Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States

Miranda A. Bridgwater, Emily Petti, Maksim Giljen, Lee Ann Akouri-Shan, Joseph S. DeLuca, Pamela Rakhshan Rouhakhtar, Caroline Millar, Nicole R. Karcher, Elizabeth A. Martin, Jordan DeVylder, Deidre Anglin, Raquel Williams, Lauren M. Ellman, Vijay A. Mittal, Jason Schiffman

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Since its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature. Results: Existing literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population. Conclusions: Collectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.

Original languageEnglish
Article number1117022
JournalFrontiers in Psychiatry
Volume14
DOIs
StatePublished - 2023
Externally publishedYes

Keywords

  • clinical high-risk
  • psychosis
  • screening
  • social determinants
  • systemic bias

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