Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder
Identifieur interne : 000427 ( Pmc/Curation ); précédent : 000426; suivant : 000428Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder
Auteurs : Christopher Ch CookSource :
- The International Journal of Social Psychiatry [ 0020-7640 ] ; 2015.
Abstract
Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management.
This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship.
A review was undertaken of the quantitative empirical English literature on RD and RH.
A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD.
Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH.
Url:
DOI: 10.1177/0020764015573089
PubMed: 25770205
PubMed Central: 4440877
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder</title><author><name sortKey="Cook, Christopher Ch" sort="Cook, Christopher Ch" uniqKey="Cook C" first="Christopher Ch" last="Cook">Christopher Ch Cook</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25770205</idno><idno type="pmc">4440877</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440877</idno><idno type="RBID">PMC:4440877</idno><idno type="doi">10.1177/0020764015573089</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000427</idno><idno type="wicri:Area/Pmc/Curation">000427</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder</title><author><name sortKey="Cook, Christopher Ch" sort="Cook, Christopher Ch" uniqKey="Cook C" first="Christopher Ch" last="Cook">Christopher Ch Cook</name></author></analytic><series><title level="j">The International Journal of Social Psychiatry</title><idno type="ISSN">0020-7640</idno><idno type="eISSN">1741-2854</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="section1-0020764015573089"><title>Background:</title><p>Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management.</p></sec><sec id="section2-0020764015573089"><title>Aims:</title><p>This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship.</p></sec><sec id="section3-0020764015573089"><title>Methods:</title><p>A review was undertaken of the quantitative empirical English literature on RD and RH.</p></sec><sec id="section4-0020764015573089"><title>Results:</title><p>A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD.</p></sec><sec id="section5-0020764015573089"><title>Conclusion:</title><p>Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ahmed, S H" uniqKey="Ahmed S">S. H. Ahmed</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Allen, C" uniqKey="Allen C">C. Allen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andreasen, N C" uniqKey="Andreasen N">N. C. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Soc Psychiatry</journal-id><journal-id journal-id-type="iso-abbrev">Int J Soc Psychiatry</journal-id><journal-id journal-id-type="publisher-id">ISP</journal-id><journal-id journal-id-type="hwp">spisp</journal-id><journal-title-group><journal-title>The International Journal of Social Psychiatry</journal-title></journal-title-group><issn pub-type="ppub">0020-7640</issn><issn pub-type="epub">1741-2854</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>Sage UK: London, England</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25770205</article-id><article-id pub-id-type="pmc">4440877</article-id><article-id pub-id-type="doi">10.1177/0020764015573089</article-id><article-id pub-id-type="publisher-id">10.1177_0020764015573089</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Cook</surname><given-names>Christopher CH</given-names></name></contrib><aff id="aff1-0020764015573089">Department of Theology and Religion, Durham University, Durham, UK</aff></contrib-group><author-notes><corresp id="corresp1-0020764015573089">Christopher CH Cook, Department of Theology and Religion, Durham University, Abbey House, Palace Green, Durham DH1 3RS, UK. Email: <email>c.c.h.cook@durham.ac.uk</email></corresp></author-notes><pub-date pub-type="epub-ppub"><month>6</month><year>2015</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><month>6</month><year>2015</year></pub-date><volume>61</volume><issue>4</issue><fpage>404</fpage><lpage>425</lpage><permissions><copyright-statement>© The Author(s) 2015</copyright-statement><copyright-year>2015</copyright-year><copyright-holder content-type="sage">SAGE Publications</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><license-p>This article is distributed under the terms of the Creative Commons Attribution 3.0 License (<ext-link ext-link-type="uri" xlink:href="http://www.creativecommons.org/licenses/by/3.0/">http://www.creativecommons.org/licenses/by/3.0/</ext-link>) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (<ext-link ext-link-type="uri" xlink:href="http://www.uk.sagepub.com/aboutus/openaccess.htm">http://www.uk.sagepub.com/aboutus/openaccess.htm</ext-link>).</license-p></license></permissions><abstract><sec id="section1-0020764015573089"><title>Background:</title><p>Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management.</p></sec><sec id="section2-0020764015573089"><title>Aims:</title><p>This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship.</p></sec><sec id="section3-0020764015573089"><title>Methods:</title><p>A review was undertaken of the quantitative empirical English literature on RD and RH.</p></sec><sec id="section4-0020764015573089"><title>Results:</title><p>A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD.</p></sec><sec id="section5-0020764015573089"><title>Conclusion:</title><p>Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH.</p></sec></abstract><kwd-group><kwd>Spirituality</kwd><kwd>religion</kwd><kwd>delusions</kwd><kwd>hallucinations</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="section6-0020764015573089"><title>Introduction</title><p>As a branch of medicine, psychiatry is concerned not only with trying to understand mental disorders but also with trying to find treatments to alleviate the suffering and stigma with which they are so notoriously associated. This concern with treatment underlies a concern for diagnosis, as it is through arriving at a diagnosis that prognosis can be predicted and the most appropriate treatment selected in any given case. Diagnosis in psychiatry is primarily based upon information gained from the history and from the mental state examination, both of which require a degree of trust between doctor and patient, and a sensitivity of the clinician to diagnostic clues which must be interpreted according to the culture and context in which the patient lives. An important component of this culture and context, even in a secular society, is contributed by religious tradition. Unfortunately, the relationship between psychiatry and religion has at times been fraught, and patients have not always felt that they could entrust their psychiatrist with a frank account of their religious experiences, for fear that such experiences might be used as evidence to make a diagnosis of mental illness. The situation has not been helped by crude attempts to employ psychiatric concepts for diagnosing saints and mystics as mentally ill (<xref rid="bibr2-0020764015573089" ref-type="bibr">Allen, 1975</xref>; <xref rid="bibr14-0020764015573089" ref-type="bibr">Cook, 2012</xref>).</p><p>In major mental disorder, the content of perceptual disorder and thought disorder has often assumed less diagnostic significance than the form of the disorder. Thus, it is the presence of a false perception that is understood as important, rather than whether the content of the perception is religious, political or scientific. Similarly, it is the falseness of unshakeable beliefs which are out of keeping with culture that renders them delusional, rather than that they are religious (or political or of another kind). This might be thought to assist in preventing normal religious or political beliefs from being used as a basis for diagnosis. However, it can also lead to a lack of interest of the clinician in religious or other significant themes which may be of central importance to the patient. This is despite evidence that religion may provide an important coping resource for people suffering from major mental disorder (<xref rid="bibr50-0020764015573089" ref-type="bibr">Mohr et al., 2010</xref>) and may significantly influence adherence to treatment (<xref rid="bibr8-0020764015573089" ref-type="bibr">Borras et al., 2007</xref>).</p><p>Studies have generally found religious themes to be commonly identifiable within the content of delusional beliefs, and some helpful reviews have been published (<xref rid="bibr7-0020764015573089" ref-type="bibr">Bhavsar & Bhugra, 2008</xref>; <xref rid="bibr21-0020764015573089" ref-type="bibr">Gearing et al., 2011</xref>). Religious delusions (RD) may be associated with higher levels of grandiosity, but are also held with a degree of flexibility that may give reason to believe that they may be more amenable to cognitive behaviour therapy (<xref rid="bibr28-0020764015573089" ref-type="bibr">Iyassu et al., 2014</xref>). Delusion-like beliefs, including some with religious content, are held widely in the general population, and so RD might be considered as one end of a spectrum of belief, with ‘normal’ religious beliefs at the opposite end of the spectrum (<xref rid="bibr54-0020764015573089" ref-type="bibr">Pechey & Halligan, 2011</xref>). It has been suggested that RD are becoming less common in the Western world as religion has declined in popularity (<xref rid="bibr68-0020764015573089" ref-type="bibr">Stompe, Ortwein-Swoboda, Ritter, & Schanda, 2003</xref>). Widely varying figures have been quoted for the prevalence of RD, and few attempts appear to have been made to systematically review this literature (none of which have attempted to be comprehensive). A large number of such studies have now been published.</p><p>Much less attention has been given to the religious content of hallucinations, and little is known about the frequency of occurrence of religious content as a feature of such phenomena. However, at least one attempt has been made to conduct a systematic and comprehensive review (<xref rid="bibr21-0020764015573089" ref-type="bibr">Gearing et al., 2011</xref>). Some attention has been given to the phenomenon of voice hearing occurring in the absence of diagnosable mental illness, including the occurrence of such phenomena in religious populations. In such a context, it appears that healthy individuals do report, at least sometimes, hearing the voice of God (<xref rid="bibr18-0020764015573089" ref-type="bibr">Dein & Littlewood, 2007</xref>; <xref rid="bibr46-0020764015573089" ref-type="bibr">Luhrmann, 2012b</xref>). Little is known about the frequency of occurrence of religious themes in hallucinations occurring in the course of mental disorder.</p><p>This study sought to review the empirical literature pertaining to the frequency of religious content of hallucinations and delusions as a feature of mental disorders.</p></sec><sec sec-type="methods" id="section7-0020764015573089"><title>Methodology</title><p>Attempts were made to ascertain relevant studies by searching bibliographic databases such as MEDLINE and PsycINFO. This was not found to be a helpful approach as large numbers of studies already known to the author were not identified by this means and it was difficult to identify any search terms which located other than very small numbers of relevant empirical studies. Accordingly, reliance was placed initially upon known review papers which referenced relevant articles on RD and/or religious hallucinations (RH). Further studies were identified by a variety of means, notably by following up references from journal articles and book chapters already identified, by careful attention to recent publications in the field and by searching the MEDLINE and PsycINFO databases with a variety of different free text terms. While it is impossible to be sure that all relevant studies have been identified, the active search for older publications was discontinued when no new articles were being located despite extensive efforts to search manually and by using available electronic databases.</p><p>Inclusion criteria for the articles that were identified included primarily that they were empirical studies which included at least some data on frequency of religious content of delusions and/or hallucinations in the population studied. Individual case reports, and case reports of very small numbers of subjects (<italic>n</italic> < 10), were not included. The study was restricted to articles published in English (with the exception of one paper in Korean, with results tables published in English). Qualitative and quantitative studies were included, but only where data allowed at least a basic quantitative calculation of the number of subjects with religious psychopathology. The primary focus was on studies providing data on RH and RD. Studies on religious rituals and obsessional ruminations, other anxiety disorders, non-psychotic affective disorder, eating disorders and religious addiction were not included.