Screening of the college students at clinical high risk for psychosis in China: a multicenter epidemiological study

Abstract

Background: To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students.

Methods: An epidemiological survey of the prevalence of the CHR syndrome in Chinese college students that was selected by stratified random sampling from Shanghai, Nanjing and Nanchang cities was done following a 3-stage procedure. Participants were initially screened with the Prodromal Questionnaire-brief version (PQ-B), and whose distress score of PQ-B exceeded 24 would be invited to a telephone assessment using the subscale for positive symptoms of the Scale of Prodromal Symptoms (SOPS)/Structured Interview for Prodromal Syndromes (SIPS). Lastly, participants who scored 3 or higher in any item of the subscale would be administered with the SIPS interview conducted by trained researchers to confirm the diagnosis of CHR syndrome.

Results: Twenty-three thousand sixty-three college students completed the survey during September 2017 to October 2018. Seventy-two students were diagnosed as CHR subjects, and the detection rate in the total sample was 0.3%. The peak age range for the first diagnosis of CHR was 17 to 20 years. Thirteen and forty-six were set as the cutoff points of PQ-B total score and distress score to balance the greatest sensitivity and specificity. Binary logistic regression revealed that 8 items in PQ-B showed significant distinction for detecting CHR subjects.

Conclusions: The 3-stage screening method can be utilized in the detection of CHR subjects for psychosis in the general population, during which delusional ideas, perceptual abnormalities and suspiciousness deserve great attention.

Keywords: Clinical high risk; College students; Early detection; Epidemiology; Ultra-high risk.

Fig. 1

The sample flowchart of this study. TJH, Tongji Hospital of Tongji University; NBH, Nanjing Brain Hospital; FAHNU, The First Affiliated Hospital of Nanchang University

Fig. 2

Age distribution for the total sample, females and males meeting CHR criteria

Fig. 3

ROC curves for the total score and distress score of PQ-B as indicator of CHR diagnosis

Fig. 4

Comparison of PQ-B item scores in CHR and non-CHR individuals: the means of PQ-B items are significantly higher in CHR individuals (p < 0.001)