Psychotic experiences and subjective cognitive complaints among 224,842 people in 48 low- and middle-income countries

Aims: Cognitive deficits are an important factor in the pathogenesis of psychosis. Subjective cognitive complaints (SCCs) are often considered to be a precursor of objective cognitive deficits, but there are no studies specifically on SCC and psychotic experiences. Thus, we assessed the association between SCC and psychotic experiences using data from 48 low- and middle-income countries. Methods: Community-based cross-sectional data of the World Health Survey were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 to 10 with higher scores representing more severe SCC. The Composite International Diagnostic Interview was used to identify past 12-month psychotic experiences. Multivariable logistic regression and mediation analyses were performed. Results: The final sample consisted of 224,842 adults aged ≥18 years [mean (SD) age 38.3 (16.0) years; 49.3% males]. After adjustment for sociodemographic factors, a one-unit increase in the SCC scale was associated with a 1.17 (95%CI=1.16-1.18) times higher odds for psychotic experiences in the overall sample, with this association being more pronounced in younger individuals: age 18-44 years OR=1.19 (95%CI=1.17-1.20); 45-64 years OR=1.15 (95%CI=1.12-1.17); ≥65 years OR=1.14 (95%CI=1.09-1.19). Collectively, other mental health conditions (perceived stress, depression, anxiety, sleep problems) explained 43.4% of this association, and chronic physical conditions partially explained the association but to a lesser extent (11.8%). Conclusions: SCC were associated with psychotic experiences. Future longitudinal studies are needed to understand temporal associations and causal inferences, while the utility of SCC as a risk marker for psychosis especially for young adults should be scrutinized.