Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Psychiatry, Pediatrics
Humans, Adolescent, Depression, Mental Health, Outpatients, Depressive Disorder, Mass Screening, Ambulatory Care Facilities
Background: Although the first two years of a psychotic disorder are a period of particularly high risk, it takes an average of 1.5 years for young people to start treatment following the onset of psychotic symptoms. Screening for psychosis in primary care may help to close this treatment gap, but there is debate on whether or not to screen all youth. Opponents argue that the risks posed to false positives are too high, and no age-appropriate psychosis screens have been developed for this population. The current study pilot tested questions for an adolescent psychosis screen and compares its overlap with the Patient Health Questionnaire (PHQ-9), a depression screen commonly given in primary care settings.
Methods: The Screening for Early & Emerging Mental Experiences (SEE-ME) screen is a 23-item scale assessing recent psychotic-like experiences. It queries all major symptom domains of psychosis at a 6th grade reading level, as well as frequency and distress of these symptoms. Recruitment of youth ages 14-21 is ongoing in an adolescent primary care clinic at Boston Children’s Hospital. An independent 2-tailed t test examined the relationship between distress on SEE-ME and PHQ-9 scores that would and would not be flagged for mental health follow-up. An ANOVA examined the relationship between distress and history of mental health treatment.
Results: Positive responses to SEE-ME questions were fairly common, with 32% endorsing 5 or more items. PHQ-9 and SEE-ME distress scores were closely related, with those who would be flagged for mental health follow-up showing significantly higher distress on SEE-ME (t = -5.3, df = 10.4, p<0.001). However, some psychosis-spectrum items (ex. paranoia) were less commonly endorsed by those with high PHQ-9 scores. We found no significant relationship between engagement in therapy and SEE-ME distress (F=2.62, p=0.11).
Conclusions: Though uncommon, there is a subset of youth for whom their psychotic-like experiences are distressing and untreated. Patients at risk for psychosis who do not have depression-like symptoms may not be flagged by the PHQ-9 or other existing screens. This key population is likely to benefit from screening.
Johnson, K A.; Eiduson, R; Parsa, N; Shrier, L; and Woodberry, K A., "In mental health screening, who gets left behind?: Comparison of Depression Scores & Psychotic-Like Experiences in an Outpatient Adolescent Clinic" (2020). Costas T. Lambrew Research Retreat 2020. 76.