Original Article

Epidemiology of Psychotic Disorders Based on Demographic Variables in Iranian Children and Adolescents


Objective: Psychosis is still among the most debilitating and severe mental disorders. The main objective of the present study was to investigate the estimated prevalence of psychotic disorders and finding the main predictors of psychotic disorders among Iranian children and adolescents.

Method: Our total sample consisted of 30 553 individuals (49% males and 51%females) from 30 provinces of Iran, aged between 6 and 18 years, who were selected via cluster sampling method from urban and rural areas of all provinces. The data were analyzed using descriptive statistical analysis and multiple logistic regression method.

Results: The results of multiple regression analysis showed that prevalence estimate of psychotic disorders was 0.25%. It was 0.3% and 0.2% in males and females, respectively. The age of 10-14 (OR = 2.24; 95% CI, 1.11-4.55) and the age of 15-18 (OR = 3.42; 95% CI, 1.74-6.75) were significant positive predictors, whereas none of the demographic variables were predictors for psychotic symptoms.

Conclusion: This research highlights the main predictors of psychosis in children and adolescents. The study design also allowed a better understanding of predictors of psychotic disorders. The assessment of the prevalence of psychiatric disorders, particularly their comorbidities, may help to prevent mental illnesses in children and adolescents.

1. American PA. Schizophrenia spectrum and other psychotic disorders: Dsm-5 selections. Place of publication not identified: Amer Psychiatric; 2015.
2. Kendall T, Hollis C, Stafford M, Taylor C. Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance. BMJ (Clinical research ed). 2013;346:f150.
3. Maloney AE, Yakutis LJ, Frazier JA. Empirical evidence for psychopharmacologic treatment in early-onset psychosis and schizophrenia. Child Adolesc Psychiatr Clin N Am. 2012;21(4):885-909.
4. Jeppesen P, Clemmensen L, Munkholm A, Rimvall MK, Rask CU, Jørgensen T, et al. Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence. J Child Psychol Psychiatry. 2015;56(5):558-65.
5. Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M. Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med. 2012;42(9):1857-63.
6. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
7. Pincus HA, Tew JD, First MB. Psychiatric comorbidity: is more less? World Psychiatry. 2004;3(1):18-23.
8. Schaeffer JL, Ross RG. Childhood-onset schizophrenia: premorbid and prodromal diagnostic and treatment histories. J Am Acad Child Adolesc Psychiatry. 2002;41(5):538-45.
9. Winklbaur B, Ebner N, Sachs G, Thau K, Fischer G. Substance abuse in patients with schizophrenia. Dialogues Clin Neurosci. 2006;8(1):37-43.
10. van Winkel R, van Nierop M, Myin-Germeys I, van Os J. Childhood trauma as a cause of psychosis: linking genes, psychology, and biology. Can J Psychiatry. 2013;58(1):44-51.
11. Davis J, Eyre H, Jacka FN, Dodd S, Dean O, McEwen S, et al. A review of vulnerability and risks for schizophrenia: Beyond the two hit hypothesis. Neurosci Biobehav Rev. 2016;65:185-94.
12. Hulshoff Pol HE, Hoek HW, Susser E, Brown AS, Dingemans A, Schnack HG, et al. Prenatal exposure to famine and brain morphology in schizophrenia. Am J Psychiatry. 2000;157(7):1170-2.
13. Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry. 2001;50(11):884-97.
14. Read J, Perry BD, Moskowitz A, Connolly J. The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry. 2001;64(4):319-45.
15. Read J, Agar K, Argyle N, Aderhold V. Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychol Psychother. 2003;76(Pt 1):1-22.
16. Hammersley P, Dias A, Todd G, Bowen-Jones K, Reilly B, Bentall RP. Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. Br J Psychiatry. 2003;182:543-7.
17. Schäfer I, Harfst T, Aderhold V, Briken P, Lehmann M, Moritz S, et al. Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study. J Nerv Ment Dis. 2006;194(2):135-8.
18. Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, et al. Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. Br J Psychiatry. 2004;185:220-6.
19. Boyd JH. Use of mental health services for the treatment of panic disorder. Am J Psychiatry. 1986;143(12):1569-74.
20. Goodwin R, Lyons JS, McNally RJ. Panic attacks in schizophrenia. Schizophr Res. 2002;58(2-3):213-20.
21. Boyd JH, Burke JD, Jr., Gruenberg E, Holzer CE, 3rd, Rae DS, George LK, et al. Exclusion criteria of DSM-III. A study of co-occurrence of hierarchy-free syndromes. Arch Gen Psychiatry. 1984;41(10):983-9.
