Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries

Ai Koyanagi, Hans Oh, Jordan DeVylder, Jae Il Shin, Karel Kostev, Lee Smith, Louis Jacob, Guillermo F. López Sánchez, Adel S. Abduljabbar, Josep Maria Haro

Research output: Contribution to journalArticlepeer-review


Purpose: Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs). Methods: Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted. Results: Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18–120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56–1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%). Conclusion: Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

Original languageEnglish (US)
Pages (from-to)1771-1780
Number of pages10
JournalSocial psychiatry and psychiatric epidemiology
Issue number9
StatePublished - Sep 2022


  • Epidemiology
  • Informal caregiving
  • Low- and middle-income countries
  • Psychotic experience

ASJC Scopus subject areas

  • Epidemiology
  • Health(social science)
  • Social Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries'. Together they form a unique fingerprint.

Cite this