Elsevier

Schizophrenia Research

Volume 228, February 2021, Pages 410-416
Schizophrenia Research

Gender differences in the experience of psychotic-like experiences and their associated factors: A study of adolescents from the general population

https://doi.org/10.1016/j.schres.2021.01.008Get rights and content

Abstract

“Psychotic-Like Experiences” (PLEs) are common in the general population. While they are usually transient and resolve spontaneously, they can be distressing and signify increased risk for later psychosis or other psychopathology. It is important to investigate factors associated with PLEs which could be targeted to reduce their prevalence and impact. Males and females are known to experience PLEs differently, but any gender differences in the relationships between PLEs and other, potentially targetable, factors are currently unknown.

302 adolescents (175 females, mean age = 16.03, SD = 0.75; 127 males, mean age = 16.09, SD = 0.74) from secondary schools in the West Midlands region of the UK completed baseline self-report measures of positive PLEs, measured by the Community Assessment of Psychic Experiences (CAPE-P), and several potentially related factors including: cannabis use, perceived stress, anxiety, depression, and daily hassles.

PLEs were common in this sample, with 67.5% of individuals experiencing at least one CAPE-P item ‘often’ or ‘almost always’. Females reported significantly higher levels of PLEs, and associated distress, than males. Anxiety, depressive, and stress symptoms were similarly associated with PLEs in both genders. However, there was a significant interaction of gender and daily hassles in the association with PLEs.

In summary, there were significant gender differences in the experience of PLEs in this sample. Although daily hassles were more common in females, they had a significantly stronger association with PLEs in males. Thus, addressing “daily life stress” in adolescents may require tailoring towards the more emotional perception of stress in females, and towards everyday life hassles in males.

Introduction

Psychotic symptoms may exist on a continuum (van Os et al., 2000; Yung et al., 2009). “Psychotic-Like Experiences” (PLEs) are symptoms which occur at a much lower level of intensity and distress than those seen in clinically significant psychosis (Nuevo et al., 2010; Yung et al., 2009). PLEs are common in the general population, with global prevalence rates of 17% in 9–12 year old children and 7.5% in 13–18 year old adolescents (Kelleher et al., 2012). The prevalence of PLEs may differ between males and females; however, this evidence is mixed. In some studies, females report more PLEs (van Os et al., 2000; Zammit et al., 2013), while other studies find a higher prevalence in males (Laurens et al., 2007; Poulton et al., 2000). Males and females also endorse different aspects of the positive psychotic-like symptoms, with females more likely to experience subclinical hallucinations and persecutory ideation (Ronald et al., 2013; Scott et al., 2008). Furthermore, males and females may experience different long-term outcomes following the experience of PLEs. In a large birth cohort study, males who reported subclinical perceptual abnormalities at age 14 were five times more likely to meet criteria for non-affective psychosis at age 21, compared to females who were two times more likely to receive such a diagnosis (Welham et al., 2009).

While not inherently pathological, persistence of PLEs can significantly increase the risk of an individual developing a psychotic disorder (Cougnard et al., 2007; van Os et al., 2009). In longitudinal studies, the presence of PLEs in adolescence is associated with an increased likelihood of an adult schizophrenia-spectrum disorder (Fisher et al., 2013; Poulton et al., 2000). PLEs are also associated with distress (Armando et al., 2010; Yung et al., 2006), suicidality (Kelleher et al., 2013; Nishida et al., 2010), self-harm (Nishida et al., 2010; Polanczyk et al., 2010), depression (Wigman et al., 2011a) and other psychiatric comorbidity (Remberk, 2017). As such, PLEs and their potential risk factors represent an important target for early intervention to prevent or delay these more serious outcomes.

