Stigma Associated with a High-Risk State for Psychosis

PROJECT SUMMARY We propose the first study to systematically examine any potential effects of stigma associated with the new 'high risk for psychosis' ('HRP') designation, a groundbreaking development in the earliest identification of psychotic signs that enables efforts to prevent psychosis. Concerns of stigma towards the new HRP status have been expressed because this designation has the potential to activate the same severe social ramifications known to be associated with an identification of 'psychosis'. Stigma may be an unnecessary risk especially because the majority of those identified as HRP even in the absence of intervention do not go on to develop psychosis. Further, the HRP designation is being used in over 6 countries (including the U.S.) and there is current debate to include it officially within the DSM 5 in 2013. Because no evidence exists regarding stigma of the HRP, we bring together expertise from two well-established research teams that have experience in treating and following HRP individuals and their family members with that of recognized researchers in stigma and the early course of psychosis. We propose a comprehensive approach to assessing stigma experiences among a HRP group (n= 196) and associated 'family attitudes' among family members (n= 155) at initial HRP identification and then at 6 months follow-up. We compare the stigma experiences of the HRP group with that of a first episode non-affective psychosis group (FEP; n= 100) who act as a benchmark for severe stigma. We examine stigma of the HRP designation at baseline, how any stigma may increase or decrease over time, and how this stigma compares with that of an FEP group. We further assess longitudinal impacts of HRP stigma and 'family attitudes' upon changes in psychological, social, and developmental outcomes in the HRP group. This research promises to greatly inform interventions to counter stigma at its earliest stages and maximize opportunities for people at HRP to attain developmental goals leading to adulthood. Further, removing or ameliorating this concern of stigma is crucial, as HRP identification is a potentially transformative means of preventing and treating schizophrenia, thus reducing burden for psychosis worldwide.