Aims Sleep problems are common in people with a psychosis‐spectrum diagnosis and are associated with worse psychotic symptoms and lower quality of life. Sleep problems are also frequent in individuals at a clinical high risk for psychosis (CHR‐P) however, less is known about the prevalence and association with symptoms in this population. This study investigates the prevalence of sleep problems within CHR‐P individuals and the associations with attenuated positive symptoms, transition to psychosis, time to transition to psychosis and functioning. Methods The clinical records interactive search (CRIS) tool was used to carry out a retrospective study of 795 CHR‐P individuals. Sleep problems, subsequent psychotic diagnoses, attenuated positive symptoms and Health of The Nation Outcome Scale scores were extracted. Regression models were used to examine the association between sleep problems and clinical outcomes. Results 59.5% of CHR‐P individuals experienced sleep problems. Perceptual abnormality severity (OR = 1.24, 95% CI = 1.05–1.48) and frequency (OR = 1.31, 95% CI = 1.08–1.58) as measured by the Comprehensive Assessment of At‐Risk Mental State interview, predicted sleep problems. Sleep problems were not associated with transition to psychosis; however, they were significantly associated with a shorter time to transition in individuals who developed psychosis (HR = 1.4, 95% CI = 1.05–1.88) and higher follow‐up Health of the Nation Outcome Scale scores (MD = 2.26, 95% CI = 0.55–3.96). Conclusions The high prevalence of sleep problems, along with the association with positive symptoms and worse functioning, highlights the need for effective sleep interventions in this population. Further research is needed to better understand the relationship between sleep problems and transition to psychosis.

Aim: Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population.Methods: We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Randomeffects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences.Results: Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = −1.33 [−1.73 to −0.94] P < .001).However, there was evidence of substantial heterogeneity (I 2 = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = −0.26, P = .02).Conclusions: UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.