Using Online Screening in the General Population to Detect Participants at Clinical High-Risk for Psychosis

Mhairi McDonald; Eleni Christoforidou; Nicola Van Rijsbergen; Ruchika Gajwani; Joachim Gross; Andrew I Gumley; Stephen M Lawrie; Matthias Schwannauer; Frauke Schultze-Lutter; Peter J Uhlhaas

doi:10.1093/schbul/sby069

Using Online Screening in the General Population to Detect Participants at Clinical High-Risk for Psychosis

Schizophr Bull. 2019 Apr 25;45(3):600-609. doi: 10.1093/schbul/sby069.

Authors

Affiliations

¹ Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
² Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
³ Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Germany.
⁴ Department of Psychiatry, University of Edinburgh, Edinburgh, UK.
⁵ Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK.
⁶ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁷ Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.

Abstract

Introduction: Identification of participants at clinical high-risk (CHR) for the development of psychosis is an important objective of current preventive efforts in mental health research. However, the utility of using web-based screening approaches to detect CHR participants at the population level has not been investigated.

Methods: We tested a web-based screening approach to identify CHR individuals. Potential participants were invited to a website via e-mail invitations, flyers, and invitation letters involving both the general population and mental health services. Two thousand two hundred seventy-nine participants completed the 16-item version of the prodromal questionnaire (PQ-16) and a 9-item questionnaire of perceptual and cognitive aberrations (PCA) for the assessment of basic symptoms (BS) online. 52.3% of participants met a priori cut-off criteria for the PQ and 73.6% for PCA items online. One thousand seven hundred eighty-seven participants were invited for a clinical interview and n = 356 interviews were conducted (response rate: 19.9%) using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). n = 101 CHR participants and n = 8 first-episode psychosis (FEP) were detected. ROC curve analysis revealed good to moderate sensitivity and specificity for predicting CHR status based on online results for both UHR and BS criteria (sensitivity/specificity: PQ-16 = 82%/46%; PCA = 94%/12%). Selection of a subset of 10 items from both PQ-16 and PCA lead to an improved of specificity of 57% while only marginally affecting sensitivity (81%). CHR participants were characterized by similar levels of functioning and neurocognitive deficits as clinically identified CHR groups.

Conclusion: These data provide evidence for the possibility to identify CHR participants through population-based web screening. This could be an important strategy for early intervention and diagnosis of psychotic disorders.

Keywords: basic symptoms; clinical high-risk; early intervention; psychosis; web screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Early Diagnosis*
Early Medical Intervention*
Female
Humans
Internet*
Interview, Psychological
Male
Mass Screening
Neuropsychological Tests*
Psychiatric Status Rating Scales
Psychotic Disorders / diagnosis*
Risk
Schizophrenia / diagnosis*
Young Adult

Grants and funding

MR/L011689/1/MRC_/Medical Research Council/United Kingdom