Bridgwater Miranda A, Petti Emily, Giljen Maksim, Akouri-Shan LeeAnn, DeLuca Joseph S, Rakhshan Rouhakhtar Pamela, Millar Caroline, Karcher Nicole R, Martin Elizabeth A, DeVylder Jordan, Anglin Deidre, Williams Raquel, Ellman Lauren M, Mittal Vijay A, Schiffman Jason
Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.
Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States.
Front Psychiatry. 2023 Mar 13;14:1117022. doi: 10.3389/fpsyt.2023.1117022. eCollection 2023.
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.
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.
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.
自开展以来，精神病临床高危（CHR）阶段的研究包括识别和探索相关社会人口学因素的影响。采用叙述性综述方法，并重点介绍来自美国的研究，从当前文献中回顾了可能影响CHR青年筛查、评估和服务利用的社会文化和背景因素。
现有文献表明，背景因素会影响广泛使用的精神病风险筛查工具的预测性能，并可能在临床评估中给鉴别诊断带来系统性偏差和挑战。所回顾的因素包括种族身份、歧视、社区环境、创伤、移民身份、性别认同、性取向和年龄。此外，种族身份和创伤经历似乎与该人群的症状严重程度和服务利用有关。
总体而言，来自美国及其他地区越来越多的研究表明，在精神病风险评估中考虑背景因素可以更准确地评估精神病风险的性质，得出更准确的结果，改善该领域对精神病转化的预测，并增进我们对精神病风险轨迹的理解。美国和全球都需要开展更多工作，以揭示结构性种族主义和系统性偏见如何影响CHR人群的筛查、评估、治疗以及临床和功能结局。
