Peer-reviewed article
O10.4. THE ROLE OF CONTEXTUAL FACTORS AND ASSESSMENT STRATEGIES IN THE ACCURATE SCREENING OF PSYCHOSIS-RISK SYMPTOMS
Schiffman J, Rakhshan Rouhakhtar P, Millman Z, Thompson E, Phalen P ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed study examines how contextual factors like race and age affect the accuracy of screening tools used to identify psychosis-risk symptoms in adolescents and young adults aged 12-25. The research finds that screening tool scores predict clinician-assessed symptoms differently across racial groups and age groups, suggesting that a one-size-fits-all approach to psychosis screening is ineffective. The authors propose tailored screening strategies that account for individual and contextual factors.
Key points
- Higher Prime Screen scores predicted clinician-assessed psychosis symptoms for White participants but not Black participants
- Younger participants were more likely to use screening tools as yes/no answers rather than quantitative measures, reducing effectiveness
- Factor analysis revealed the Prime Screen measures two distinct constructs rather than a single unified concept
- An ultra-brief two-item measure showed promise as an alternative screening approach
- A comprehensive behavioral measure (BASC-2) predicted psychosis symptoms and offered broader conceptualizations of symptoms
Limitations
This study does not evaluate an intervention to improve child well-being or outcomes; rather, it assesses the validity of different screening and assessment approaches. The document focuses on methodology for identifying risk rather than on evidence about what improves children's mental health or overall well-being.
Abstract
Abstract Background Falsely observing symptoms of psychosis risk in youth is a critical limitation to pluripotent prevention efforts. Factors including race, age, and measurement construction may affect the validity of semi-structured interviews and self-report screening tools designed to identify symptoms. Consideration of different constructs measured within a single screening tool, what a screening tool can offer beyond prediction of psychosis-like symptoms, and how to maximize efficiency may all influence the ability to effectively identify people who would benefit from services. Methods Help-seeking adolescents (N=134) ages 12–25 completed various screening tools for psychosis risk, and the Structured Interview for Psychosis-risk Syndromes (SIPS). The influence of race and age on screen scores and SIPS (CHR) symptoms were examined. We also evaluated alternatives to CHR symptom screening beyond conventional CHR screening tools. Results Higher Prime Screen scores increased the probability of clinician assessed symptoms among White participants, but not Black participants (interaction: b = -0.50 Wald χ2[1] = 4.63, p = .03, Exp[B] = 0.60), and younger participants were more likely to use the Prime Screen as a dichotomous (yes/no) screener relative to older participants, reducing screener efficacy (b = -0.04, Wald χ2[1] = 3.75, p = .05, Exp[B] = 0.96). Given discrepancies across groups, we attempted to expand screening strategies. First, to better understand the Prime Screen, factor analysis suggested two distinct factors that appear to measure different constructs. Additionally, an IRT model of several CHR screening tools suggested the value of an ultra-brief two-item measure. Finally, analyses of the BASC-2, a more comprehensive measure of behavior that includes, but is not limited to, psychosis risk items, also demonstrated accurate prediction of psychosis symptoms, as well as more pluripotent conceptualizations of symptoms. Discussion Results suggest that contextual or individual factors influence the accurate identification of individuals exhibiting psychosis-risk symptoms. Tailored approaches to screening based on an awareness of context, identity, setting, and preferences of clients are possible, and customizing assessment efforts accordingly may be useful for the accurate identification of a variety of people who might benefit from services.