Criminal victimization and psychotic experiences: cross-sectional associations in 35 low- and middle-income countries

Objective: Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low- and middle-income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts. Method: We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N=146999) using cross-sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences. Results: Victimization was associated with greater odds of psychotic experiences, OR (95% CI)=1.72 (1.50-1.98), and was significantly more strongly associated with psychotic experiences in non-urban, OR (95% CI)=1.93 (1.60-2.33), compared to urban settings, OR (95% CI)=1.48 (1.21-1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization. Conclusions: In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make-up.