</p></sec><sec sec-type="results" id="section8-0020764015573089"><title>Results</title><p>A total of 55 publications were identified as meeting inclusion criteria and were included in the study (see <xref ref-type="table" rid="table1-0020764015573089">Table 1</xref>). Of these, 45 publications provided at least some quantitative information on numbers of subjects with RD (see <xref ref-type="table" rid="table2-0020764015573089">Table 2</xref>) and 28 provided at least some information (qualitative or quantitative) on the occurrence and nature of RH (see <xref ref-type="table" rid="table2-0020764015573089">Table 2</xref>). The two publications by <xref rid="bibr31-0020764015573089" ref-type="bibr">Kala and Wig (1978</xref>, <xref rid="bibr32-0020764015573089" ref-type="bibr">1982</xref>), appearing in <xref ref-type="table" rid="table1-0020764015573089">Tables 1</xref> and <xref ref-type="table" rid="table2-0020764015573089">2</xref>, would appear to relate to the same study – although slightly different results are published in each paper.</p><table-wrap id="table1-0020764015573089" position="float"><label>Table 1.</label><caption><p>Overview of empirical studies of religious delusions and hallucinations.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Publication</th><th align="left" rowspan="1" colspan="1">Country</th><th align="left" colspan="3" rowspan="1">Study subjects<hr></hr></th><th align="left" colspan="2" rowspan="1">Age<hr></hr></th><th align="left" rowspan="1" colspan="1">Ethnicity</th><th align="left" rowspan="1" colspan="1">Religion</th><th align="left" rowspan="1" colspan="1">Diagnosis</th><th align="left" rowspan="1" colspan="1">Ascertainment</th><th align="left" rowspan="1" colspan="1">Methodology</th><th align="left" rowspan="1" colspan="1">RD</th><th align="left" rowspan="1" colspan="1">Hallucinations</th></tr><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">Total, <italic>n</italic></th><th align="left" rowspan="1" colspan="1">Male, <italic>n</italic></th><th align="left" rowspan="1" colspan="1">Female, <italic>n</italic></th><th align="left" rowspan="1" colspan="1">Range</th><th align="left" rowspan="1" colspan="1">Mean</th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref rid="bibr44-0020764015573089" ref-type="bibr">Lucas et al. (1962)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">405</td><td rowspan="1" colspan="1">196</td><td rowspan="1" colspan="1">209</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">49.5 (M)<break></break>53.3 (F)</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, S-aff, Par</td><td rowspan="1" colspan="1">ip in 1st half of 1958</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr58-0020764015573089" ref-type="bibr">Rin et al. (1962)</xref></td><td rowspan="1" colspan="1">Taiwan – Chinese</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">74</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Par</td><td rowspan="1" colspan="1">ip, 1948–1959</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Taiwan – Formosan</td><td rowspan="1" colspan="1">94</td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">49</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr74-0020764015573089" ref-type="bibr">Weinstein (1962)</xref></td><td rowspan="1" colspan="1">Virgin Islands</td><td rowspan="1" colspan="1">148</td><td rowspan="1" colspan="1">83</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">P</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr35-0020764015573089" ref-type="bibr">Kiev (1963)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">25–35</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">ip at least 1 year</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr24-0020764015573089" ref-type="bibr">Gordon (1965)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">>15</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, S-form, Aff, S-aff, Org, PD, N</td><td rowspan="1" colspan="1">ip, 1961–1964</td><td rowspan="1" colspan="1">IS and CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="3" valign="top" colspan="1"><xref rid="bibr51-0020764015573089" ref-type="bibr">Mott, Small, and Anderson (1965)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.2</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">42.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">SA (alcoholic)</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">56.0</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Medical</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr60-0020764015573089" ref-type="bibr">Scott (1967)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">P</td><td rowspan="1" colspan="1">2nd week of January 1966</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="2" valign="top" colspan="1"><xref rid="bibr47-0020764015573089" ref-type="bibr">McCabe, Fowler, Cadoret, and Winokur (1972)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">16–77</td><td rowspan="1" colspan="1">31.4</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Good prognosis S</td><td rowspan="1" colspan="1">Consecutive ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">17–55</td><td rowspan="1" colspan="1">32.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Poor prognosis S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr20-0020764015573089" ref-type="bibr">El Sendiony (1976)</xref></td><td rowspan="1" colspan="1">Egypt</td><td rowspan="1" colspan="1">110</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">S, Par</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr1-0020764015573089" ref-type="bibr">Ahmed (1978)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">16–55</td><td rowspan="1" colspan="1">30</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">op</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr31-0020764015573089" ref-type="bibr">Kala and Wig (1978)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">107</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD8: S, Par</td><td rowspan="1" colspan="1">Consecutive op, 10 January–15 September 1974</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr43-0020764015573089" ref-type="bibr">Littlewood and Lipsedge (1981)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">244</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">15–45</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, Aff, Par, Other P, PD</td><td rowspan="1" colspan="1">Consecutive ip</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr32-0020764015573089" ref-type="bibr">Kala and Wig (1982)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">109</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD8: S, Par</td><td rowspan="1" colspan="1">Consecutive op</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr52-0020764015573089" ref-type="bibr">Ndetei and Singh (1982)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">15–65</td><td rowspan="1" colspan="1">27.7</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr53-0020764015573089" ref-type="bibr">Ndetei and Vadher (1985)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">593</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr16-0020764015573089" ref-type="bibr">Cothran and Harvey (1986)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIII: S, Mania</td><td rowspan="1" colspan="1">Consecutive ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr40-0020764015573089" ref-type="bibr">Kulhara et al. (1986)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">59</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">>14</td><td rowspan="1" colspan="1">27.7</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr3-0020764015573089" ref-type="bibr">Andreasen (1987)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">111</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Consecutive ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="2" valign="top" colspan="1"><xref rid="bibr49-0020764015573089" ref-type="bibr">Mitchell and Vierkant (1988)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">>16</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">ip, 1933–1939</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ip, 1986 and 1987</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr57-0020764015573089" ref-type="bibr">Renvoize and Beveridge (1989)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">118</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">20–79</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1">ip, 1st admission, 1880–1884</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr29-0020764015573089" ref-type="bibr">Jablensky et al. (1992)</xref></td><td rowspan="1" colspan="1">Colombia, Czechoslovakia, Denmark, India, Ireland, Japan, Nigeria, United Kingdom, United States, USSR</td><td rowspan="1" colspan="1">1,379</td><td rowspan="1" colspan="1">745</td><td rowspan="1" colspan="1">643</td><td rowspan="1" colspan="1">15–54</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD9: S, Par, Other P, SA, PD</td><td rowspan="1" colspan="1">1st episode contact with ‘helping agency’</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr37-0020764015573089" ref-type="bibr">Kim et al. (1993)</xref></td><td rowspan="1" colspan="1">Korea</td><td rowspan="1" colspan="1">370</td><td rowspan="1" colspan="1">199</td><td rowspan="1" colspan="1">171</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.0</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">DSMIIIR: S</td><td rowspan="1" colspan="1">ip, October 1991</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Korean-Chinese)</td><td rowspan="1" colspan="1">225</td><td rowspan="1" colspan="1">137</td><td rowspan="1" colspan="1">88</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">41.2</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Chinese)</td><td rowspan="1" colspan="1">176</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">78</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">34.9</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr72-0020764015573089" ref-type="bibr">Tateyama et al. (1993)</xref></td><td rowspan="1" colspan="1">Germany</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">ip, July–December 1984</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">324</td><td rowspan="1" colspan="1">158</td><td rowspan="1" colspan="1">166</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.9</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ip, January1983–March 1986</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr10-0020764015573089" ref-type="bibr">Brewerton (1994)</xref></td><td rowspan="1" colspan="1">Hawaii</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.3</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">DSMIIIR: S, S-TEEG, Aff, P-CPS</td><td rowspan="1" colspan="1">ip, 1982–1984</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr6-0020764015573089" ref-type="bibr">Azhar et al. (1995)</xref></td><td rowspan="1" colspan="1">Malaysia – Penang (Malay)</td><td rowspan="1" colspan="1">82</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Malaysia – Penang (Chinese)</td><td rowspan="1" colspan="1">84</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Malaysia – Kota Bharu (Malay)</td><td rowspan="1" colspan="1">84</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr33-0020764015573089" ref-type="bibr">Kanemoto et al. (1996)</xref></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Interictal P</td><td rowspan="1" colspan="1">Archives of regional epilepsy centre</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">30</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">37.7</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Postictal P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">32.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Chronic P + CPS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr34-0020764015573089" ref-type="bibr">Kent and Wahass (1996)</xref></td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">20–65</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1">ip and op</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">United Kingdom</td><td rowspan="1" colspan="1">35</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr73-0020764015573089" ref-type="bibr">Tateyama et al. (1998)</xref></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">324</td><td rowspan="1" colspan="1">158</td><td rowspan="1" colspan="1">166</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.9</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">ip, January 1983–May 1986</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">101</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.0</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ip, September 1992–December 1993</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Germany</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ip, July–December 1984</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr4-0020764015573089" ref-type="bibr">Appelbaum et al. (1999)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">1136</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">18–40</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">DSMIIIR: S, S-form, S-aff, Aff, Other P, SA, PD</td><td rowspan="1" colspan="1">ip – randomly selected</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr67-0020764015573089" ref-type="bibr">Stompe et al. (1999)</xref></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">29.5</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIIIR: S</td><td rowspan="1" colspan="1">Consecutive ip, January 1992–December 1994</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">108</td><td rowspan="1" colspan="1">73</td><td rowspan="1" colspan="1">35</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">32.