Jason Schiffman1, Zachary B. Millman1, Pamela Rakhshan1, Nicole Andorko1; 1University of Maryland, Baltimore (UMBC)
Introduction: False positive identification of youth at Ultra High Risk (UHR) for psychosis is a critical limitation to psychosis prevention efforts. Contextual factors including race, neighborhood safety, and age may affect the validity of semi-structured interviews and self-report screeners designed to target this population. Methods: Help-seeking adolescents/young adults (N=134) ages 12-25 completed the Prime Screen and the Structured Interview for Psychosis-risk Syndromes (SIPS). A neighborhood crime index was calculated based on federal data and participant addresses. The influence of race, neighborhood crime, and age on Prime Screen scores, SIPS symptoms, and SIPS (UHR) diagnosis was examined. Results: Higher Prime Screen scores increased the probability of meeting UHR criteria for White participants, but not Black participants, even after controlling for age, household income, and mood disorder (interaction: b = -0.50 Wald χ2[1] = 4.63, p = .03, Exp[B] = 0.60). Neighborhood crime uniquely predicted suspiciousness scores over and above other UHR symptoms (b = 0.20, t = 2.14, p = .04, f2 = 0.08). 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] = 4.69, p = .03, Exp[B] = 0.96). Discussion: The results collectively suggest that contextual factors influence the accurate identification of youth at UHR, through their effect on both screener- and interview-based assessment. Sensitivity to these and other individual differences is important for accurate identification and prevention of early psychosis.
