Psychosis-risk screening and assessment among help-seeking university students

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Evidence supports the use of brief psychosis-spectrum screeners for identifying individuals at an increased risk of developing a psychotic disorder. Research in this area, however, has focused on specialized settings, where individuals are often referred specifically for psychosis-spectrum symptoms, or in non-clinical settings where the utility of screening may be limited. Screening has not been well-studied in general mental health settings, such as college counseling centers, that serve young adults in the age range associated with highest risk for psychosis. This study investigated several approaches to psychosis-risk screening among help-seeking students at a university counseling center. The following screening methods were evaluated: 1) the PRIME Screen, a measure of psychosis-risk symptom severity, 2) the PRIME With Distress (PRIME-WD), a modified version of the PRIME with an embedded distress scale, and 3) a key-item approach that used scores from two psychosis-related questions within the Behavioral Health Measure-43 (BHM-43), a measure administered within the standard intake battery. Screening scores were compared to interview-based risk assessment to investigate the ability of each approach for identifying high-risk individuals. At intake, 510 students completed the PRIME and 26.7% screened positive. Overall, more PRIME symptomatology was associated with greater distress on all BHM-43 scales (e.g., general mental health, functioning, anxiety, and mood), with the exception of substance abuse. Psychosis-risk evaluations were completed with 44 participants. Participants categorized as high-risk upon clinical interview (n = 24) had greater functional impairment compared to the low-risk group (n = 20). Screening results indicated that PRIME scores identified high-risk individuals adequately, with some scoring methods (e.g., continuous rather than dichotomous scores) producing higher rates of accuracy (62.8-76.7%) for predicting risk status. Based on findings from this project, the PRIME may be a more accurate screen for psychosis-risk syndromes than BHM-43 key-items (76.7% versus 60.5% accuracy, respectively). This study demonstrated a need for psychosis-risk screening and assessment within a help-seeking college population. Overall, results suggest that assessing risk in a university counseling center is feasible and offers the promise of early identification to a much larger population relative to specialty clinics.