22. Robins LN RD. Psychiatric Disorders in America: the Epidemiological Catchment Area Study. NewYork, NY: The Free Press; 1991.
23. Morgan C, Fisher H. Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma--a critical review. Schizophr Bull. 2007;33(1):3-10.
24. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048-60.
25. Tien AY, Eaton WW. Psychopathologic precursors and sociodemographic risk factors for the schizophrenia syndrome. Arch Gen Psychiatry. 1992;49(1):37-46.
26. Endicott J, Spitzer RL. [Schedule for Affective Disorders and Schizophrenia (SADS)]. Acta Psychiatr Belg. 1987;87(4):361-516.
27. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980-8.
28. Birmaher B, Ehmann M, Axelson DA, Goldstein BI, Monk K, Kalas C, et al. Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children--a preliminary psychometric study. J Psychiatr Res. 2009;43(7):680-6.
29. Ghanizadeh A. ADHD, bruxism and psychiatric disorders: does bruxism increase the chance of a comorbid psychiatric disorder in children with ADHD and their parents? Sleep Breath. 2008;12(4):375-80.
30. Driver DI, Gogtay N, Rapoport JL. Childhood onset schizophrenia and early onset schizophrenia spectrum disorders. Child Adolesc Psychiatr Clin N Am. 2013;22(4):539-55.
31. Gundersen SV, Goodman R, Clemmensen L, Rimvall MK, Munkholm A, Rask CU, et al. Concordance of child self-reported psychotic experiences with interview- and observer-based psychotic experiences. Early Interv Psychiatry. 2019;13(3):619-26.
32. Jenkins R, Othieno C, Ongeri L, Ogutu B, Sifuna P, Kingora J, et al. Adult psychotic symptoms, their associated risk factors and changes in prevalence in men and women over a decade in a poor rural district of Kenya. Int J Environ Res Public Health. 2015;12(5):5310-28.
33. Ndetei DM, Muriungi SK, Owoso A, Mutiso VN, Mbwayo AW, Khasakhala LI, et al. Prevalence and characteristics of psychotic-like experiences in Kenyan youth. Psychiatry Res. 2012;196(2-3):235-42.
34. Rössler W, Hengartner MP, Ajdacic-Gross V, Haker H, Gamma A, Angst J. Sub-clinical psychosis symptoms in young adults are risk factors for subsequent common mental disorders. Schizophr Res. 2011;131(1-3):18-23.
35. Mamah D, Mbwayo A, Mutiso V, Barch DM, Constantino JN, Nsofor T, et al. A survey of psychosis risk symptoms in Kenya. Compr Psychiatry. 2012;53(5):516-24.
36. McClellan J. Psychosis in Children and Adolescents. J Am Acad Child Adolesc Psychiatry. 2018;57(5):308-12.
37. Fisher HL, Caspi A, Poulton R, Meier MH, Houts R, Harrington H, et al. Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychol Med. 2013;43(10):2077-86.
38. Cochran DM, Dvir Y, Frazier JA. "Autism-plus" spectrum disorders: intersection with psychosis and the schizophrenia spectrum. Child Adolesc Psychiatr Clin N Am. 2013;22(4):609-27.
39. Carlson GA. Affective disorders and psychosis in youth. Child Adolesc Psychiatr Clin N Am. 2013;22(4):569-80.
40. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull. 2009;35(2):383-402.
41. Rapoport J, Chavez A, Greenstein D, Addington A, Gogtay N. Autism spectrum disorders and childhood-onset schizophrenia: clinical and biological contributions to a relation revisited. J Am Acad Child Adolesc Psychiatry. 2009;48(1):10-8.
42. Morgan C, Gayer-Anderson C. Childhood adversities and psychosis: evidence, challenges, implications. World Psychiatry. 2016;15(2):93-102.
43. Mohammadi MR, Alavi SS, Ahmadi N, Khaleghi A, Kamali K, Ahmadi A, et al. The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression. J Affect disord. 2019;247:1-10.
44. Talepasand S, Mohammadi MR, Alavi SS, Khaleghi A, Sajedi Z, Akbari P, et al. Psychiatric disorders in children and adolescents: Prevalence and sociodemographic correlates in Semnan Province in Iran. Asian J Psychiatr. 2019;40:9-14.
45. Nasiri M, mohammadi M, Ahmadi N, Alavi S, Rezazade H, Ostovar rostami F, et al. The Epidemiology of Psychiatric Disorders in Children and Adolescents in Mazandaran Province. JBUMS. 2019;21(1):314-9.
IssueVol 16 No 1 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v16i1.5372
Children and Adolescents Epidemiology Psychotic Disorders

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How to Cite
Alavi SS, Mohammadi MR, Hooshyari Z, Mohammadi Kalhori S, Salehi M, Salmanian M, Khaleghi A, Zarafshan H, Ahmadi A, Kamali K, Ahmadi N. Epidemiology of Psychotic Disorders Based on Demographic Variables in Iranian Children and Adolescents. Iran J Psychiatry. 16(1):1-12.