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Adults with psychosis or psychotic experiences may report adverse life events prior to the onset of symptoms but direction of causality cannot be inferred

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Question: Are stressful events during adulthood associated with the onset of psychosis?

Outcomes: First-episode psychosis or subclinical psychotic experiences. Outcome criteria were not further specified a priori. The observational studies included in the review used various measures of psychosis including: International Classification of Diseases ninth edition (ICD-9) or ICD-10 and Diagnostic and Statistical Manual (DSM) II or DSM-IV diagnoses of psychosis or schizophrenia; Research Diagnostic Criteria for Schizophrenia (RDCS); Present State Examination (PSE); Categorical Assessment of Psychiatric Disorder (CATEGO); Psychosis Screening Questionnaire (PSQ); Composite International Diagnostic Interview (CIDI); and in one study paranoid thinking was assessed using a self-report questionnaire.


Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, PsycINFO and Web of Science were searched (dates not given). Only English language studies published in peer-reviewed journals were included.

Study selection and analysis: Studies were eligible if they assessed life events in adulthood (aged above 16 years) and the included individuals had a first episode psychosis or …

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  • Sources of funding: Wellcome Trust, the European Union and the Department of Health.


  • Competing interests None.