292 than previously thought [7] and so does psychosis with late onset. The high incidence rate of psychotic symptoms as opposed to clinical disorder may not only be due to the fact that most of the sample with isolated psychotic symptoms would not have clinical needs, but may also be related to the argument that paranoid elderly often do not seek help [10, 47], and LOP, therefore, tends to be associated with longer community stays [49]. This lack of help-seeking behaviour may, in turn, be a direct reﬂection of per- secutory ideation, illness behaviour or of social iso- lation in old age [49, 68]. In a post-hoc analysis for those with the broad psychosis outcome, however, we were unable to ﬁnd any differences in ﬁrst-contact rates as a function of age at onset (young versus middle: v2 = .61, df = 1, p = .435; young versus old: v2 = .08, df = 1, p = .777; middle versus old: v2 = .14, df = 1, p = .708). It has to be noted that cell sizes for new psychosis were rather small and decreased even further by stratiﬁcation for age groups. Hence, only 12 subjects out of 1,282 aged 50–64 years developed a recent- onset psychosis in the present study. This number may be considered too small to calculate reliable incidence rates. This ﬁnding, therefore, calls for rep- lication, but echoes similar ﬁndings in the younger age groups [22]. j Risk factors Symptoms of depression and neurotic personality styles were found to have some association with age at onset. In young age, subjects reporting life-time depressive symptoms at baseline run a higher risk of developing psychotic experiences later on than those who do not report depressive symptoms. The risk- enhancing effect in young age decreased to a much lower level in middle and old age. Although effect sizes did not reach signiﬁcance in those aged 50–64, a history of depressive symptoms went together with a two-fold increase in psychosis risk, which suggests that signiﬁcance may have been reached with bigger cell sizes. Depression is known to be a common antecedent of psychosis in general [35, 69] and in late life [24], but it now seems that the strength of this relationship diminishes as the illness onset shifts to- wards later ages, pointing towards aetiological dif- ferences between LOP en EOP. This observation very nicely ﬁts the repeated ﬁnding of less emotional co- morbidity in LOP [31, 38, 49, 63]. In a similar fashion, the risk-enhancing effect of neuroticism has been studied previously [34], but its association with psychosis appears to be less strong with onset in old age [23]. Ha¨fner et al. found that, although the severity of psychopathology decreased with age at ﬁrst episode, this was not caused by a decrease in the severity of psychotic symptoms but by a decrease in neurotic syndrome levels [18]. Neurot- icism is a personality trait related to stress reactivity, anxiety proneness and emotional instability in the context of daily stressors [40, 42]. In schizophrenic patients, high neuroticism levels are associated with avoidant coping styles and emotional discomfort [37], which might indicate that the diminishing effect of neuroticism in LOP reﬂects more adaptive coping skills in later adulthood. This lends further support to the notion of possible aetiological differences with psychosis in young age. Men and women run an equal risk for LOP in the present study, which is at odds with earlier ﬁndings, but in line with the community-based study by Hen- derson and colleagues [24]. The authors explain their result by the higher refusal of women to take part in the study. This does not apply to NEMESIS. Alternatively, it may be that older men are less likely to come to professional attention and are for this reason missed in clinical studies. Although being highly speculative, it is compatible with the notion of profoundly lower symptom levels in males with LOP [18]. Unfortunately, we were unable to explore this issue in depth. Sensory impairment was not found to increase the risk for psychosis in later life. The outcome measures of deafness and visual impairment appeared to be too stringent. In addition, the sample may have been too young for these variables to exert signiﬁcant effects. Only two out of 132 subjects with recent-onset psy- chotic symptoms suffered from severe visual deﬁcits and four reported severe auditory deﬁcits. All were younger than 50 years. No notable differences in risk proﬁles between groups were found for level of urbanisation, life-time cannabis use, life-time manic symptoms, family his- tory of psychiatric treatment, family history of psy- chosis or single living status. j Limitations Regrettably, NEMESIS does not provide information for those older than 64 years. One may expect (qualitative) differences in risk proﬁles with EOP to show up more profoundly in those aged 65 years and older including cognitive ageing, sensory loss, death of a spouse or retirement [2, 28, 29]. The reported differences between LOP and EOP might be considered an underestimation of true risk differences, because analyses of risk factors was based on the broad psychosis outcome. It has been shown previously that this outcome results in smaller effect sizes than narrowly deﬁned psychosis [22, 41]. Further limitations include the use of lay inter- viewers and difﬁculties in excluding psychosis due to prodromal dementia. Although the CIDI is designed for the use by non-clinicians and interviewers underwent intensive training, these well-known problems cannot be completely solved in studies of this kind [68]. They were nevertheless minimized by