Psychological Medicine

Dimensions of depression, mania and psychosis in the general population

a1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands; Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK; Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands; Rudolf Magnus Institute, Department of Psychiatry, University Medical Centre Utrecht and Altrecht Institute for Mental Health Care, Utrecht, The Netherlands; Social and Cultural Planning Office, The Hague, The Netherlands

Article author query
krabbendam l   [PubMed][Google Scholar] 
myin-germeys i   [PubMed][Google Scholar] 
de graaf r   [PubMed][Google Scholar] 
vollebergh w   [PubMed][Google Scholar] 
nolen wa   [PubMed][Google Scholar] 
iedema j   [PubMed][Google Scholar] 
van os j   [PubMed][Google Scholar] 


Background. In order to investigate whether correlated but separable symptom dimensions that have been identified in clinical samples also have a distribution in the general population, the underlying structure of symptoms of depression, mania and psychosis was studied in a general population sample of 7072 individuals.

Method. Data were obtained from the three measurements of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Symptoms of depression, mania and the positive symptoms of psychosis were assessed using the Composite International Diagnostic Interview. Confirmatory factor-analysis was used to test statistically the fit of hypothesized models of one, two, three or seven dimensions.

Results. The seven-dimensional model comprising core depression, sleep problems, suicidal thoughts, mania, paranoid delusions, first-rank delusions and hallucinations fitted the data best, whereas the unidimensional model obtained the poorest fit. This pattern of results could be replicated at both follow-up measurements. The results were similar for the subsamples with and without a lifetime DSM-III-R diagnosis. The seven dimensions were moderately to strongly correlated, with correlations ranging from 0·18 to 0·73 (mean 0·45).

Conclusions. In the general population, seven correlated but separable dimensions of experiences exist that resemble dimensions of psychopathology seen in clinical samples with severe mental illness. The substantial correlations between these dimensions in clinical and non-clinical samples may suggest that there is aetiological overlap between the different dimensions regardless of level of severity and diagnosable disorder.

c1 Dr L. Krabbendam, Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616 (PAR45), 6200 MD Maastricht, The Netherlands. (Email: