Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 47, Issue 8, pp 1195–1203 | Cite as

Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking

  • Daniel FreemanEmail author
  • Daniel Stahl
  • Sally McManus
  • Howard Meltzer
  • Traolach Brugha
  • Nicola Wiles
  • Paul Bebbington
Original Paper

Abstract

Purpose

Our theoretical model proposes that insomnia, worry, and negative affect are important determinants of paranoid thinking. Anxiety produces anticipation of threat, depression increases the sense of vulnerability, worry leads to implausible ideas, and insomnia exacerbates negative affect and creates an altered perceptual state. The study objective was to examine for the first time these factors as predictors of the onset of new paranoid thinking and of the persistence of existing paranoid thinking.

Method

A total of 2,382 participants in the 2000 British National Psychiatric Morbidity Survey were followed-up 18 months after their first assessment. Baseline assessments were used to predict the development and persistence of paranoid thinking at follow-up. Data were weighted to be representative of the general household population.

Results

Insomnia, worry, anxiety, depression and depressive ideas were each substantial predictors both of new inceptions of paranoia and of the persistence of existing paranoid thinking. Worry and insomnia were the strongest predictors. For example, insomnia at the first assessment led to a more than threefold increase in later inceptions of paranoid thinking.

Conclusions

The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.

Keywords

Delusions Paranoia Insomnia Worry Schizophrenia 

Notes

Acknowledgments

Daniel Freeman is supported by an MRC Senior Clinical Fellowship.

Conflict of interest

None.

