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Mood, anxiety and psychotic phenomena measure a common psychopathological factor

Published online by Cambridge University Press:  14 November 2014

J. Stochl ,
G. M. Khandaker ,
G. Lewis ,
J. Perez ,
I. M. Goodyer ,
S. Zammit ,
S. Sullivan ,
T. J. Croudace  and
P. B. Jones
J. Stochl
Affiliation:
Department of Psychiatry, University of Cambridge, NIHR Biomedical Research Centre and CLAHRC East of England, Cambridge, UK Cameo Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
G. M. Khandaker
Affiliation:
Department of Psychiatry, University of Cambridge, NIHR Biomedical Research Centre and CLAHRC East of England, Cambridge, UK Cameo Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
G. Lewis
Affiliation:
Mental Health Sciences Unit, University College London, London, UK
J. Perez
Affiliation:
Department of Psychiatry, University of Cambridge, NIHR Biomedical Research Centre and CLAHRC East of England, Cambridge, UK Cameo Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
I. M. Goodyer
Affiliation:
Department of Psychiatry, University of Cambridge, NIHR Biomedical Research Centre and CLAHRC East of England, Cambridge, UK
S. Zammit
Affiliation:
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
S. Sullivan
Affiliation:
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
T. J. Croudace
Affiliation:
Mental Health and Addiction Research Group (MHARG), Hull York Medical School (HYMS) and Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
P. B. Jones*
Affiliation:
Department of Psychiatry, University of Cambridge, NIHR Biomedical Research Centre and CLAHRC East of England, Cambridge, UK Cameo Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
*
*Address for correspondence: P. B. Jones, Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Box 189, Cambridge CB2 0QQ, UK. (Email: pbj21@cam.ac.uk)
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Abstract

Background

Psychotic phenomena are common in the general population but are excluded from diagnostic criteria for mild to moderate depression and anxiety despite their co-occurrence and shared risk factors. We used item response theory modelling to examine whether the co-occurrence of depressive, anxiety and psychotic phenomena is best explained by: (1) a single underlying factor; (2) two separate, uncorrelated factors; (3) two separate yet linked factors; or (4) two separate domains along with an underlying ‘common mental distress’ (CMD) factor. We defined where, along any latent continuum, the psychopathological items contributed most information.

Method

We performed a secondary analysis of cross-sectional, item-level information from measures of depression, anxiety and psychotic experiences in 6617 participants aged 13 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort and 977 participants aged 18 years from the ROOTS schools-based sample. We replicated results from one sample in the other and validated the latent factors against an earlier parental measure of mental state.

Results

In both cohorts depression, anxiety and psychotic items were best represented as a bi-factor model with a single, unitary CMD factor on which psychotic items conveyed information about the more severe end (model 4); residual variation remained for psychotic items. The CMD factor was significantly associated with the prior parental measure.

Conclusions

Psychotic phenomena co-occur with depression and anxiety in teenagers and may be a marker of severity in a single, unitary dimension of CMD. Psychotic phenomena should be routinely included in epidemiological assessments of psychiatric morbidity, otherwise the most severe symptomatology remains unmeasured.

Keywords

Depressionepidemiologynosologypsychometricspsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1483 - 1493
Copyright
Copyright © Cambridge University Press 2014 

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