Lawrence H Yang1, Kristen A Woodberry2, Bruce G Link3, Cheryl M Corcoran4, Caitlin Bryant5, Daniel I Shapiro6, Donna Downing7, Ragy R Girgis8, Gary Brucato8, Debbie Huang9, Francesca M Crump10, Mary Verdi7, William R McFarlane11, Larry J Seidman6. 1. New York University College of Global Public Health, 715 Broadway, New York, NY 10003, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA. Electronic address: Lawrence.yang@nyu.edu. 2. Maine Medical Center Research Institute, Portland, ME 04102, USA; Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA; Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA; Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. 3. University of California at Riverside, 900 University Ave, Riverside, CA 92521, USA. 4. Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 1 Gustave L. Levy Pl., New York, NY 10029, USA; Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peter Veterans Affairs Medical Center, 130 West Kingsbridge Rd, Bronx, NY 10468, USA. 5. Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA; University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA. 6. Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA; Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA; Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. 7. Maine Medical Center Research Institute, Portland, ME 04102, USA. 8. New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Dr. New York, NY 10032, USA; The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, USA. 9. Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA. 10. The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, USA. 11. Maine Medical Center Research Institute, Portland, ME 04102, USA; Department of Psychiatry, School of Medicine, Tufts University, 0 Park Plaza #1101, Boston, MA 02116, USA.
Abstract
BACKGROUND: Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves. METHODS: 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects. FINDINGS: The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p < 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p < 0.05). INTERPRETATION: Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies.
BACKGROUND: Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves. METHODS: 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects. FINDINGS: The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p < 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p < 0.05). INTERPRETATION:Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies.
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