References

  1. 1.
    Allardyce J, McCreadie RG, Morrison G, van Os J (2007) Do symptom dimensions or categorical diagnoses best discriminate between risk factors for psychosis. Soc Psychiatry Psychiatr Epidemiol 42:429–437PubMedCrossRefGoogle Scholar
  2. 2.
    Bebbington PE, Nayani T (1995) The Psychosis Screening Questionnaire. Int J Methods Psychiatr Res 5:11–20Google Scholar
  3. 3.
    Bebbington PE, Wilkins S, Jones P, Forester A, Murray RM, Toone B, Lewis S (1993) Life events and psychosis: results from the Camberwell Collaborative Psychosis Study. Br J Psychiatry 162:72–79PubMedCrossRefGoogle Scholar
  4. 4.
    Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39:411–418PubMedCrossRefGoogle Scholar
  5. 5.
    Claridge G (1997) Schizotypy: implications for illness and health. Oxford University Press, OxfordGoogle Scholar
  6. 6.
    First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin L (1997) Structured clinical interview for DSMIV axis ii personality disorders. American Psychiatric Press, WashingtonGoogle Scholar
  7. 7.
    Foster C, Startup H, Potts L, Freeman D (2010) A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. J Behavior Ther Exp Psychiatry 41:45–51CrossRefGoogle Scholar
  8. 8.
    Freeman D (2007) Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 27:425–457PubMedCrossRefGoogle Scholar
  9. 9.
    Freeman D (2011) Improving cognitive treatments for delusions. Schizophr Res. doi: 10.1016/j.schres.2011.08.012
  10. 10.
    Freeman D, Brugha T, Meltzer H, Jenkins R, Stahl D, Bebbington P (2010) Persecutory ideation and insomnia: findings from the second British National Survey of Psychiatric Morbidity. J Psychiatr Res 44:1021–1026PubMedCrossRefGoogle Scholar
  11. 11.
    Freeman D, Freeman J, Garety P (2008) Overcoming paranoid and suspicious thoughts. Basic Books, New YorkGoogle Scholar
  12. 12.
    Freeman D, Garety PA, Bebbington PE, Smith B, Rollinson R, Fowler D, Kuipers E, Ray K, Dunn G (2005) Psychological investigation of the structure of paranoia in a non-clinical population. Br J Psychiatry 186:427–435PubMedCrossRefGoogle Scholar
  13. 13.
    Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE (2002) A cognitive model of persecutory delusions. Br J Clin Psychol 41:331–347PubMedCrossRefGoogle Scholar
  14. 14.
    Freeman D, McManus S, Brugha T, Meltzer H, Jenkins R, Bebbington P (2011) Concomitants of paranoia in the general population. Psychol Med 41:923–936PubMedCrossRefGoogle Scholar
  15. 15.
    Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D, Garety PA (2008) A virtual reality study of paranoid thinking in the general population. Br J Psychiatry 192:258–263PubMedCrossRefGoogle Scholar
  16. 16.
    Freeman D, Pugh K, Vorontsova N, Antley A, Slater M (2010) Testing the continuum of delusional beliefs. J Abnorm Psychol 119:83–92PubMedCrossRefGoogle Scholar
  17. 17.
    Freeman D, Pugh K, Vorontsova N, Southgate L (2009) Insomnia and paranoia. Schizophr Res 108:280–284PubMedCrossRefGoogle Scholar
  18. 18.
    Harrow M, Jobe T, Astrachan-Fletcher EB (2008) Prognosis of persecutory delusions in schizophrenia: a 20-year longitudinal study. In: Freeman D, Bentall R, Garety P (eds) Persecutory delusions. Oxford University Press, Oxford, pp 73–90Google Scholar
  19. 19.
    Hepworth C, Startup H, Freeman D (2011) Developing treatments for persistent persecutory delusions: the impact of an emotional processing and metacognitive awareness (EPMA) intervention. J Nerv Mental Dis 199:653–658Google Scholar
  20. 20.
    Jenkins R, Meltzer H, Bebbington P, Brugha T, Farrell M, McManus S, Singleton N (2009) The British Mental Health Survey Programme: achievements and latest findings. Soc Psychiatry Psychiatr Epidemiol 44:899–904PubMedCrossRefGoogle Scholar
  21. 21.
    Jones P, Rodgers B, Murray R, Marmot M (1994) Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344:1398–1402PubMedCrossRefGoogle Scholar
  22. 22.
    Kendler KS, Hettema JM, Butera F, Gardner CO, Prescott CA (2003) Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalised anxiety. Arch Gen Psychiatry 60:789–796PubMedCrossRefGoogle Scholar
  23. 23.
    Krabbendam L, Janssen I, Bijl RV, Vollebergh WAM, van Os J (2002) Neuroticism and low self-esteem as risk factors for psychosis. Soc Psychiatry Psychiatr Epidemiol 37:1–6PubMedCrossRefGoogle Scholar
  24. 24.
    Larkin W, Morrison AP (eds) (2006) Trauma and Psychosis. Routledge, HoveGoogle Scholar
  25. 25.
    Lewis G, Pelosi A, Araya RC, Dunn G (1992) Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychol Med 22:465–468PubMedCrossRefGoogle Scholar
  26. 26.
    Lincoln TM, Lange J, Burau J, Exner C Moritz S (2010) The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophr Bull 36:1140–1148. doi: 10.1093/schbul/sbp029 Google Scholar
  27. 27.
    Lincoln TM, Peter N, Schäfer M, Moritz S (2008) Impact of stress on paranoia: an experimental investigation of moderators and mediators. Psychol Med 39:1129–1139PubMedCrossRefGoogle Scholar
  28. 28.
    McGrath JJ (2007) The surprisingly rich contours of schizophrenia epidemiology. Arch Gen Psychiatry 64:14–16PubMedCrossRefGoogle Scholar
  29. 29.
    Moffitt TE, Caspi A, Harrington H, Milne BJ, Melchior M, Goldberg D, Poulton R (2007) Generalised anxiety disorder and depression; childhood risk factors in a birth cohort followed to age 32. Psychol Med 37:441–452PubMedCrossRefGoogle Scholar
  30. 30.
    Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR (2007) Epidemiology of insomnia: a longitudinal study in a UK population. Sleep 30:274–280PubMedGoogle Scholar
  31. 31.
    Myers E, Startup H, Freeman D (2011) Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions. J Behav Ther Exp Psychiatry 42:330–336PubMedCrossRefGoogle Scholar
  32. 32.
    Myin-Germeys I, van Os J (2007) Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clin Psychol Rev 27:409–424PubMedCrossRefGoogle Scholar
  33. 33.
    Peralta V, Cuesta MJ (1999) Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders. Schizophr Res 38:13–26PubMedCrossRefGoogle Scholar
  34. 34.
    Shevlin M, Adamson G, Vollebergh W, de Graaf R, van Os J (2007) An application of item response mixture modelling to psychosis indicators in two large community samples. Soc Psychiatry Psychiatr Epidemiol 42:771–779PubMedCrossRefGoogle Scholar
  35. 35.
    Singleton N, Bumpstead R, O’Brien M, Lee A, Meltze H (2001) Psychiatric morbidity among adults living in private households. TSO, LondonGoogle Scholar
  36. 36.
    Singleton N, Lewis G (2003) Better or worse: a longitudinal study of the Mental Health of Adults Living in Private Households in Great Britain. London, TSOGoogle Scholar
  37. 37.
    SPSS (2006) SPSS Base 15.0 User’s Guide. SPSS Inc., ChicagoGoogle Scholar
  38. 38.
    Startup H, Freeman D, Garety PA (2007) Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behav Res Ther 45:523–537PubMedCrossRefGoogle Scholar
  39. 39.
    Thewissen V, Bentall RP, Oorschot M, à Campo J, van Lierop T, van Os J, Myin-Germeys I (2011) Emotions, self-esteem, and paranoid episodes: an experience sampling study. Br J Clin Psychol 50:178–195. doi: 10.1348/014466510X508677 Google Scholar
  40. 40.
    Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum. Psychol Med 39:179–195PubMedGoogle Scholar
  41. 41.
    Vázquez-Barquero JL, Lastra I, Nuñez MJC, Castanedo SH, Dunn G (1996) Patterns of positive and negative symptoms in first episode schizophrenia. Br J Psychiatry 168:693–701PubMedCrossRefGoogle Scholar
  42. 42.
    Wigman JTW, Vollebergh WAM, Raaijmakers QAW, Iedema J, van Dorsselaer S, Ormel J, Verhulst FC, van Os J (2011) The structure of the extended psychosis phenotype in early adolescence—a cross-sample replication. Schizophr Bull 37:850–860. doi: 10.1093/schbul/sbp154 Google Scholar
  43. 43.
    Wiles NJ, Zammit S, Bebbington P, Singleton N, Meltzer H, Lewis G (2006) Self-reported psychotic symptoms in the general population. Br J Psychiatry 188:519–526PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Daniel Freeman
    • 1
    Email author
  • Daniel Stahl
    • 2
  • Sally McManus
    • 3
  • Howard Meltzer
    • 4
  • Traolach Brugha
    • 4
  • Nicola Wiles
    • 5
  • Paul Bebbington
    • 6
  1. 1.Department of Psychiatry, Warneford HospitalOxford UniversityOxfordUK
  2. 2.Department of BiostatisticsInstitute of Psychiatry, King’s College LondonLondonUK
  3. 3.National Centre for Social ResearchLondonUK
  4. 4.Department of Health SciencesUniversity of LeicesterLeicesterUK
  5. 5.Academic Unit of PsychiatryBristol UniversityBristolUK
  6. 6.Mental Health Sciences UnitUniversity College LondonLondonUK

Personalised recommendations