Treated incidence of psychotic disorders in the multinational EU-GEI study

Hannah E. Jongsma, Charlotte Gayer-Anderson, Antonio Lasalvia, Diego Quattrone, Alice Mulè, Andrei Szöke, Jean Paul Selten, Caitlin Turner, Celso Arango, Ilaria Tarricone, Domenico Berardi, Andrea Tortelli, Pierre Michel Llorca, Lieuwe De Haan, Julio Bobes, Miguel Bernardo, Julio Sanjuán, José Luis Santos, Manuel Arrojo, Cristina Marta Del-BenPaulo Rossi Menezes, Robin M. Murray, Bart P. Rutten, Peter B. Jones, Jim Van Os, Craig Morgan, James B. Kirkbride*, Ulrich Reininghaus, Marta Di Forti, Kathryn Hubbard, Stephanie Beards, Simona A. Stilo, Giada Tripoli, Mara Parellada, Pedro Cuadrado, José Juan Rodríguez Solano, Angel Carracedo, Enrique García Bernardo, Laura Roldán, Gonzalo López, Bibiana Cabrera, Esther Lorente-Rovira, Paz Garcia-Portilla, Javier Costas, Estela Jiménez-López, Mario Matteis, Marta Rapado, Emiliano González, Covadonga Martínez, Emilio Sánchez, The European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) WP2 Group members include

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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IMPORTANCE Psychotic disorders contribute significantly to the global disease burden, yet the latest international incidence study of psychotic disorders was conducted in the 1980s. 

OBJECTIVES To estimate the incidence of psychotic disorders using comparable methods across 17 catchment areas in 6 countries and to examine the variance between catchment areas by putative environmental risk factors. 

DESIGN, SETTING, AND PARTICIPANTS An international multisite incidence study (the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions) was conducted from May 1, 2010, to April 1, 2015, among 2774 individuals from England (2 catchment areas), France (3 catchment areas), Italy (3 catchment areas), the Netherlands (2 catchment areas), Spain (6 catchment areas), and Brazil (1 catchment area) with a first episode of nonorganic psychotic disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes F20-F33) confirmed by the Operational Criteria Checklist. Denominator populations were estimated using official national statistics. EXPOSURES Age, sex, and racial/ethnic minority status were treated as a priori confounders. Latitude, population density, percentage unemployment, owner-occupied housing, and single-person households were treated as catchment area-level exposures. 

MAIN OUTCOMES AND MEASURES Incidence of nonorganic psychotic disorders (ICD-10 codes F20-F33), nonaffective psychoses (ICD-10 codes F20-F29), and affective psychoses (ICD-10 codes F30-F33) confirmed by the Operational Criteria Checklist. RESULTS A total of 2774 patients (1196 women and 1578 men; median age, 30.5 years [interquartile range, 23.0-41.0 years]) with incident cases of psychotic disorders were identified during 12.9 million person-years at risk (crude incidence, 21.4 per 100 000 person-years; 95%CI, 19.4-23.4 per 100 000 person-years). A total of 2183 patients (78.7%) had nonaffective psychotic disorders. After direct standardization for age, sex, and racial/ethnic minority status, an 8-fold variation was seen in the incidence of all psychotic disorders, from 6.0 (95%CI, 3.5-8.6) per 100 000 person-years in Santiago, Spain, to 46.1 (95%CI, 37.3-55.0) per 100 000 person-years in Paris, France. Rates were elevated in racial/ethnic minority groups (incidence rate ratio, 1.6; 95%CI, 1.5-1.7), were highest for men 18 to 24 years of age, and were lower in catchment areas with more owner-occupied homes (incidence rate ratio, 0.8; 95%CI, 0.7-0.8). Similar patterns were observed for nonaffective psychoses; a lower incidence of affective psychoses was associated with higher area-level unemployment (incidence rate ratio, 0.3; 95%CI, 0.2-0.5). 

CONCLUSIONS AND RELEVANCE This study confirmed marked heterogeneity in risk for psychotic disorders by person and place, including higher rates in younger men, racial/ethnic minorities, and areas characterized by a lower percentage of owner-occupied houses.

Original languageEnglish
Pages (from-to)36-46
Number of pages11
JournalJAMA Psychiatry
Issue number1
Early online date6 Dec 2017
Publication statusPublished - 1 Jan 2018


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