Psychiatric polygenic risk scores: Child and adolescent psychiatrists' knowledge, attitudes, and experiences

Abstract

Psychiatric polygenic risk scores (PRS) have potential utility in psychiatric care and prevention, but there are concerns about their implementation. We surveyed 960 US-based practicing child and adolescent psychiatrists' (CAP) about their experiences, perspectives, and potential uses of psychiatric PRS. While 23% of CAP reported that they had never heard of PRS, 10 % of respondents have had a patient/family bring PRS to them and 4% have generated PRS for patients. Though 25% stated they would request PRS if a patient/caregiver asked, 35% indicated that nothing would prompt them to request PRS. Most respondents (54%) believed psychiatric PRS are currently at least slightly useful and 87% believed they will be so in 5 years. More than 70% indicated they would take action in response to a child with a top fifth percentile psychiatric PRS but no diagnosis: 48% would increase monitoring of symptoms, 42% would evaluate for current symptoms, and 4% would prescribe medications. Yet, most respondents were concerned that high-PRS results could lead to overtreatment and negatively impact patients' emotional well-being. Findings indicate emerging use of psychiatric PRS within child and adolescent psychiatry in the US. It is critical to examine the ethical and clinical challenges that PRS may generate and begin efforts to promote their informed and responsible use.

Keywords: genetics; pediatrics; pharmacotherapy; polygenic risk scores; psychiatric practice.

FIGURE 1

Study flow. ^aConfirmed training in child and adolescent psychiatry. ^bQuestion asked respondents to rate their knowledge of polygenic risk scores (PRS) with five response options: very good, good, poor, very poor, I have never heard of PRS. ^cWe excluded n = 2 who did not answer the knowledge question because that question determined whether they received questions about PRS.

FIGURE 2

Percentage of CAP who endorsed any level of concern that a “high” (top 5%) psychiatric polygenic risk scores (PRS) could cause each outcome. Respondents rated their level of concern on a 4-point scale: not at all concerned. Slightly concerned. Somewhat concerned. Very concerned

FIGURE 3

P endorsed hypothetical actions in response to a high (top 5%) psychiatric polygenic risk scores (PRS) in a child or adolescent with no current psychiatric diagnosis by self-rated knowledge. Respondents chose all that applied

FIGURE 4

CAP endorsed hypothetical actions in response to a high (top 5%) psychiatric polygenic risk scores (PRS) in a child or adolescent with no current psychiatric diagnosis by PRS graph interpretation. respondents chose all that applied