | 259,153 | 260,053 | 259,726 | 0.00 | 0.88 | 0.00 | 2 |
5 | −129,004 | 129 | 258,267 | 259,394 | 258,984 | 0.68 | 0.85 | 0.00 | 3 |
6 | − 128,604 | 155 | 257,519 | 258,874 | 258,381 | 0.10 | 0.86 | 0.00 | 5 |
Level 5 | |||||||||
2 | −13,929 | 51 | 27,960 | 28,208 | 28,046 | 0.00 | 0.83 | 0.000 | 0 |
3 | −13,748 | 77 | 27,651 | 28,024 | 27,780 | 0.0004 | 0.85 | 0.000 | 0 |
4 | −13,579 | 103 | 27,365 | 27,864 | 27,537 | 0.001 | 0.87 | 0.000 | 0 |
5 | −13,456 | 129 | 27,170 | 27,795 | 27,386 | 0.11 | 0.83 | 0.000 | 0 |
6 | −13,389 | 155 | 27,088 | 27,839 | 27,347 | 0.72 | 0.78 | 0.000 | 1 |
Class 1 (High Risk) N = 490 (52.2%) | Class 2 (Depression) N = 337 (35.9%) | Class 3 (Prototypical Scizophrenia) N = 51 (5.4%) | Class 4 (Schizophrenia/Depression) N = 61 (6.5%) | Class 1 β(95%CI) | Class 2 β(95%CI) | Class 3 β(95%CI) | Class 4 β(95%CI) | Class 4 vs.3 β(95%CI) | |
---|---|---|---|---|---|---|---|---|---|
Psychotic Experiences (SCL-90-R) | 27.40 ± 4.45 | 29.30 ± 5.45 | 39.67 ± 10.35 | 42.80 ± 10.17 | 0 (ref) | 1.91***$ (1.11–2.72) | 12.26***$ (10.6–13.93) | 15.42***$ (13.88–16.97) | 2.93 (−0.9–6.76) |
Paranoid ideation subscale | 11.00 ± 2.96 | 11.12 ± 3.39 | 15.18 ± 4.15 | 16.15 ± 4.18 | 0 (ref) | 0.10 (−0.35–0.56) | 4.18***$ (3.23–5.12) | 5.13***$ (4.25–6.00) | 0.85 (− 0.70–2.39) |
Psychoticism subscale | 16.40 ± 3.56 | 18.18 ± 4.23 | 24.49 ± 6.48 | 26.66 ± 6.70 | 0 (ref) | 1.81***$ (1.22–2.40) | 8.09***$ (6.86–9.32) | 10.29***$ (9.16–11.43) | 2.08 (− 0.39–4.56) |
Class 1 OR(95%CI) | Class 2 OR (95%CI) | Class 3 OR (95%CI) | Class 4 OR (95%CI) | Class 4 vs.3 OR (95%CI) | |||||
Hallucinations and Delusions | 115 (23.5%) | 38 (11.3%) | 27 (52.9%) | 34 (55.7%) | 1 (ref) | 0.40***$ (0.27–0.60) | 3.71***$ (2.05–6.72) | 3.93***$ (2.26–6.85) | 1.07 (0.50–2.27) |
Schizophrenia nuclear symptoms | 131 (26.7%) | 66 (19.6%) | 50 (98.0%) | 55 (90.2%) | 1 (ref) | 0.65* (0.47–0.92) | 144.17***$ (19.68–1056.25) | 26.35***$ (11.03–62.96) | 0.21 (0.02–1.84) |
Nuclear symptoms and Depression | 0 (0%) | 37 (11%) | 0 (0%) | 45 (73.8%) | 1 (ref) | n.a. | n.a. | n.a. | n.a. |
Depression (cutoff) | 0 (0%) | 195 (57.9%) | 0 (0%) | 51 (83.6%) | 1 (ref) | n.a. | n.a. | n.a. | n.a. |
Diagnosed Schizophrenia | 4 (0.8) | 7 (2.1) | 1 (2.0) | 2 (3.3) | 1 (ref) | 2.57 (0.74–8.92) | 2.14 (0.23–19.97) | 3.13 (0.53–18.53 | 1.38 (0.11–17.44) |