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ip</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr41-0020764015573089" ref-type="bibr">Kulhara et al. (2000)</xref></td><td rowspan="1" colspan="1">North India</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">32.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1">op, 1st contact (<italic>n</italic> = 11 admitted)</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr55-0020764015573089" ref-type="bibr">Raja, Azzoni, and Lubich (2000)</xref></td><td rowspan="1" colspan="1">Italy</td><td rowspan="1" colspan="1">313 (cases); 271 (patients)</td><td rowspan="1" colspan="1">124</td><td rowspan="1" colspan="1">189</td><td rowspan="1" colspan="1">18–87</td><td rowspan="1" colspan="1">41.8</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">DSMIV: S, S-form, S-aff, Aff, Other P, Psy-ep, Other</td><td rowspan="1" colspan="1">ip – consecutive admissions to PICU 26 May 1994–10 July 1995</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr5-0020764015573089" ref-type="bibr">Atallah, El-Dosoky, Coker, Nabil, and El-Islam (2001)</xref></td><td rowspan="1" colspan="1">Egypt</td><td rowspan="1" colspan="1">5,275</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.0</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">S, S-aff, Aff</td><td rowspan="1" colspan="1">ip, 1975–1996</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr23-0020764015573089" ref-type="bibr">Getz, Fleck, and Strakowski (2001)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">71</td><td rowspan="1" colspan="1">42</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">18–45</td><td rowspan="1" colspan="1">32.0</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIV: P</td><td rowspan="1" colspan="1">ip – consecutive admissions</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">33.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">31.2</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr25-0020764015573089" ref-type="bibr">Gutiérrez-Lobos et al. (2001)</xref></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">639</td><td rowspan="1" colspan="1">239</td><td rowspan="1" colspan="1">400</td><td rowspan="1" colspan="1">15–89</td><td rowspan="1" colspan="1">48.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD8: S, Aff, Org, Par, N, SA</td><td rowspan="1" colspan="1">ip, 1 January 1971–30 June 1974</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref></td><td rowspan="1" colspan="1">Korea (Seoul)</td><td rowspan="1" colspan="1">143</td><td rowspan="1" colspan="1">82</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">34.2</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">ip, January/February 1999</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Shanghai)</td><td rowspan="1" colspan="1">147</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">36.5</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Taiwan (Taipei)</td><td rowspan="1" colspan="1">140</td><td rowspan="1" colspan="1">76</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.5</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref></td><td rowspan="1" colspan="1">China (Shanghai)</td><td rowspan="1" colspan="1">182</td><td rowspan="1" colspan="1">119</td><td rowspan="1" colspan="1">63</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">38.1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">ip, 1 March–30 June 1998</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Korea (Seoul)</td><td rowspan="1" colspan="1">214</td><td rowspan="1" colspan="1">125</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.6</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle, Haddock, Tarrier, and Faragher (2002)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">193</td><td rowspan="1" colspan="1">135</td><td rowspan="1" colspan="1">58</td><td rowspan="1" colspan="1">18.4–64.8</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Other P</td><td rowspan="1" colspan="1">ip, 1st admissions</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr70-0020764015573089" ref-type="bibr">Suhail and Cochrane (2002)</xref></td><td rowspan="1" colspan="1">England (White)</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">36.5</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, Par, S-aff</td><td rowspan="1" colspan="1">Ip</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">England (British-Pakistani)</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">38.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr69-0020764015573089" ref-type="bibr">Suhail (2003)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">ip, January–April 1998</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr65-0020764015573089" ref-type="bibr">Smith et al. (2005)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">18–65</td><td rowspan="1" colspan="1">37.1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Aff, Other P</td><td rowspan="1" colspan="1">op and ip</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr48-0020764015573089" ref-type="bibr">Miller and McCormack (2006)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">77</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">16–38</td><td rowspan="1" colspan="1">23</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIV: S, S-form, S-aff</td><td rowspan="1" colspan="1">Community hospital</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr59-0020764015573089" ref-type="bibr">Rudalevičienė et al. (2008)</xref></td><td rowspan="1" colspan="1">Lithuania</td><td rowspan="1" colspan="1">295</td><td rowspan="1" colspan="1">143</td><td rowspan="1" colspan="1">152</td><td rowspan="1" colspan="1">20–74</td><td rowspan="1" colspan="1">42.4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr9-0020764015573089" ref-type="bibr">Brakoulias and Starcevic (2008)</xref></td><td rowspan="1" colspan="1">Australia</td><td rowspan="1" colspan="1">90</td><td rowspan="1" colspan="1">49</td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">18–65</td><td rowspan="1" colspan="1">37.8</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, S-aff, Aff, SA, Other P</td><td rowspan="1" colspan="1">ip, May 2006</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr64-0020764015573089" ref-type="bibr">Skodlar, Dernovsek, and Kocmur (2008)</xref></td><td rowspan="1" colspan="1">Slovenia</td><td rowspan="1" colspan="1">120</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">ip, 1st admission, 10 records selected for each 10-year interval, 1881–2000</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr22-0020764015573089" ref-type="bibr">Gecici et al. (2010)</xref></td><td rowspan="1" colspan="1">Turkey</td><td rowspan="1" colspan="1">373</td><td rowspan="1" colspan="1">215</td><td rowspan="1" colspan="1">158</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">36.2</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">ip, January–April 2008</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr50-0020764015573089" ref-type="bibr">Mohr et al. (2010)</xref></td><td rowspan="1" colspan="1">Switzerland and Canada</td><td rowspan="1" colspan="1">236</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">86</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">42.9</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">ICD10: S, S-aff</td><td rowspan="1" colspan="1">op: May 2003–June 2004 (Geneva); October–December 2006 (Quebec)</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr71-0020764015573089" ref-type="bibr">Suhail and Ghauri (2010)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">35.2</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">ip admitted July–December 2007</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr17-0020764015573089" ref-type="bibr">de Araujo Filho et al. (2011)</xref></td><td rowspan="1" colspan="1">Brazil</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">38.5</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">TLE-MTS with Psy-ep</td><td rowspan="1" colspan="1">op, July 2005–July 2010</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">32.6</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">JME with Psy-ep</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr26-0020764015573089" ref-type="bibr">Huang et al. (2011)</xref></td><td rowspan="1" colspan="1">Taiwan</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">32.6</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">Day-patients</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr42-0020764015573089" ref-type="bibr">Linskey (2011)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">18–72</td><td rowspan="1" colspan="1">37.7</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">DSMIII: S, Aff</td><td rowspan="1" colspan="1">ip and op</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr11-0020764015573089" ref-type="bibr">Cannon and Kramer (2012)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">102</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">38.7</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S, Par, Mania, Other P</td><td rowspan="1" colspan="1">ip records – randomly sampled by decade</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr39-0020764015573089" ref-type="bibr">Krzystanek, Krysta, Klasik, and Krupka-Matuszczyk (2012)</xref></td><td rowspan="1" colspan="1">Poland</td><td rowspan="1" colspan="1">400</td><td rowspan="1" colspan="1">204</td><td rowspan="1" colspan="1">196</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">ip, 1932, 1952, 1972 and 1992</td><td rowspan="1" colspan="1">CR</td><td rowspan="1" colspan="1">[✓]</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr28-0020764015573089" ref-type="bibr">Iyassu et al. (2014)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">383</td><td rowspan="1" colspan="1">266</td><td rowspan="1" colspan="1">117</td><td rowspan="1" colspan="1">18–65</td><td rowspan="1" colspan="1">38.9</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">ICD10: S, S-aff, Other P</td><td rowspan="1" colspan="1">Age 18–65 years, drawn from previous studies</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr12-0020764015573089" ref-type="bibr">Connell et al. (2014)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">73</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">25–71</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Convenience sample – participants in previous research</td><td rowspan="1" colspan="1">IS</td><td rowspan="1" colspan="1">✓</td><td rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="table-fn1-0020764015573089"><p>Refer <xref ref-type="app" rid="app1-0020764015573089">Appendix 1</xref> for abbreviations.</p></fn></table-wrap-foot></table-wrap><table-wrap id="table2-0020764015573089" position="float"><label>Table 2.</label><caption><p>Empirical studies of religious delusions.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Publication</th><th align="left" rowspan="1" colspan="1">Country</th><th align="left" rowspan="1" colspan="1"><italic>n</italic></th><th align="left" rowspan="1" colspan="1">Diagnosis</th><th align="left" colspan="2" rowspan="1">Prevalence of delusions<hr></hr></th><th align="left" colspan="5" rowspan="1">RD<hr></hr></th><th align="left" rowspan="1" colspan="1">Definition of RD</th><th align="left" rowspan="2" colspan="1">Information given about hallucinations</th></tr><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"><italic>n</italic></th><th align="left" rowspan="1" colspan="1">% of total sample</th><th align="left" rowspan="1" colspan="1"><italic>n</italic></th><th align="left" rowspan="1" colspan="1">% of delusional subjects</th><th align="left" rowspan="1" colspan="1">% of total sample</th><th align="left" rowspan="1" colspan="1"><italic>n</italic> (%) of delusional males</th><th align="left" rowspan="1" colspan="1"><italic>n</italic> (%) of delusional females</th><th rowspan="1" colspan="1"></th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref rid="bibr44-0020764015573089" ref-type="bibr">Lucas et al. (1962)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">405</td><td rowspan="1" colspan="1">S, S-aff, Par</td><td rowspan="1" colspan="1">288</td><td rowspan="1" colspan="1">71</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">21.2</td><td rowspan="1" colspan="1">15.1</td><td rowspan="1" colspan="1">23 (18)</td><td rowspan="1" colspan="1">38 (24)</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr58-0020764015573089" ref-type="bibr">Rin et al. (1962)</xref></td><td rowspan="1" colspan="1">Taiwan – Chinese</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">Par</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">9.5</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">Content = ‘religion and gods’</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Taiwan – Formosan</td><td rowspan="1" colspan="1">94</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">7.4</td><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr74-0020764015573089" ref-type="bibr">Weinstein (1962)</xref></td><td rowspan="1" colspan="1">Virgin Islands</td><td rowspan="1" colspan="1">148</td><td rowspan="1" colspan="1">P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">17.6</td><td rowspan="1" colspan="1">10 (12.0)</td><td rowspan="1" colspan="1">16 (24.6)</td><td rowspan="1" colspan="1">‘Delusions and hallucinations concerning religion …’<break></break>‘The majority of these delusions and hallucinations concerned God and Jesus’.