A systematic review and meta-analysis of the incidence of psychotic disorders: the distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level

Abstract

Background: Considering existing knowledge on the relationship between certain environmental factors and incidence rates of psychosis, we carried out a systematic review to provide a broad and updated picture of the incidences of different psychotic disorder subgroups worldwide and how some environmental factors influence these rates.

Methods: Studies with original data related to the incidence of psychosis (published between 2000 and 2015) were identified via searching electronic databases (CINAHL, MEDLINE, PSYCINFO, PUBMED, and SCOPUS). Data on the following risk factors were extracted: gender, urbanicity, immigration and socio-economic level. Descriptive appraisals of variation in incidence rates (IR) and incidence rate ratios (IRR), with a 95% confidence interval were calculated. In addition, a meta-analysis was performed to calculate IR pooled by diagnosis group and IRR pooled by diagnosis and gender, urbanity, immigration and socio-economic level, using a random effects model.

Results: We identified 33 reports to analyse. Overall IR per 100 000 persons for non-affective psychoses (IR pooled = 22.53 (16.51-28.54)) were higher than affective psychoses (IR pooled = 7.12 (5.03-9.22)). There was an increase in rates of psychosis in men v. women (IRR pooled = 1.54 (1.37-1.72)), in urban v. rural areas (IRR pooled = 1.64 (1.38-1.95)), in immigrants v. natives (IRR pooled = 3.09 (2.74-3.49)), and in lower socio-economic level areas (IRR pooled = 1.78 (1.43-2.22)).

Conclusions: IR among different psychotic disorders was found to vary depending on gender, urbanicity, and immigration (as most of the previous literature focuses on non-affective psychosis or schizophrenia).

Keywords: Psychosis; environmental factors; epidemiology; gender; immigration; incidence; socio-economic level; urbanicity.