Conditional Disclosure on Pathways to Care: Coping Preferences of Young People at Risk of Psychosis

Abstract

The interrelationship between stigma and help-seeking is under-researched amongst children and adolescents. This study explored stigma in relation to pathways to care amongst young people putatively in an early stage of increased risk of developing psychotic disorders. 'Pathways to care' was defined as help-seeking and support from informal and formal resources, and increased risk was determined though the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology.Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the super-ordinate theme in these data as "conditional disclosure"; a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people's perceptions of a range of preclinical symptoms, and on how they seek support for these symptoms. 3Mental health problems are estimated to affect around one in ten children and adolescents (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015). These early difficulties can develop into longstanding issues; indeed, the origins of most adult mental disorders can be tracked back to early life, with onset for around half of lifetime cases occurring before the age of fifteen years, and three-quarters by the midtwenties (Kessler et al., 2007). Early difficulties are also associated with disrupted social functioning, compromised educational attainment, and negative impacts on, for example, adulthood relationships and marriage stability, parenting, physical health, and socio-economic outcomes (A. Goodman, Joyce, & Smith, 2011;Riglin, Petrides, Frederickson, & Rice, 2014). These early difficulties remain untreated for many, and this under-treatment of mental disorders amongst children and adolescents is recognized as a public health concern around the world (Polanczyk et al., 2015). For example, in Great Britain, only 24% of children aged 5-16 years with a diagnosable mental disorder had received treatment from specialist mental health services within the previous year (Green, McGinnity, Meltzer, Ford, & Goodman, 2005).An improved understanding of the mechanisms, stages and patterns underlying young people's helpseeking and service use, and the potential barriers to these processes, could inform strategies aiming to reduce this treatment gap.One potential barrier to receiving care is mental-health related stigma. Stigma has been defined as the situation of a person disqualified from social acceptance due to possessing a deeply discredited attribute, which reduces the stigmatized individual from a whole and usual person to a tainted and discounted one (Goffman, 1963). This definition outlines that, in the case of mental illness, this attribute reflects a blemish on the individual character. Stigma has been conceptualized in many ways. For example, one freque...

Terminology and assessment tools of psychosis: A systematic narrative review

“…‘Psychotic‐like experiences’ (PLE) were recognized among the general population, but also as risk factors, predictors, or early symptoms for psychosis . They were often less severe than symptoms of psychotic disorders and transient . They were sometimes described as present in both groups with or without psychotic disorders .…”

“…An article defined PLE as ‘qualitatively similar to the symptomatology of psychotic disorders but quantitatively less severe in terms of intensity, frequency, and impairment’, and used the term interchangeably with ‘subclinical psychotic experiences’ . A study which examined youths at risk of developing psychotic disorders defined PLE as ‘attenuated psychotic symptoms below the threshold of frank psychosis’ . They were considered as present during the early stage of developing psychotic disorders, even before the prodromal phase.…”

“…38 symptoms of psychotic disorders 44,53 and transient. 7,48,54 They were sometimes described as present in both groups with or without psychotic disorders. 46,50,54 PLE were reported at the milder end of the psychosis continuum.…”

“…Experiences which resemble psychotic disorder symptoms but are less severe or not associated with impairment and distress are increasingly acknowledged . They are found within the community, at‐risk populations, psychotic prodrome, and at the mild end of the psychotic continuum . These phenomena have been termed ‘attenuated psychotic symptoms’, ‘subclinical psychotic experiences’, and other phrases.…”

“…1 They are found within the community, 2,3 at-risk populations, 4 psychotic prodrome, 5,6 and at the mild end of the psychotic continuum. 3,7 These phenomena have been termed 'attenuated psychotic symptoms', 1,8 'subclinical psychotic experiences', 9 and other phrases. However, these have described an array of contexts, from healthy individuals 3 to people with psychotic and non-psychotic disorders.…”