When does experience of psychosis result in a need for care? A prospective general population study.

Not all individuals with experience of psychosis develop a need for care. The present study investigated differences in coping strategies and associated levels of perceived control over psychotic symptoms, in relation to need for care status. The influence of coping on need for care was assessed in 47 individuals incident for psychosis in a general population sample of 4,722. Need for care was associated with severity of psychotic experiences rather than associated distress, mean level of control, or average number of coping strategies used. Qualitative differences were apparent, however, in that those who resorted to the strategy of symptomatic coping (a coping strategy characterized by going along with and indulging in symptoms) experienced less control over their symptoms (odds ratio [OR] = 0.79, 95% confidence interval [CI]: 0.63-0.98) and had a higher probability of need for care (OR = 6.07, 95% CI: 1.94-18.95). The results suggest that qualitative differences in self-initiated coping modify the risk for need for care and subsequent patient status in those who experience psychotic symptoms and point to the possible importance of early coping-based interventions.