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

Jordan E. DeVylder, Ai Koyanagi, Jay Unick, Hans Oh, Boyoung Nam, Andrew Stickley

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1353-1362
Number of pages10
JournalSchizophrenia bulletin
Issue number6
StatePublished - Nov 1 2016


  • psychosis
  • schizophrenia
  • stress
  • World Health Survey

ASJC Scopus subject areas

  • Psychiatry and Mental health


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