Diagnosed Non-Psychotic Disorder | 90 (18.4) | 99 (29.4) | 11 (21.6) | 20 (32.8) | 1 (ref) | 1.84***$ (1.33–2.56) | 1.21 (0.60–2.45) | 2.09* (1.17–3.75) | 1.72 (0.71–4.16) |
Class 1 (High Risk) N = 490 (52.2%) | Class 2 (Depression) N = 337 (35.9%) | Class 3 (Prototypical Schizophrenia) N = 51 (5.4%) | Class 4 (Schizophrenia/Depression) N = 61 (6.5%) | Class 1 OR (95%CI) | Class 2 OR (95%CI) | Class 3 OR (95%CI) | Class 4 OR (95%CI) | Class 4 vs.3 OR (95%CI) | |
---|---|---|---|---|---|---|---|---|---|
Male | 252 (51.4%) | 157 (46.6%) | 28 (54.9%) | 32 (52.5%) | 1 (ref) | 0.82 (0.62–1.09) | 1.15 (0.64–2.05) | 1.04 (0.61–1.78) | 0.91 (0.43–1.91) |
Ethnic minority | 56 (11.4%) | 38 (11.3%) | 4 (7.8%) | 5 (8.2%) | 1 (ref) | 35.59***$ (23.51–53.87) | 1.56 (0.63–3.90) | 83.76***$ (36.7–191.16) | 0.84 (0.31–2.31) |
Low family income | 83 (16.9%) | 70 (20.8%) | 13 (25.5%) | 18 (29.5%) | 1 (ref) | 1.29 (0.90–1.83) | 1.68 (0.86–3.29) | 2.05* (1.13–3.74) | 1.22 (0.53–2.82) |
Family History (psychosis) | 6 (1.2%) | 7 (2.1%) | 1 (2.0%) | 2 (3.3%) | 1 (ref) | 1.65 (0.55–4.99) | 1.66 (0.19–14.12) | 3.06 (0.60–15.68) | 1.74 (0.15–20.52) |
Family History (non-psychosis) | 3 (0.6%) | 7 (2.1%) | 0 (0%) | 0 (0%) | 1 (ref) | 3.37 (0.86–13.17) | 0 (0-Inf) | 0 (0-Inf) | 1 (0-Inf) |
Urban birth | 72 (14.7%) | 39 (11.6%) | 10 (19.6%) | 4 (6.6%) | 1 (ref) | 0.76 (0.50–1.15) | 1.43 (0.69–2.99) | 0.42 (0.15–1.19) | 0.28* (0.08–0.97) |
Loss of parent (divorce) | 31 (6.3%) | 24 (7.1%) | 2 (3.9%) | 4 (6.6%) | 1 (ref) | 1.13 (0.65–1.97) | 0.59 (0.14–2.54) | 0.97 (0.33–2.87) | 1.75 (0.3–10.01) |
Loss of parent (death) | 12 (2.4%) | 7 (2.1%) | 1 (2.0%) | 1 (1.6%) | 1 (ref) | 0.83 (0.32–2.14) | 0.79 (0.10–6.22) | 0.60 (0.08–4.79) | 0.89 (0.05–15.71) |
Physical abuse | 262 (53.5%) | 204 (60.5%) | 30 (58.8%) | 43 (70.5%) | 1 (ref) | 1.36* (1.03–1.81) | 1.22 (0.68–2.20) | 2.04* (1.14–3.66) | 1.75 (0.79–3.90) |
Sexual abuse | 26 (5.3%) | 27 (8.0%) | 6 (11.8%) | 14 (23.0%) | 1 (ref) | 1.53 (0.87–2.67) | 2.41 (0.94–6.18) | 5.09***$ (2.47–10.49) | 2.17 (0.76–6.21) |
Neglect | 279 (56.9%) | 244 (72.4%) | 31 (60.8%) | 44 (72.1%) | 1 (ref) | 1.99***$ (1.47–2.68) | 1.16 (0.64–2.10) | 1.91* (1.06–3.44) | 1.72 (0.77–3.84) |
Class 1 β (95%CI) | Class 2 β (95%CI) | Class 3 β (95%CI) | Class 4 β (95%CI) | ||||||
Age | 18.14 ± 0.81) | 18.18 ± 0.81 | 18.20 ± 0.80 | 18.38 ± 1.05 | 0 (ref) | 0.04 (−0.07–0.16) | 0.06 (−0.18–0.30) | 0.24* (0.02–0.46) | 0.18 (−0.17–0.53) |