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Is our concept of schizophrenia influenced by Berkson’s bias?

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Abstract

Background

If both positive and negative dimensions of schizophrenia independently influence need for care, a higher estimate of the comorbidity between these dimensions is expected in clinical samples than would be the case if non–clinical cases were investigated (i. e. Berkson’s bias). The present paper investigates whether positive and negative dimensions independently contribute to mental health care use in a general population sample.

Method

A prospective cohort study was conducted, in which 7076 individuals were interviewed with the Composite International Diagnostic Interview Schedule at baseline and 1 and 3 years later. Lifetime positive and negative psychotic experiences (PPE, NPE) were assessed at baseline. Mental health care use (MHC) was assessed at baseline, and prospectively 1 and 3 years later.

Results

The rating of MHC was strongly associated with NPE and PPE, both retrospectively and prospectively and the effects of both variables remained strong and significant in the analyses with both variables included.

Conclusions

These results, therefore, suggest that the concept of schizophrenia, as a unitary entity with high comorbidity between positive and negative dimensions, is in part the result of Berkson’s bias.

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Authors and Affiliations

  1. Dept. of Psychiatry & Neuropsychology, South Limburg Mental Health Research and TEACHING Network, EURON Maastricht University, Maastricht, The Netherlands

    N. Maric MD,MRCPsych,  I. Myin-Germeys PhD, P. Delespaul PhD & J. Van Os PhD, MRCPsych

  2. Institute of Psychiatry, University Clinical Center of Serbia, Belgrad, Yugoslavia

    N. Maric MD,MRCPsych

  3. Mondriaan Zorggroep, Section Social Cognition, Heerlen, The Netherlands

    I. Myin-Germeys PhD

  4. Dept. of Psychiatry & Neuropsychology, Maastricht University, 616 (PAR 45), 6200 MD, Maastricht, The Netherlands

    I. Myin-Germeys PhD

  5. Netherlands Institute of Mental Health & Addiction, Trimbos-Institute, Utrecht, The Netherlands

    R. de Graaf PhD & W. Vollebergh PhD

  6. Division of Psychological Medicine, Institute of Psychiatry, London, UK

    J. Van Os PhD, MRCPsych

Authors
  1. N. Maric MD,MRCPsych
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  2. I. Myin-Germeys PhD
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  3. P. Delespaul PhD
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  4. R. de Graaf PhD
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  5. W. Vollebergh PhD
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  6. J. Van Os PhD, MRCPsych
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Correspondence to I. Myin-Germeys PhD.

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Maric, N., Myin-Germeys, I., Delespaul, P. et al. Is our concept of schizophrenia influenced by Berkson’s bias?. Soc Psychiatry Psychiatr Epidemiol 39, 600–605 (2004). https://doi.org/10.1007/s00127-004-0803-z

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  • DOI: https://doi.org/10.1007/s00127-004-0803-z

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