<break></break>Religion reported separately to death (within which beliefs about spirits included) and Obeah (witchcraft)</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr35-0020764015573089" ref-type="bibr">Kiev (1963)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr24-0020764015573089" ref-type="bibr">Gordon (1965)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">S, S-form, Aff, S-aff, Org, PD, N</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">39.3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘Religious delusions and/or religiose colouring’</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr47-0020764015573089" ref-type="bibr">McCabe, Fowler, Cadoret, and Winokur (1972)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">Good prognosis S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">46</td><td rowspan="1" colspan="1">46</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">Poor prognosis S</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">76</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr20-0020764015573089" ref-type="bibr">El Sendiony (1976)</xref></td><td rowspan="1" colspan="1">Egypt</td><td rowspan="1" colspan="1">110</td><td rowspan="1" colspan="1">S, Par</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">20 (36)</td><td rowspan="1" colspan="1">24 (44)</td><td rowspan="1" colspan="1">‘religious ideology’</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr1-0020764015573089" ref-type="bibr">Ahmed (1978)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">422</td><td rowspan="1" colspan="1">50.9</td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">49</td><td rowspan="1" colspan="1">49</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘religious content’ <italic>n</italic> = 25<break></break>‘religious and/or magic content’ <italic>n</italic> = 34</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr31-0020764015573089" ref-type="bibr">Kala and Wig (1978)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">ICD8: S, Par</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">15.5</td><td rowspan="1" colspan="1">15.5</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">23</td><td rowspan="1" colspan="1">‘Magic & religion’<break></break>Modified from <xref rid="bibr58-0020764015573089" ref-type="bibr">Rin et al. (1962)</xref></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr32-0020764015573089" ref-type="bibr">Kala and Wig (1982)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">200</td><td rowspan="1" colspan="1">ICD8: S, Par</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">20.5</td><td rowspan="1" colspan="1">20.5</td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">PSE</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr52-0020764015573089" ref-type="bibr">Ndetei and Singh (1982)</xref></td><td rowspan="1" colspan="1">Kenya</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1">62</td><td rowspan="1" colspan="1">78.4</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">27.4</td><td rowspan="1" colspan="1">21.3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">Modified PSE. RD classified as a sub-category of grandiose delusions</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr53-0020764015573089" ref-type="bibr">Ndetei and Vadher (1985)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">593</td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">3.4</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘any religious symptoms regardless of whether they were delusions or just ideas’</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr16-0020764015573089" ref-type="bibr">Cothran and Harvey (1986)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">DSMIII: S, Mania</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">58.5</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">54.2</td><td rowspan="1" colspan="1">31.7</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘Subjects were rated as delusional with religious content if they reported at least one delusion over the course of the SADS interview and delusional content included a report of religious state, experience, practice or belief that exceeded SADS/DSM-III criteria for legitimate subcultural experience’</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr40-0020764015573089" ref-type="bibr">Kulhara et al. (1986)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">87.5</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">14.3</td><td rowspan="1" colspan="1">12.5</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr3-0020764015573089" ref-type="bibr">Andreasen (1987)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">111</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">102</td><td rowspan="1" colspan="1">92</td><td rowspan="1" colspan="1">34</td><td rowspan="1" colspan="1">33.3</td><td rowspan="1" colspan="1">30.6</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">SAPS</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr57-0020764015573089" ref-type="bibr">Renvoize and Beveridge (1989)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">118</td><td rowspan="1" colspan="1">All psych</td><td rowspan="1" colspan="1">86</td><td rowspan="1" colspan="1">72.9</td><td rowspan="1" colspan="1">30</td><td rowspan="1" colspan="1">34.9</td><td rowspan="1" colspan="1">25.4</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘religious content’</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr29-0020764015573089" ref-type="bibr">Jablensky et al. (1992)</xref></td><td rowspan="1" colspan="1">Colombia, Czechoslovakia, Denmark, India, Ireland, Japan, Nigeria, United Kingdom, United States, USSR</td><td rowspan="1" colspan="1">1,379</td><td rowspan="1" colspan="1">ICD9: S, Par, Other P, SA, PD</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">~10.0</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE Category 78</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr37-0020764015573089" ref-type="bibr">Kim et al. (1993)</xref></td><td rowspan="1" colspan="1">Korea</td><td rowspan="1" colspan="1">370</td><td rowspan="1" colspan="1">DSMIIIR: S</td><td rowspan="1" colspan="1">370</td><td rowspan="1" colspan="1">80.9</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">25.1</td><td rowspan="1" colspan="1">20.4</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘Religious, supernatural’<break></break>(Not clear if ‘possession’ counted separately)</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Korean-Chinese)</td><td rowspan="1" colspan="1">225</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">225</td><td rowspan="1" colspan="1">77.4</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Chinese)</td><td rowspan="1" colspan="1">176</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">176</td><td rowspan="1" colspan="1">76.2</td><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">1.1</td><td rowspan="1" colspan="1">0.9</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr72-0020764015573089" ref-type="bibr">Tateyama et al. (1993)</xref></td><td rowspan="1" colspan="1">Germany</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">131</td><td rowspan="1" colspan="1">87</td><td rowspan="1" colspan="1">32</td><td rowspan="1" colspan="1">24.4</td><td rowspan="1" colspan="1">21.3</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">324</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">289</td><td rowspan="1" colspan="1">89.2</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">7.6</td><td rowspan="1" colspan="1">6.8</td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr6-0020764015573089" ref-type="bibr">Azhar et al. (1995)</xref></td><td rowspan="1" colspan="1">Malaysia – Penang (Malay)</td><td rowspan="1" colspan="1">82</td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Malaysia – Penang (Chinese)</td><td rowspan="1" colspan="1">84</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Malaysia – Kota Bharu (Malay)</td><td rowspan="1" colspan="1">84</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">37</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr33-0020764015573089" ref-type="bibr">Kanemoto et al. (1996)</xref></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">Interictal P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">SAPS</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">30</td><td rowspan="1" colspan="1">Postictal P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">23.3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">Chronic P + CPS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr73-0020764015573089" ref-type="bibr">Tateyama et al. (1998)</xref></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">324</td><td rowspan="1" colspan="1">ICD9: S</td><td rowspan="1" colspan="1">290</td><td rowspan="1" colspan="1">89.50</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">6.8</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">12 (8.4)</td><td rowspan="1" colspan="1">10 (6.8)</td><td rowspan="1" colspan="1"><xref rid="bibr27-0020764015573089" ref-type="bibr">Huber and Gross (1977)</xref></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">101</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">92</td><td rowspan="1" colspan="1">91.10</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">19.8</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">9 (20)</td><td rowspan="1" colspan="1">11 (23.4)</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Germany</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">131</td><td rowspan="1" colspan="1">87.30</td><td rowspan="1" colspan="1">32</td><td rowspan="1" colspan="1">21.3</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">18 (30)</td><td rowspan="1" colspan="1">14 (19.7)</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr4-0020764015573089" ref-type="bibr">Appelbaum et al. (1999)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">1,136</td><td rowspan="1" colspan="1">DSMIIIR: S, S-form, S-aff, Aff, Other P, SA, PD</td><td rowspan="1" colspan="1">328</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">93</td><td rowspan="1" colspan="1">28.4</td><td rowspan="1" colspan="1">8.2</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘content-based typology based largely on DSM-III-R’</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr67-0020764015573089" ref-type="bibr">Stompe et al. (1999)</xref></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">DSMIIIR: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">27</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">21.4</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"><xref rid="bibr27-0020764015573089" ref-type="bibr">Huber and Gross (1977)</xref></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">108</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">4.6</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr41-0020764015573089" ref-type="bibr">Kulhara et al. (2000)</xref></td><td rowspan="1" colspan="1">North India</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1">37</td><td rowspan="1" colspan="1">92</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">10.8</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr55-0020764015573089" ref-type="bibr">Raja, Azzoni, and Lubich (2000)</xref></td><td rowspan="1" colspan="1">Italy</td><td rowspan="1" colspan="1">313 (cases) 271 (patients)</td><td rowspan="1" colspan="1">DSMIV: S, S-form, S-aff, Aff, Other P, Psy-ep, Other</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">63</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">20.1</td><td rowspan="1" colspan="1">27</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">SAPS item on RD score >1</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr23-0020764015573089" ref-type="bibr">Getz, Fleck, and Strakowski (2001)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">133</td><td rowspan="1" colspan="1">DSMIV: P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">33.8</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">SAPS item on RD score >1</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr25-0020764015573089" ref-type="bibr">Gutiérrez-Lobos et al. (2001)</xref></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">639</td><td rowspan="1" colspan="1">ICD8: S, Aff, Org, Par, N, SA</td><td rowspan="1" colspan="1">639</td><td rowspan="1" colspan="1">7.8</td><td rowspan="1" colspan="1">42</td><td rowspan="1" colspan="1">6.6</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">15 (6.3)</td><td rowspan="1" colspan="1">27 (6.8)</td><td rowspan="1" colspan="1">‘religious