Several previously established risk factors for frank psychosis may also be associated with PLEs, such as cannabis use (Arseneault et al., 2002; Arseneault et al., 2004; Zammit et al., 2002), affective dysregulation (Hartley et al., 2013), and stress (Corcoran et al., 2003). For example, cannabis use has been linked with PLEs (Hides et al., 2009), particularly when commenced from an early age (Stefanis et al., 2004) and when paired with other risk factors (Bourque et al., 2017). Affective dysregulation, including feelings of depression (Armando et al., 2010; van Os et al., 2000; Wigman et al., 2011a; Yung et al., 2009) and anxiety (Mackie et al., 2011) has also been associated with PLEs. Stress is another factor implicated in the development of PLEs (van Os et al., 2009). Higher levels of perceived stress (Ered et al., 2017) and greater emotional reactivity to stress (Lataster et al., 2009; Mackie et al., 2011) have been associated with higher levels of PLEs. Stressful life events may increase the risk for PLEs (Arseneault et al., 2011; Wigman et al., 2011b), and may interact with underlying vulnerability to mental illness (Zubin and Spring, 1977). Less intense ‘daily hassles’ can also lead to high levels of stress and be associated with psychopathology in adolescence (Seiffge-Krenke, 2000). Increased reactivity to daily stress has been identified as a key differentiator between transient and persistent PLEs (Collip et al., 2013) and, as mentioned, persistence of PLEs can increase the risk of transition to clinical psychosis (van Os et al., 2009).

There is evidence for gender differences in the prevalence, symptoms, and outcome of PLEs. However, little is known about whether these other, potentially associated, factors may differ between males and females. There is some evidence that daily hassles are more commonly reported by females (Kohn and Milrose, 1993), and that females show heightened vulnerability to stress levels (Myin-Germeys et al., 2004). Therefore, the effect of stress on PLEs may differ in these two genders, although this needs to be confirmed. Gender is often used as a covariate in investigations of factors associated with PLEs, thus removing any potential effects. Any differences between males and females in the prevalence and associated factors of PLEs could prove to be important for informing intervention strategies, in that they may need to be tailored to achieve maximum effectiveness.

In this study, we investigated the association of several previously discussed factors to positive PLEs. The present study sought to investigate the prevalence and distress of PLEs in adolescents from the general population, and aimed to clarify whether the experience of PLEs significantly differed for males and females. The study also focused on identifying the association of factors previously linked with PLEs, and whether they vary according to gender.

Section snippets

Participants

Three hundred and two adolescent students aged 14–18 (175 females, mean age = 16.03, SD = 0.75; 127 males, mean age = 16.09, SD = 0.74) were recruited from secondary schools in the West Midlands, UK. Informed consent was obtained from both a parent or legal guardian and student prior to participation. All parents/ legal guardians were contacted first and opt-out consent was gained by providing a form and pre-paid envelope to withdraw their child if they wished. Students who had not been

Sample characteristics

Table 1 shows the demographics of the sample and descriptive statistics of the variables. Males and females significantly differed on whether they had used cannabis during their lifetime, and on all self-report measures. They did not significantly differ on age, ethnicity, or age of first cannabis use.

Prevalence of PLEs

In this sample, 67.5% of individuals (74.3% of females and 58.3% of males) endorsed at least one CAPE-P item at a level of ‘often’ or ‘almost always’. As illustrated in Table 1, females scored

Discussion

This study aimed to investigate gender differences in the prevalence and distress of PLEs, as well as the association of anxiety and depressive symptoms, stress, cannabis use, and daily hassles in adolescents from the general population. PLEs were common in this sample, significantly more so in females, with 67.5% of individuals endorsing at least one CAPE-P item at a frequency of ‘often’ or ‘almost always’. In comparison, Wigman et al. (2009) previously identified a prevalence of 43.3% in a

Role of the funding source

There was no funding associated with this work.

CRediT authorship contribution statement

Authors AL, RLEPR, KC, & SJW designed the study and wrote the protocol. Authors AL, TW & DH collected the data. AS conducted the statistical analysis and prepared the manuscript. All authors contributed to and have approved the final manuscript.

Declaration of competing interest

The authors have no conflicts of interest to disclose.

Acknowledgments

AL is supported by an NHMRC Career Development Fellowship (#1148793).

References (65)

  • J.T.W. Wigman et al.

    Subclinical psychosis and depression: co-occurring phenomena that do not predict each other over time

    Schizophr. Res.

    (2011)
  • K. Williams et al.

    Coping strategies in adolescents

    J. Appl. Dev. Psychol.

    (1999)
  • L. Arseneault et al.

    Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study

    BMJ

    (2002)
  • L. Arseneault et al.

    Causal association between cannabis and psychosis: examination of the evidence

    Br. J. Psychiatry

    (2004)
  • L. Arseneault et al.

