15 research outputs found
A conceptual model of mental health service utilization among young adults at clinical high-risk for developing psychosis.
6.94 RELATIONSHIPS BETWEEN SOCIAL AND ROLE FUNCTIONING WITH SYMPTOMS IN INDIVIDUALS AT CLINICAL HIGH RISK FOR PSYCHOSIS
Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis
BackgroundDespite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma.MethodsThirty-eight CHR subjects were ascertained using standard measures from the Center of Prevention and Evaluation/New York State Psychiatric Institute/ Columbia University. Labeling-related measures adapted to the CHR group included "stereotype awareness and self-stigma" ("Stereotype awareness", "Stereotype Agreement", "Negative emotions [shame]"), and a parallel measure of "Negative emotions (shame)" for symptoms. These measures were examined in relation to symptoms of anxiety and depression, adjusting for core CHR symptoms (e.g. attenuated psychotic symptoms).ResultsCHR participants endorsed awareness of mental illness stereotypes, but largely did not themselves agree with these stereotypes. Furthermore, CHR participants described more stigma associated with symptoms than they did with the risk-label itself. Shame related to symptoms was associated with depression, while shame related to the risk-label was associated with anxiety.ConclusionBoth stigma of the risk-label and of symptoms contribute to the experience of CHR individuals. Stereotype awareness was relatively high and labeling-related shame was associated with increased anxiety. Yet limited agreement with stereotypes indicated that labeling-related stigma had not fully permeated self-conceptions. Furthermore, symptom-related stigma appeared more salient overall and was linked with increased depression, suggesting that alleviating symptom-related shame via treating symptoms might provide major benefit
T70. IDENTIFYING YOUTH AT CLINICAL HIGH RISK: WHAT\u27S THE EMOTIONAL IMPACT?...The 2019 Congress of the Schizophrenia International Research Society, April 10-14, 2019, Orlando, Florida
Background In spite of advances in early intervention in major mental illness, concerns linger regarding the risks of identifying youth as at clinical high risk (CHR) for psychosis. In particular, stigma in this population has been associated with increased emotional distress, social withdrawal, non-engagement in treatment, and suicide risk. Being told one has a CHR syndrome may be one source of stigma, yet no prior studies have conducted assessments both before and after people are given this feedback. Within the context of a larger study of stigma, we compared emotional responses to the CHR concept assessed before and after feedback by study clinicians. Notably, some participants had been already told of their risk prior to study entry whereas others had not. We expected different reactions to study feedback in these two groups. An informed discussion of risk might reduce stigma in those already worried about psychosis whereas it might increase stigma for those considering their risk for the first time. Thus, we predicted a small decrease in negative emotions following feedback in the first group, a small increase in the second, and no significant change in negative emotions for the group as a whole. Methods Fifty-seven CHR participants ages 12–35 were interviewed both before and after receiving formal clinical feedback about their risk status and eligibility for the study. This feedback typically included elements of psychoeducation and information about treatment options. In each interview participants were asked 1) the degree to which they felt 12 emotions in relation to risk for psychosis or schizophrenia, 2) whether they thought it was better to not tell anyone about psychosis risk. We analyzed pre-post change using general linear modeling with group (those told before study entry and those first told in the study context) as a between-subjects variable and the time between pre and post interviews as a covariate. Results Stigma was a significant concern in this sample as the vast majority of participants endorsed It is better that I not tell people that I am at-risk, both before and after feedback (75% pre to 71% post, McNemar test, p = 0.75). However, contrary to our hypothesis, participants experienced a significant decline in negative emotions (embarrassed, different, angry, ashamed, sad, worried; F= 20.7, p \u3c0.001) post- vs. pre-feedback, even controlling for the significant effects of time (M = 16 days between assessments; F= 3.7, p =0.033). This was true for those who reported already having been told that they were at risk for psychosis (N = 35; F = 20.0, p \u3c 0.001) as well as for those who were first told they were at risk in the context of the study (F =4.0, p = 0.038). Strikingly, a third of this latter group continued to report not having been told they were at risk even immediately after feedback. Additionally, in the larger group, ten believed that they already had schizophrenia and two maintained this belief even after being told that they did not. Discussion This is the first study to assess emotional aspects of stigma in CHR youth both before and after formal feedback about their psychosis risk. In contrast to concerns, feedback provided in the context of specialized early psychosis programs may actually reduce distress in these youth. The fact that the number of days between assessments did not fully account for the significant changes in negative emotions suggests that these changes were unlikely to be due to time alone. Importantly, participants\u27 varied impressions of what they had been told or whether they were at risk suggest that feedback is not the only factor influencing self-identification and stigma
An imaging-based risk calculator for prediction of conversion to psychosis in clinical high-risk individuals using glutamate 1H MRS
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Impact of psychosis risk identification: Examining predictors of how youth view themselves.
BACKGROUND: Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves.
METHODS: 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects.
FINDINGS: The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p \u3c 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p \u3c 0.05).
INTERPRETATION: Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies
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The association between mental health stigma and face emotion recognition in individuals at risk for psychosis.
Self-stigma has been associated with reduced accuracy of face emotion recognition in individuals at clinical high risk for psychosis (CHR). Stigma may also relate to slowing of performance during cognitive tasks for which a negative stereotype is relevant. This study aimed to investigate the association of mental illness stigma with face emotion recognition among CHR individuals. Participants were 143 CHR individuals identified using the Structured Interview for Psychosis-Risk Syndromes (SIPS). Face emotion recognition was assessed using the Penn Emotion Recognition Task (ER-40). Stigma was assessed using discrimination, stereotype awareness, and stereotype agreement subscales of the Mental Health Attitudes Interview for CHR. We tested associations of ER-40 accuracy and response times with these stigma variables, including the role of clinical and demographic factors. Racial/ethnic minoritized participants had higher attenuated positive symptoms than non-minoritized participants. Longer ER-40 response times were correlated with greater stereotype agreement (r=.17, p=.045) and discrimination (r=.22, p=.012). A regression model predicting ER-40 response times revealed an interaction of stereotype agreement with minoritized status (p=.008), with slower response times for minoritized participants as stereotype agreement increased. Greater disorganized symptoms and male gender also predicted longer response times. ER-40 accuracy was not associated with stigma. Overall, minoritized CHR individuals with greater internalized stigma took longer to identify face emotions. Future research is needed to assess whether slower response times are specific to social cues, and if internalized stigma interferes with performance in real-world social situations. Reducing stigma may be an important target for interventions that aim to improve social skills