or metaphysical’</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref></td><td rowspan="1" colspan="1">Korea (Seoul)</td><td rowspan="1" colspan="1">143</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">599</td><td rowspan="1" colspan="1">92.2</td><td rowspan="1" colspan="1">67</td><td rowspan="1" colspan="1">47.1</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘religious/supernatural’ theme<break></break>‘possession’ classified separately</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">China (Shanghai)</td><td rowspan="1" colspan="1">147</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">7.9</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Taiwan (Taipei)</td><td rowspan="1" colspan="1">140</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">57</td><td rowspan="1" colspan="1">41</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle, Haddock, Tarrier, and Faragher (2002)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">193</td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Other P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">23.3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE + <xref rid="bibr63-0020764015573089" ref-type="bibr">Sims (1995)</xref> criteria<break></break>Algorithm to establish RD</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr70-0020764015573089" ref-type="bibr">Suhail and Cochrane (2002)</xref></td><td rowspan="1" colspan="1">England (White)</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">S, Par, S-aff</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE Category 78</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">England (British-Pakistani)</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr69-0020764015573089" ref-type="bibr">Suhail (2003)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">PSE Category 78</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr65-0020764015573089" ref-type="bibr">Smith et al. (2005)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Aff, Other P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">Clinical Assessment in Neuropsychiatry (<xref rid="bibr75-0020764015573089" ref-type="bibr">WHO, 1992</xref>)</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr48-0020764015573089" ref-type="bibr">Miller and McCormack (2006)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">77</td><td rowspan="1" colspan="1">DSMIV: S, S-form, S-aff</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">46.8</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">‘false fixed beliefs of a religious nature’<break></break>36 patients identified in this study had RD ‘that significantly affected their functioning’<break></break>2 categories of RD identified: ‘clearly’ RD and ‘delusions with religious content’</td><td rowspan="1" colspan="1">[✓]</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr59-0020764015573089" ref-type="bibr">Rudalevičienėė et al. (2008)</xref></td><td rowspan="1" colspan="1">Lithuania</td><td rowspan="1" colspan="1">295</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">190</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">64.4</td><td rowspan="1" colspan="1">89 (62.2)</td><td rowspan="1" colspan="1">101 (66.4)</td><td rowspan="1" colspan="1">Semi-structured questionnaire – FPS</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr9-0020764015573089" ref-type="bibr">Brakoulias and Starcevic (2008)</xref></td><td rowspan="1" colspan="1">Australia</td><td rowspan="1" colspan="1">90</td><td rowspan="1" colspan="1">S, S-aff, Aff, SA, Other P</td><td rowspan="1" colspan="1">90</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">26.7</td><td rowspan="1" colspan="1">18.5</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr64-0020764015573089" ref-type="bibr">Skodlar, Dernovsek, and Kocmur (2008)</xref></td><td rowspan="1" colspan="1">Slovenia</td><td rowspan="1" colspan="1">120</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">31.7</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr22-0020764015573089" ref-type="bibr">Gecici et al. (2010)</xref></td><td rowspan="1" colspan="1">Turkey</td><td rowspan="1" colspan="1">373</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">346</td><td rowspan="1" colspan="1">92.8</td><td rowspan="1" colspan="1">58</td><td rowspan="1" colspan="1">16.8</td><td rowspan="1" colspan="1">15.5</td><td rowspan="1" colspan="1">34 (16.8)</td><td rowspan="1" colspan="1">24 (16.7)</td><td rowspan="1" colspan="1"><xref rid="bibr27-0020764015573089" ref-type="bibr">Huber and Gross (1977)</xref></td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr50-0020764015573089" ref-type="bibr">Mohr et al. (2010)</xref></td><td rowspan="1" colspan="1">Switzerland and Canada</td><td rowspan="1" colspan="1">236</td><td rowspan="1" colspan="1">ICD10: S, S-aff</td><td rowspan="1" colspan="1">123</td><td rowspan="1" colspan="1">52.1</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">30.9</td><td rowspan="1" colspan="1">16.1</td><td rowspan="1" colspan="1">27 (71)</td><td rowspan="1" colspan="1">8 (29)</td><td rowspan="1" colspan="1">‘delusions with religious content’</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr71-0020764015573089" ref-type="bibr">Suhail and Ghauri (2010)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">62.3</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">PSE Category 78</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr17-0020764015573089" ref-type="bibr">de Araujo Filho et al. (2011)</xref></td><td rowspan="1" colspan="1">Brazil</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">TLE-MTS + Psy-ep</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">13.8</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">JME + Psy-ep</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">33.3</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr42-0020764015573089" ref-type="bibr">Linskey (2011)</xref></td><td rowspan="1" colspan="1">India</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">DSMIII: S, Aff</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">32</td><td rowspan="1" colspan="1">32</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">‘religious’<break></break>(‘magical’ & ‘spirit-possession’ classified separately)</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr11-0020764015573089" ref-type="bibr">Cannon and Kramer (2012)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">102</td><td rowspan="1" colspan="1">S, Par, Mania, Other P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">39</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr28-0020764015573089" ref-type="bibr">Iyassu et al. (2014)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">383</td><td rowspan="1" colspan="1">ICD10: S, S-aff, Other P</td><td rowspan="1" colspan="1">383</td><td rowspan="1" colspan="1">89.7</td><td rowspan="1" colspan="1">87</td><td rowspan="1" colspan="1">22.7</td><td rowspan="1" colspan="1">20.5</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">27</td><td rowspan="1" colspan="1">RD = Item 12 on SAPS: ‘The patient is preoccupied with false beliefs of a religious nature’</td><td rowspan="1" colspan="1">✓</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr12-0020764015573089" ref-type="bibr">Connell et al. (2014)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">73</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">82</td><td rowspan="1" colspan="1">42</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">57.5</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">After <xref rid="bibr19-0020764015573089" ref-type="bibr">Drinnan and Lavender (2006)</xref> and <xref rid="bibr30-0020764015573089" ref-type="bibr">Jones and Watson (1997)</xref></td><td rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn id="table-fn2-0020764015573089"><p>Refer <xref ref-type="app" rid="app1-0020764015573089">Appendix 1</xref> for abbreviations.</p></fn></table-wrap-foot></table-wrap><p>Sample size for the studies included in the total group of 55 publications ranged between 50 and 5,275 for case record studies and between 10 and 1,379 for interview studies. Less than half of the total group of publications included provided any information on the ethnicity (<italic>n</italic> = 22) or religious affiliation (<italic>n</italic> = 24) of the subject sample. A wide range of diagnostic groups was included in some studies, and in others, the sample was restricted to schizophrenia. Only three studies explicitly included psychosis related to epilepsy.</p><p>Studies were undertaken in a wide range of countries, and 11 studies explicitly included international and/or ethnic comparisons. Notably, studies appear to have been undertaken in every populated continent in the world, albeit the two countries in which many more studies have been undertaken than in any other are the United Kingdom (<italic>n</italic> = 12) and the United States (<italic>n</italic> = 10). More than half the studies (<italic>n</italic> = 31) included subjects from Europe and/or North America, whereas only one study included subjects from South America (Colombia).</p><p>Only five studies in the sample incorporated some kind of longitudinal analysis. <xref rid="bibr49-0020764015573089" ref-type="bibr">Mitchell and Vierkant (1988)</xref> compared patients admitted in 1933–1939 with those admitted in 1986–1987. <xref rid="bibr64-0020764015573089" ref-type="bibr">Skodlar, Dernovsek, and Kocmur (2008)</xref> selected case notes from each 10-year period between 1881 and 2000. Similarly, Cannon and Kramer (2011) sampled case notes by decade across the course of the 20th century. These three studies will be discussed further below. In another two studies, RD and RH were not distinguished. <xref rid="bibr5-0020764015573089" ref-type="bibr">Atallah, El-Dosoky, Coker, Nabil, and El-Islam (2001)</xref> conducted a longitudinal analysis of case notes in a psychiatric hospital in Egypt across the period 1975–1996 and found peaks of religious symptoms in the mid-1970s to early 1980s and again in the early/mid-1990s. <xref rid="bibr39-0020764015573089" ref-type="bibr">Krzystanek et al. (2012)</xref> studied case notes of patients admitted to a neuropsychiatric hospital in Poland in 1932, 1952, 1972 and 1992 and found religious topics identified in delusions and/or hallucinations in 50%, 46%, 49% and 42%, respectively.</p><p>Studies of RD (<xref ref-type="table" rid="table2-0020764015573089">Table 2</xref>) have found between 1.1% and 80% of deluded subjects to report at least some religious content in their delusions. More typically, figures between 20% and 60% are reported. However, variable definitions of what counted as religious content were employed. In eight studies, no information at all was given concerning the definitions employed. Themes related to magic, death, spirit possession, witchcraft, the supernatural and so on were sometimes included and sometimes not included. Often it appears that it was taken for granted that what was ‘religious’ should be obvious to both the researcher and reader.</p><p><xref rid="bibr64-0020764015573089" ref-type="bibr">Skodlar et al. (2008)</xref> found that the frequency of delusions in Slovenia with religious and magical themes fluctuated during the study period 1881–2000, with low levels observed in the periods 1901–1920 and 1961–1980. Cannon and Kramer (2011) did not find variation in RD across the 20th century in the United States.</p><p>There generally seems to be a positive relationship between religiosity and RD. <xref rid="bibr16-0020764015573089" ref-type="bibr">Cothran and Harvey (1986)</xref> and <xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle, Haddock, Tarrier, and Faragher (2002)</xref> report higher religiosity in those with RD. <xref rid="bibr23-0020764015573089" ref-type="bibr">Getz, Fleck, and Strakowski (2001)</xref> report that religious involvement prior to admission predicted severity of RD and that Protestants are significantly more likely to report RD than Roman Catholics. <xref rid="bibr71-0020764015573089" ref-type="bibr">Suhail and Ghauri (2010)</xref> report that more religious patients were more likely to have RD. However, <xref rid="bibr59-0020764015573089" ref-type="bibr">Rudalevičienė, Stompe, Narbekovas, Raškauskienė, and Bunevičius (2008)</xref> concluded from their multivariate analysis that religiosity does not directly influence the religious content of delusions.</p><p><xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle et al. (2002)</xref> reported that patients with RD had higher symptom scores, were functioning less well and were prescribed more medication. Similarly, <xref rid="bibr55-0020764015573089" ref-type="bibr">Raja, Azzoni, and Lubich (2000)</xref> found that patients with RD started neuroleptic treatment earlier, had worse global functioning and more severe psychopathology. However, <xref rid="bibr50-0020764015573089" ref-type="bibr">Mohr et al. (2010)</xref> reported that RD were not associated with greater clinical severity, and <xref rid="bibr47-0020764015573089" ref-type="bibr">McCabe, Fowler, Cadoret, and Winokur (1972)</xref> found that RD did not distinguish good and poor prognosis groups of patients. Similarly, in a subsequent publication, <xref rid="bibr62-0020764015573089" ref-type="bibr">Siddle, Haddock, Tarrier, and Faragher (2004)</xref> reported that in the subjects included in their 2002 study, after 4 weeks of treatment there was no difference in response to treatment between patients who had RD and those who did not.