    Childhood trauma and children’s emerging psychotic symptoms: a genetically sensitive longitudinal cohort study

    Am. J. Psychiatry

    (2011)
  • G.W. Bohrnstedt et al.

    Robustness in regression analysis

    Sociol. Methodol.

    (1971)
  • J. Bourque et al.

    Cannabis use and psychotic-like experiences trajectories during early adolescence: the coevolution and potential mediators

    J. Child Psychol. Psychiatry

    (2017)
  • S. Cohen et al.

    A global measure of perceived stress

    Journal of Health and Social Behavior

    (1983)
  • D. Collip et al.

    From epidemiology to daily life: linking daily life stress reactivity to persistence of psychotic experiences in a longitudinal general population study

    PLoS One

    (2013)
  • C.M. Corcoran et al.

    The stress cascade and schizophrenia: etiology and onset

    Schizophr. Bull.

    (2003)
  • A. Cougnard et al.

    Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model

    Psychol. Med.

    (2007)
  • J.R. Crawford et al.

    The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample

    Br. J. Clin. Psychol.

    (2003)
  • H. Eschenbeck et al.

    Gender differences in coping strategies in children and adolescents

    J. Individ. Differ.

    (2007)
  • H.L. Fisher et al.

    Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study

    Psychol. Med.

    (2013)
  • M. Hanssen et al.

    The incidence and outcome of subclinical psychotic experiences in the general population

    Br J Clin Psychol

    (2005)
  • S. Hartley et al.

    Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms

    Acta Psychiatr. Scand.

    (2013)
  • L.L. Havlicek et al.

    Robustness of the Pearson correlation against violations of assumptions

    Perceptual and Motor Skills

    (1976)
  • IBM Corp

    IBM SPSS Statistics for Windows, Version 24.0

    (2016)
  • I. Kelleher et al.

    Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview

    Schizophr. Bull.

    (2011)
  • I. Kelleher et al.

    Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies

    Psychol. Med.

    (2012)
  • I. Kelleher et al.

    Psychotic symptoms and population risk for suicide attempt: a prospective cohort study

    JAMA Psychiatry

    (2013)
  • K.S. Kendler et al.

    Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample

    Arch. Gen. Psychiatry

    (1996)
  • Cited by (22)

    • Sex difference in the prevalence of psychotic-like experiences in adolescents: results from a pooled study of 21,248 Chinese participants

      2022, Psychiatry Research
      Citation Excerpt :

      There have been a number of studies that explored the possible sex differences in the prevalence of PLEs, but their conclusions were mixed. For example, some previous studies reported that female adolescents had a higher prevalence of PLEs (Isaksson et al., 2020; Stainton et al., 2021; Zammit et al., 2013), while some others reported opposite conclusions (Laurens et al., 2007). In our study sample, no significant sex differences were found in the overall prevalence of PLEs.

    • Sex-based differences in the longitudinal association between autistic traits and positive psychotic experiences in adolescents: A population-based cohort study

      2022, Schizophrenia Research
      Citation Excerpt :

      Some studies have shown that autism spectrum conditions are risk factors for future positive PEs (Bevan Jones et al., 2012; Sullivan et al., 2013), while other studies showed that autistic traits and schizotypal traits are inversely correlated (Zhou et al., 2019). Autistic traits are more frequently seen in males than females (Ruzich et al., 2015), and PEs have also been reported to show sex-based differences (Myin-Germeys et al., 2004; Stainton et al., 2021; Walder et al., 2016; Zammit et al., 2013). Therefore, a sex-related interaction may affect the association between autistic traits and PEs.

    • Epidemiology of psychotic-like experiences by subtypes and their relationship with emotional regulation and affective lability among Chinese college students

      2022, Schizophrenia Research
      Citation Excerpt :

      However, knowledge concerning the correlations between PLE subtypes and the level of affective lability is scarce, and the role of gender in these associations is unclear. A recent study reported no gender differences in the relationships between PLEs and anxiety, depression, and stress symptoms (Stainton et al., 2021). Accordingly, the current study aimed to examine the relationship between PLE subtypes in adolescence and the level of affective lability among Chinese college students and determine whether these associations vary across gender.

    View all citing articles on Scopus
    View full text