Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community

Abstract

Background: An efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic.

Methods: Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16-40 years; response rate: 63.4%).

Results: The point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse.

Conclusions: Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.

Keywords: Basic symptoms; clinical relevance; general population; prevalence; psychoses; ultra-high risk.

Fig. 1.

Results of recruitment. Survey outcome rates of the BEAR study according to the definitions of the American Association for Public Opinion Research (AAPOR, 2016).

Fig. 2.

Distribution of psychosis-risk criteria (n = 64). APS: attenuated psychotic symptoms criterion; BIPS: brief intermittent psychotic symptoms criterion; COPER: cognitive–perceptive basic symptoms criterion; COGDIS: cognitive disturbances criterion. For detailed descriptions of criteria, see online Supplementary Text S1.