</p><p>Studies of RH (<xref ref-type="table" rid="table3-0020764015573089">Table 3</xref>) provide much less quantitative information. In some studies, content of delusions and hallucinations is not distinguished and it is noted only that there is religious content to delusions and/or hallucinations. Only a few studies distinguish between religious themes appearing within the content of auditory verbal hallucinations (AVH) and ascription of a religious identity to the perceived source of the AVH. Very few studies give any significant information on hallucinations in modalities other than the auditory. As with studies of RD, definitions of what counts as ‘religious’ content of hallucinations are variable and often imprecise.</p><table-wrap id="table3-0020764015573089" position="float"><label>Table 3.</label><caption><p>Empirical studies of religious hallucinations.</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col></colgroup><thead><tr><th align="left" rowspan="1" colspan="1">Publication</th><th align="left" rowspan="1" colspan="1">Country</th><th align="left" colspan="3" rowspan="1">Study subjects<hr></hr></th><th align="left" rowspan="1" colspan="1">Diagnosis</th><th align="left" colspan="3" rowspan="1">Prevalence of hallucinations<hr></hr></th><th align="left" rowspan="2" valign="top" colspan="1">Definition of RH</th><th align="left" rowspan="2" valign="top" colspan="1">Information given about hallucinations</th><th align="left" rowspan="2" valign="top" colspan="1">RD (% of total sample)</th></tr><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">Total, <italic>n</italic></th><th align="left" rowspan="1" colspan="1">Male, <italic>n</italic></th><th align="left" rowspan="1" colspan="1">Female, <italic>n</italic></th><th rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1"><italic>n</italic></th><th align="left" rowspan="1" colspan="1">%</th><th align="left" rowspan="1" colspan="1">Type</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><xref rid="bibr58-0020764015573089" ref-type="bibr">Rin et al. (1962)</xref></td><td rowspan="1" colspan="1">Taiwan – Chinese</td><td rowspan="1" colspan="1">126</td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">74</td><td rowspan="1" colspan="1">Par</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">Content = ‘religion and gods’ – no distinction made between delusions and hallucinations</td><td rowspan="1" colspan="1">Symptom content ‘not so fluently expressed in hallucinations as in delusions’</td><td rowspan="1" colspan="1">9.5</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Taiwan – Formosan</td><td rowspan="1" colspan="1">94</td><td rowspan="1" colspan="1">45</td><td rowspan="1" colspan="1">49</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">7.4</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr74-0020764015573089" ref-type="bibr">Weinstein (1962)</xref></td><td rowspan="1" colspan="1">Virgin Islands</td><td rowspan="1" colspan="1">148</td><td rowspan="1" colspan="1">83</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">‘Delusions and hallucinations concerning religion …’<break></break>‘The majority of these delusions and hallucinations concerned God and Jesus’.<break></break>Religion reported separately to death (within which beliefs about spirits included) and Obeah (witchcraft)</td><td rowspan="1" colspan="1">Content of RD and RH not distinguished in this study</td><td rowspan="1" colspan="1">17.6</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr35-0020764015573089" ref-type="bibr">Kiev (1963)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">‘Most’ RD accompanied by ‘hallucinatory commands to preach and heal …’</td><td rowspan="1" colspan="1">80</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr51-0020764015573089" ref-type="bibr">Mott, Small, and Anderson (1965)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">66</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">Spiritual theme = ‘seeing dead relatives, visions of spirits, etc’<break></break>Ascribed identity or sources = ‘religious personages’</td><td rowspan="1" colspan="1"><italic>n</italic> = 9 (18%) spirituality a major theme<break></break><italic>n</italic> = 8 (16%) ascribed to religious personages</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">SA (alcoholic)</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">76</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>n</italic> = 12 (24%) spirituality a major theme<break></break><italic>n</italic> = 10 (20%) ascribed to religious personages</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">Medical</td><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">32</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>n</italic> = 13 (26%) spirituality a major theme<break></break><italic>n</italic> = 6 (12%) ascribed to religious personages</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr24-0020764015573089" ref-type="bibr">Gordon (1965)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">S, S-form, Aff, S-aff, Org, PD, N</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">‘religiose content was usually associated in the schizophrenics with auditory, and often visual, hallucinations, the patients frequently seeing visions and receiving commands from God’</td><td rowspan="1" colspan="1">39.3</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr60-0020764015573089" ref-type="bibr">Scott (1967)</xref></td><td rowspan="1" colspan="1">South Africa</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">0</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">P</td><td rowspan="1" colspan="1">85</td><td rowspan="1" colspan="1">85</td><td rowspan="1" colspan="1">AVH</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">44/85 = 51.8% ascribed to God</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr47-0020764015573089" ref-type="bibr">McCabe, Fowler, Cadoret, and Winokur (1972)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">Good prognosis S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">More likely to have VH (<italic>p</italic> < .01)</td><td rowspan="1" colspan="1">46</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">Poor prognosis S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">More likely to have ‘Special types’ of AH and haptic hallucinations (<italic>p</italic> < .05)</td><td rowspan="1" colspan="1">25</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr43-0020764015573089" ref-type="bibr">Littlewood and Lipsedge (1981)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">244</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">S, Aff, Par, Other P, PD</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Religious flavour defined as ‘constant preoccupation with a religious or supernatural theme, religious delusions or hallucinations, a belief in a personal religious mission or interpretation of recent events in religious or magical terms’</td><td rowspan="1" colspan="1">None</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr3-0020764015573089" ref-type="bibr">Andreasen (1987)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">111</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">83</td><td rowspan="1" colspan="1">75</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">Voices commenting − 58%<break></break>Voices conversing − 57%</td><td rowspan="1" colspan="1">30.6</td></tr><tr><td rowspan="2" valign="top" colspan="1"><xref rid="bibr49-0020764015573089" ref-type="bibr">Mitchell and Vierkant (1988)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">61</td><td rowspan="2" valign="top" colspan="1">Delusions and hallucinations reported in files</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">‘perceived source of auditory hallucinations’</td><td rowspan="1" colspan="1">Perceived source of AVH include God (16), Holy Ghost/spirits (5), angels</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">150</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Perceived source of AVH include God (3), devils/demons (9), the ‘Trinity’, Matthew (of scriptures)</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr57-0020764015573089" ref-type="bibr">Renvoize and Beveridge (1989)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">118</td><td rowspan="1" colspan="1">54</td><td rowspan="1" colspan="1">64</td><td rowspan="1" colspan="1">RDC: S, Aff, Other</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">‘mainly’ AH and VH</td><td rowspan="1" colspan="1">‘religious theme’</td><td rowspan="1" colspan="1">28.6% of patients with hallucinations had ‘a religious theme’</td><td rowspan="1" colspan="1">25.4</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr10-0020764015573089" ref-type="bibr">Brewerton (1994)</xref></td><td rowspan="1" colspan="1">Hawaii</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">DSMIIIR: S, S with temporal lobe EEG abnormalities, Aff, P secondary to CPS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">‘clearly noted religious themes as part of the delusions and/or hallucinations’<break></break>Religion defined according to Webster’s Dictionary: ‘belief in a divine or superhuman power or powers to be obeyed and worshipped’ or ‘any specific system of belief, worship, conduct, etc, often involving a code of ethics and a philosophy’</td><td rowspan="1" colspan="1">AVH were typically of God (<italic>n</italic> = 14), devil/demons (<italic>n</italic> = 12) or spirits/saints (<italic>n</italic> = 4)<break></break>RD and/or RH = 74% of total</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr33-0020764015573089" ref-type="bibr">Kanemoto et al. (1996)</xref></td><td rowspan="1" colspan="1">Japan</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">Interictal P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1"><italic>n</italic> = 9 voices commenting<break></break><italic>n</italic> = 12 other AH<break></break><italic>n</italic> = 6 somatic/tactile hallucinations</td><td rowspan="1" colspan="1">3</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">30</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">Postictal P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>n</italic> = 1 voices commenting<break></break><italic>n</italic> = 3 other AH<break></break><italic>n</italic> = 5 somatic/tactile hallucinations</td><td rowspan="1" colspan="1">23.3</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">25</td><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">Chronic P + CPS</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><italic>n</italic> = 8 voices commenting<break></break><italic>n</italic> = 11 other AH<break></break><italic>n</italic> = 3 somatic/tactile hallucinations</td><td rowspan="1" colspan="1">0</td></tr><tr><td rowspan="2" valign="top" colspan="1"><xref rid="bibr34-0020764015573089" ref-type="bibr">Kent and Wahass (1996)</xref></td><td rowspan="1" colspan="1">Saudi Arabia</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="2" valign="top" colspan="1">Religious themes = ‘relationship between the patient and his god, eg instructions to read a holy book, chastisement after death, or mention of paradise’<break></break>Superstitious content = ‘mention of demons, magic and spirits’</td><td rowspan="1" colspan="1">Second-person voices 53% religious<break></break>Third-person voices 33% religious</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1">United Kingdom</td><td rowspan="1" colspan="1">35</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Second-person voices 11% religious<break></break>Third-person voices 6% religious</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr41-0020764015573089" ref-type="bibr">Kulhara et al. (2000)</xref></td><td rowspan="1" colspan="1">North India</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">ICD10: S</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">70</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">70% hallucinated<break></break>No information on content</td><td rowspan="1" colspan="1">10</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr5-0020764015573089" ref-type="bibr">Atallah, El-Dosoky, Coker, Nabil, and El-Islam (2001)</xref></td><td rowspan="1" colspan="1">Egypt</td><td rowspan="1" colspan="1">5,275</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">NK</td><td rowspan="1" colspan="1">S, S-aff, Aff</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">‘Religious symptoms’ defined as all symptoms with religious content, including ‘everything from increased praying or reading religious books, increased religiosity, spending all one’s time in the church or mosque, to believing oneself to be (or be married to) a religious figure, on a religious mission to save the world, and so on. In addition, supernatural beliefs such as black magic (A’mal), demon possession, or the evil eye were included’</td><td rowspan="1" colspan="1"><italic>n</italic> = 135/632 patients with religious