Social Psychiatry and Psychiatric Epidemiology

, Volume 39, Issue 8, pp 600–605 | Cite as

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

  • N. Maric
  • I. Myin-Germeys
  • P. Delespaul
  • R. de Graaf
  • W. Vollebergh
  • J. Van Os



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.


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.


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.


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.

Key words

schizophrenia continuum Berkson’s bias mental health care comorbidity symptoms 


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Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • N. Maric
    • 1
    • 2
  • I. Myin-Germeys
    • 1
    • 3
    • 4
  • P. Delespaul
    • 1
  • R. de Graaf
    • 5
  • W. Vollebergh
    • 5
  • J. Van Os
    • 1
    • 6
  1. 1.Dept. of Psychiatry & NeuropsychologySouth Limburg Mental Health Research and TEACHING Network, EURON Maastricht UniversityMaastrichtThe Netherlands
  2. 2.Institute of PsychiatryUniversity Clinical Center of SerbiaBelgradYugoslavia
  3. 3.Mondriaan ZorggroepSection Social CognitionHeerlenThe Netherlands
  4. 4.Dept. of Psychiatry & NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
  5. 5.Netherlands Institute of Mental Health & AddictionTrimbos-InstituteUtrechtThe Netherlands
  6. 6.Division of Psychological MedicineInstitute of PsychiatryLondonUK

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