symptoms (21.3%) had auditory RHs, 105 (16.62%) had visual RHs and 12 (1.9%) had tactile RHs<break></break>Hallucinations equally common among patients with and without religious symptoms</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="3" valign="top" colspan="1"><xref rid="bibr23-0020764015573089" ref-type="bibr">Getz, Fleck, and Strakowski (2001)</xref></td><td rowspan="1" colspan="1">United States</td><td rowspan="1" colspan="1">71</td><td rowspan="1" colspan="1">42</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">DSMIV: P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">No information given</td><td rowspan="3" valign="top" colspan="1">SAPS Hallucination Score = 3.4SAPS Hallucination Score = 3.6SAPS Hallucination Score = 3.2</td><td rowspan="1" colspan="1">43</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">20.7</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">24.2</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr25-0020764015573089" ref-type="bibr">Gutiérrez-Lobos et al. (2001)</xref></td><td rowspan="1" colspan="1">Austria</td><td rowspan="1" colspan="1">639</td><td rowspan="1" colspan="1">239</td><td rowspan="1" colspan="1">400</td><td rowspan="1" colspan="1">ICD8: S, Aff, Org, Par, Other P, N, SA</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">Mean age for 1st hearing voices 44.4 years</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref></td><td rowspan="1" colspan="1">China (Shanghai)</td><td rowspan="1" colspan="1">182</td><td rowspan="1" colspan="1">119</td><td rowspan="1" colspan="1">63</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">101</td><td rowspan="1" colspan="1">56</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1">‘Religious/supernatural themes’</td><td rowspan="2" valign="top" colspan="1">12 (11.9%) AH with supernatural/religious identity<break></break>12 (12.2%) AH with religious/supernatural theme</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Korea (Seoul)</td><td rowspan="1" colspan="1">214</td><td rowspan="1" colspan="1">125</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">130</td><td rowspan="1" colspan="1">61</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">37 (28.5%) AH with supernatural/religious identity<break></break>41 (36%) AH with religious/supernatural theme</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">128</td><td rowspan="1" colspan="1">60</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle, Haddock, Tarrier, and Faragher (2002)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">193</td><td rowspan="1" colspan="1">135</td><td rowspan="1" colspan="1">58</td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Other P</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><50</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">Over 50% of the sample reported no AH<break></break>RD most commonly secondary to hallucination<break></break>RD more likely to indicate more certainty in an external cause for their voices than an internal cause</td><td rowspan="1" colspan="1">23.3</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr70-0020764015573089" ref-type="bibr">Suhail and Cochrane (2002)</xref></td><td rowspan="1" colspan="1">England (White)</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">S, Par, S-aff</td><td rowspan="1" colspan="1">44</td><td rowspan="1" colspan="1">88</td><td rowspan="1" colspan="1">AVH</td><td rowspan="1" colspan="1">Voices identified as God</td><td rowspan="1" colspan="1">Voice of God: 5 (10%)</td><td rowspan="1" colspan="1">14</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">26</td><td rowspan="1" colspan="1">VH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">England (British-Pakistani)</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">31</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">38</td><td rowspan="1" colspan="1">72</td><td rowspan="1" colspan="1">AVH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Voice of God: 5 (9%)</td><td rowspan="1" colspan="1">21</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">24</td><td rowspan="1" colspan="1">VH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">98</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">50</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">52</td><td rowspan="1" colspan="1">AVH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">Voice of God: 6 (6%)</td><td rowspan="1" colspan="1">11</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">VH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr65-0020764015573089" ref-type="bibr">Smith et al. (2005)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">DSMIV: S, S-aff, S-form, Aff, Other P</td><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">35</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">Clinical Assessment in Neuropsychiatry (<xref rid="bibr75-0020764015573089" ref-type="bibr">WHO, 1992</xref>)</td><td rowspan="1" colspan="1"><italic>n</italic> = 7 had AH</td><td rowspan="1" colspan="1">55</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr22-0020764015573089" ref-type="bibr">Gecici et al. (2010)</xref></td><td rowspan="1" colspan="1">Turkey</td><td rowspan="1" colspan="1">373</td><td rowspan="1" colspan="1">215</td><td rowspan="1" colspan="1">158</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1">236</td><td rowspan="1" colspan="1">63</td><td rowspan="1" colspan="1">AH</td><td rowspan="1" colspan="1">AVH classified according to source (God/Prophet/Devil)<break></break>VH classified according to object seen (Prophet, Devil, God, saint)</td><td rowspan="1" colspan="1"><italic>n</italic> = 15 voices from God, <italic>n</italic> = 10 voices from the Prophet, <italic>n</italic> = 9 voices from the Devil (VH n=9, n=11, n=10 respectively)</td><td rowspan="1" colspan="1">15.5</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr71-0020764015573089" ref-type="bibr">Suhail and Ghauri (2010)</xref></td><td rowspan="1" colspan="1">Pakistan</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">74</td><td rowspan="1" colspan="1">AVH</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">More/less religious patients did not differ on AVH (65% vs 76%)</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">59</td><td rowspan="1" colspan="1">VH</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">VH of spirits/ghosts/jinee/holy – <italic>n</italic> = 3 (12%) in less religious group and <italic>n</italic> = 14 (50%) in more religious group</td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">Olfactory</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr17-0020764015573089" ref-type="bibr">de Araujo Filho et al. (2011)</xref></td><td rowspan="1" colspan="1">Brazil</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">TLE-MTS with Psy-ep</td><td rowspan="1" colspan="1">29</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1">NA</td><td rowspan="1" colspan="1">None</td><td rowspan="1" colspan="1">NA</td></tr><tr><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">JME with Psy-ep</td><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr26-0020764015573089" ref-type="bibr">Huang et al. (2011)</xref></td><td rowspan="1" colspan="1">Taiwan</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">22</td><td rowspan="1" colspan="1">33</td><td rowspan="1" colspan="1">DSMIV: S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">PANSS<break></break>‘The term “religion” was defined as belief in divine or superhuman power or powers to be obeyed and worshipped; or any specific system of belief, worship, conduct, etc, often involving a code of ethics and a philosophy’</td><td rowspan="1" colspan="1">7 (12.7%) of total sample had ‘psychopathology with religious content’ (RD, RH or ritual behaviour)<break></break>RD/RH related to higher religiosity<break></break>RD/RH associated with lower satisfaction with psychiatric therapy and received more magico-religious healing</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr39-0020764015573089" ref-type="bibr">Krzystanek, Krysta, Klasik, and Krupka-Matuszczyk (2012)</xref></td><td rowspan="1" colspan="1">Poland</td><td rowspan="1" colspan="1">400</td><td rowspan="1" colspan="1">204</td><td rowspan="1" colspan="1">196</td><td rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1">‘symptoms with religious content’<break></break>Thematic groups = the Holy Trinity, the Virgin Mary, the Bible, saints, religious imagery, church and names of deities</td><td rowspan="1" colspan="1">None specifically</td><td rowspan="1" colspan="1">NK</td></tr><tr><td rowspan="1" colspan="1"><xref rid="bibr28-0020764015573089" ref-type="bibr">Iyassu et al. (2014)</xref></td><td rowspan="1" colspan="1">England</td><td rowspan="1" colspan="1">383</td><td rowspan="1" colspan="1">266</td><td rowspan="1" colspan="1">117</td><td rowspan="1" colspan="1">ICD10: S, S-aff, Other P</td><td rowspan="1" colspan="1">248</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">Any</td><td rowspan="1" colspan="1">No information given</td><td rowspan="1" colspan="1">RD group scored more highly on hallucinations</td><td rowspan="1" colspan="1">20.5</td></tr></tbody></table><table-wrap-foot><fn id="table-fn3-0020764015573089"><p>Refer <xref ref-type="app" rid="app1-0020764015573089">Appendix 1</xref> for abbreviations.</p></fn></table-wrap-foot></table-wrap><p><xref rid="bibr51-0020764015573089" ref-type="bibr">Mott, Small, and Anderson (1965)</xref> observed spiritual themes in 18%−26% of AVH. <xref rid="bibr57-0020764015573089" ref-type="bibr">Renvoize and Beveridge (1989)</xref> found that 28.6% of patients with hallucinations (which were ‘mainly auditory and visual’) had a religious theme. <xref rid="bibr5-0020764015573089" ref-type="bibr">Atallah et al. (2001)</xref> found that only 135 (21.3%) out of 632 patients with religious symptoms had auditory RH. In the same study, 105 (16.2%) had visual RH and 12 (1.9%) had tactile RH. <xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref> found religious/supernatural themes in 12.2% of the auditory hallucinations of their Chinese subjects and in 36% of their Korean subjects. <xref rid="bibr34-0020764015573089" ref-type="bibr">Kent and Wahass (1996)</xref> found that religious themes were less common in hallucinations experienced by subjects in the United Kingdom than in Saudi Arabia and also less common in third-person voices than in second-person voices. <xref rid="bibr49-0020764015573089" ref-type="bibr">Mitchell and Vierkant (1988)</xref> found that command hallucinations more often included religious content in the 1930s than in the 1980s.</p><p><xref rid="bibr51-0020764015573089" ref-type="bibr">Mott et al. (1965)</xref> found that 16%−20% of AVH were ascribed to religious personages. <xref rid="bibr60-0020764015573089" ref-type="bibr">Scott (1967)</xref> found that 51.8% of AVH in a study in South Africa were ascribed to God. <xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al. (2001)</xref> found that a religious/supernatural identity was ascribed to the source of the voices in 11.9% of their Chinese subjects and 28.5% of their Korean subjects. <xref rid="bibr70-0020764015573089" ref-type="bibr">Suhail and Cochrane (2002)</xref> found that 10% (<italic>n</italic> = 5) of their White English subjects and 9% (<italic>n</italic> = 5) of their British-Pakistani subjects, but only 6% (<italic>n</italic> = 6) of their Pakistani subjects living in Pakistan, reported hearing voices which they identified as God. In a sample of 373 patients with schizophrenia in Turkey, <xref rid="bibr22-0020764015573089" ref-type="bibr">Gecici et al. (2010)</xref> identified only 15 subjects who heard voices that they believed to be from God, 10 who heard the voice of the prophet Mohammed and 9 who heard voices from the devil.</p><p>The relationship between RD and RH seems to have received surprisingly little attention. In a small and early study of West Indian immigrants in London, <xref rid="bibr35-0020764015573089" ref-type="bibr">Kiev (1963)</xref> reported that ‘most’ RD were accompanied by ‘hallucinatory commands to preach and heal …’ In a similar but larger early study, Gordon reported that
<disp-quote><p>The religiose content was usually associated in the schizophrenics with auditory, and often visual, hallucinations, the patients frequently seeing visions and receiving commands from God.</p></disp-quote></p><p><xref rid="bibr71-0020764015573089" ref-type="bibr">Suhail and Ghauri (2010)</xref> report that more religious patients are both more likely to experience RD and to hear voices of ‘paranormal agents’. <xref rid="bibr61-0020764015573089" ref-type="bibr">Siddle et al. (2002)</xref> report that RD occur most commonly secondary to RH. <xref rid="bibr28-0020764015573089" ref-type="bibr">Iyassu et al. (2014)</xref> reported that 75.9% of those with RD and 61.7% of those with other delusions had ‘anomalous experiences’ (by which they meant hallucinatory experiences in any modality).</p></sec><sec sec-type="discussion" id="section9-0020764015573089"><title>Discussion</title><p>Religious content of delusions and hallucinations would appear to be relatively common, and yet there is a lack of agreed definition as to where the boundaries of what is truly ‘religious’ lie. Even where standardised instruments such as the Present State Examination (PSE) or Scale for the Assessment of Positive Symptoms (SAPS) have been used, much is left to the discretion of the researcher. The lack of definition provides further cause for concern where, in some studies, little or no attention appears to have been paid to the religious affiliation or context of the research subjects. In the case of RH, only a few studies have distinguished between content and identity or source of AVH. All of this raises the important question of what properly constitutes ‘religious’ content of delusions and/or hallucinations.</p><p>To take a narrower view of things, it might be argued that religious content should be understood to reflect or refer to traditional religious beliefs, persons or stories. Thus, references to ‘sin’ (as opposed to more general concerns of morality), divinity, resurrection or reincarnation, and witchcraft would all appear to qualify as religious, as would references to figures such as Buddha, Jesus or Mohammed. However, much traditional religious belief has now become detached from its original context and is upheld by those who follow newer spiritual paths which they may determine as ‘spiritual but not religious’. For example, spirit possession is a feature of various religious traditions, including the major monotheistic faiths, but interaction with spirits of various kinds is also seen in the so-called New Age spiritualities. References to the supernatural, superstition, magic and voices of (or delusions concerning) the dead are similarly ambiguous.</p><p>To broaden the category of interest to ‘spiritual’ (rather than religious) would be in danger of making the boundaries even more blurred. However, definitions of spirituality generally encompass relatively few subsidiary concepts (<xref rid="bibr13-0020764015573089" ref-type="bibr">Cook, 2004</xref>), and these might prove to be more helpful categories for future research. For example, delusions might be classified according to whether they refer to immanent or transcendent relationships. (Immanent relationships refer to those with people and things in the natural order and transcendent relationships to those with a non-material, spiritual or divine order understood as being above and beyond the natural. For further discussion, see <xref rid="bibr15-0020764015573089" ref-type="bibr">Cook, 2013</xref>.) As <xref rid="bibr38-0020764015573089" ref-type="bibr">Koenig, King, and Carson (2012)</xref> have pointed out, definitions of religion and spirituality commonly emphasise broadly transcendent over immanent concerns (although see also <xref rid="bibr15-0020764015573089" ref-type="bibr">Cook (2013))</xref>. Similarly, content might be classified according to reference to matters of meaning or purpose in life, concepts of life-force or soul, ultimate concerns and other deeply held values, all of which may reflect either religious concerns or spiritual-but-not-religious concerns, or perhaps both of these or neither of these.</p><p>An important difference between delusions and hallucinations is that delusional thought (with the important exception of thought insertion) is generally owned as ego-syntonic. Hallucinations are identified as originating from external agency, and so the source or identity of that agency becomes a separate, albeit related, concern to the matter of the content of the hallucination. Few studies to date have clearly or carefully addressed this important distinction, and the identity of AVH has often not been clarified. Thus, for example, the author once encountered a patient who reported what appeared to be an olfactory hallucination of the smell of rotting meat, which in itself is not a religious theme. However, taken in the whole context of the clinical history, and in particular of a delusional belief that she was demon-possessed, this hallucination had clear religious significance and was attributed by the patient to the activity of evil spirits.</p><p>It is therefore not immediately apparent that there is a simple answer as to how RD/RH should be defined, but it is clear that better characterisation and description of terms within future research will be important. It would also appear likely that the prevalence of RD and RH may have been underestimated in at least some studies.</p><p>Notwithstanding these concerns, the frequency of occurrence of RD and RH does clearly appear to vary widely with time and place. In most cases, as in the comparisons between Saudi Arabia and the United Kingdom (<xref rid="bibr34-0020764015573089" ref-type="bibr">Kent & Wahass, 1996</xref>) or Korea and China (<xref rid="bibr36-0020764015573089" ref-type="bibr">Kim et al., 2001</xref>), it would appear likely that this reflects an influence of culture and environment on the individual. The work of <xref rid="bibr70-0020764015573089" ref-type="bibr">Suhail and Cochrane (2002)</xref> suggests that the culture in which one lives may be more important than country of origin in determining whether or not the source of RH is identified as being from God.</p><p>However, within any given environment, and notwithstanding the findings of <xref rid="bibr59-0020764015573089" ref-type="bibr">Rudalevičienė et al. (2008)</xref>, it might also be expected that personal religiosity would also play a part. Thus, personal beliefs that precede any illness, disorder or disturbance would be expected to contribute to shaping the content of psychopathology.</p><p>Some support for the impact of personal religiosity may be found in other published research. In normal volunteers without mental illness who are subjected to a primed word-detection task, subjects high in religiosity are more likely to report false perception with religious content than are those low in religiosity (<xref rid="bibr56-0020764015573089" ref-type="bibr">Reed & Clarke, 2014</xref>). In a study of 1,006 subjects with schizophrenia, undertaken across six different countries, 15.5% of Roman Catholics, but only 3.8% of Muslim patients, reported delusions of guilt, suggesting that religious confession may influence delusional content independently of culture (<xref rid="bibr66-0020764015573089" ref-type="bibr">Stompe et al., 2006</xref>). On the other hand, qualitative research involving subjects with RD suggests that it is clearly possible to be influenced by religious beliefs without considering oneself to be religious (<xref rid="bibr19-0020764015573089" ref-type="bibr">Drinnan & Lavender, 2006</xref>, p. 326).</p><p>It must also be the case that the content of primary psychopathology itself plays an important part in shaping the content of other psychopathology. Very few studies appear to have addressed this, but where they have given the matter attention it appears to be agreed that the content of RH is often the primary basis for forming secondary RD. In principle, there would seem to be no reason to suppose that the reverse relationship might not also occur – that is, that the religious content of delusions is determinative of the religious content of hallucinations. More research on this would appear to be needed.</p><p>Notwithstanding reports in the German literature (<xref rid="bibr68-0020764015573089" ref-type="bibr">Stompe et al., 2003</xref>) that RD are less common than formerly, it is not entirely clear that they are in continued or consistent decline in the 20th and 21st century studies included in the present review. The retrospective case note studies included in the present review showed a fluctuating rather than inexorably declining prevalence of RD. Furthermore, if we observe in <xref ref-type="table" rid="table2-0020764015573089">Table 2</xref> the proportion of delusional subjects reporting RD in studies undertaken in any one country (e.g. the United States or the United Kingdom) over the last 50 years or so, we do not gain a clear picture of steady decline but rather of fluctuation.</p><p>The research findings considered here suggest that religious content of delusions and hallucinations, and the perceived source of RH, may not always be identified in clinical practice. More careful enquiry into the relationship between faith (or spirituality) and psychopathology might elicit a fuller understanding of the patient’s beliefs and experiences. This may be important in helping patients to feel more fully understood and, if handled sensitively, in building trust. In some cases, it may also have diagnostic significance.</p><p>Given that we now know that voices are heard in religious contexts which are not necessarily associated with major mental illness and that some voice hearers appear to derive benefit from dialogue with their voices (<xref rid="bibr45-0020764015573089" ref-type="bibr">Luhrmann, 2012a</xref>), the question arises as to whether or not engagement of dialogue with RH might be helpful in the course of treatment.</p></sec><sec sec-type="conclusions" id="section10-0020764015573089"><title>Conclusion</title><p>RD and RH are commonly encountered in major mental illness, albeit prevalence varies according to time, place and personal religiosity. Comparisons between studies, and accurate estimates of prevalence, are hampered by lack of clear working definitions of exactly what constitutes a ‘religious’ delusion or hallucination and also by failure to obtain data on religious affiliation of research subjects. There is need for more critical attention to these issues in research design, and it is proposed here that a focus on transcendent concerns may well prove fruitful for future research, especially within multi-ethnic groups, and in other contexts where there is a plurality of religious belief and affiliation. Study of RH has especially been neglected, and more attention needs to be paid in future research to hallucinatory experiences in all modalities, rather than focusing almost exclusively on AVH, to distinguish between the content of the hallucination and its believed source or identity and to establish whether the RD or RH constitute the primary source of religious themes.</p></sec></body><back><fn-group><fn fn-type="financial-disclosure"><p><bold>Funding:</bold> The author is pleased to acknowledge funding from a Wellcome Trust Strategic Award (WT098455MA).</p></fn></fn-group><app-group><app id="app1-0020764015573089"><title>Appendix 1</title><sec id="section11-0020764015573089"><title>Abbreviations</title><list list-type="simple" id="list1-0020764015573089"><list-item><p>Aff affective disorder</p></list-item><list-item><p>All psych all psychiatric diagnoses</p></list-item><list-item><p>CPS complex partial seizures</p></list-item><list-item><p>JME juvenile myoclonic epilepsy</p></list-item><list-item><p>MTS mesial temporal sclerosis</p></list-item><list-item><p>N neurosis</p></list-item><list-item><p>Org organic psychosis</p></list-item><list-item><p>Other P other Psychosis</p></list-item><list-item><p>Par paranoid psychosis</p></list-item><list-item><p>P psychosis (any/all – unless otherwise specified)</p></list-item><list-item><p>P-CPS psychosis secondary to complex partial seizures</p></list-item><list-item><p>PD personality disorder</p></list-item><list-item><p>Psy-ep psychosis of epilepsy</p></list-item><list-item><p>S schizophrenia</p></list-item><list-item><p>S-aff schizoaffective disorder</p></list-item><list-item><p>S-form schizophreniform disorder</p></list-item><list-item><p>SA substance abuse</p></list-item><list-item><p>S-TEEG schizophrenia with temporal lobe EEG abnormalities</p></list-item><list-item><p>TLE temporal lobe epilepsy</p></list-item><list-item><p>ip in-patients</p></list-item><list-item><p>op out-patients</p></list-item><list-item><p>CR case record study</p></list-item><list-item><p>IS interview study</p></list-item><list-item><p>AH auditory hallucinations</p></list-item><list-item><p>AVH auditory verbal hallucinations</p></list-item><list-item><p>NA not applicable</p></list-item><list-item><p>NK not known</p></list-item><list-item><p>PICU psychiatric intensive care unit</p></list-item><list-item><p>RD religious delusions</p></list-item><list-item><p>RH religious hallucinations</p></list-item><list-item><p>VH visual hallucinations</p></list-item><list-item><p>FPS Fragebogen fur Psychotische Symptome</p></list-item><list-item><p>PANSS Positive and Negative Symptom Scale</p></list-item><list-item><p>PSE Present State Examination</p></list-item><list-item><p>SADS Schedule for Affective Disorders and Schizophrenia</p></list-item><list-item><p>SAPS Scale for the Assessment of Positive Symptoms</p></list-item><list-item><p>DSM <italic>Diagnostic and Statistical Manual of the American Psychiatric Association</italic></p></list-item><list-item><p>ICD International Classification of Diseases</p></list-item><list-item><p>RDC Research Diagnostic Criteria</p></list-item><list-item><p>✓ Information provided in the publication</p></list-item><list-item><p>[✓] Some information provided in the publication</p></list-item></list></sec></app></app-group><ref-list><title>References</title><ref id="bibr1-0020764015573089"><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ahmed</surname><given-names>S. 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