Teenagers and Precision Psychiatry: A Window of Opportunity

Abstract

<b><i>Objective:</i></b> Precision medicine raises hope for translating genetic-based knowledge about psychiatric risks into mental health benefits by motivating health-related, risk-reducing behaviors. Teenagers (ages 14–17) are an important age-group to engage in preventive efforts but, their views about psychiatric genetics are understudied. <b><i>Method:</i></b> An online survey with a nationally representative sample of teenagers (<i>n</i> = 417) was conducted. Participants were randomly assigned to receive 1 of 2 handouts, 1 emphasizing the genetic underpinnings of psychiatric conditions; the other agency-oriented and focusing on gene-environment interactions. Survey questions queried their views about behavioral changes in response to psychiatric genetic risk information and expressed willingness to undertake them. Participants’ decision-making characteristics (i.e., self-efficacy, empowerment, intolerance of uncertainty, and sensation-seeking) were assessed at baseline. <b><i>Results:</i></b> Teenagers strongly valued the information provided and its potential usefulness for their mental health. Information about psychiatric genetics alone impacted views about the causes of mental illness. Contrary to our hypothesis, the type of handout did not impact participants’ expressed willingness to make behavioral changes to reduce their risk of developing a psychiatric condition, but their sense of empowerment played a key role in their responses. <b><i>Conclusion:</i></b> Educating teenagers about gene-environment interactions may help facilitate the translational efforts of precision psychiatry. Research with teenagers across racial/ethnic groups, especially those with family histories, is needed to better understand the factors that impact teenagers’ empowerment in psychiatric genomic settings and to identify measures, including the best enablers of empowerment (e.g., educators, parents), which would allow them to reap the benefits of precision psychiatry.

How do experts in psychiatric genetics view the clinical utility of polygenic risk scores for schizophrenia?

“…The relative lack of enthusiasm for testing minors is notable given the fact that schizophrenia is typically diagnosed in early adulthood, and risk assessment would arguably be more valuable in adolescence than later in life. Possible explanations include concerns about the child's autonomy, decision‐making options, and lack of available interventions (Sabatello et al, 2021). Furthermore, child and adolescent psychiatrists believe that using PRS in pediatric settings could result in excessive treatment (Pereira et al, 2022).…”

Research priorities in psychiatric genetic counselling: how to talk to children and adolescents about genetics and psychiatric disorders

“…Thus, childhood or adolescence could be a particularly suitable window within which to receive psychiatric genetic counselling. This may prevent misconceptions about the causes of one's mental illness, manage stigmatising beliefs related to personal or family history of mental health problems [7], and encourage risk-reducing behaviours [8,9]. Psychiatric genetic counselling could also have a positive impact on parents and caregivers, who often feel responsible for their child's mental health and may experience feelings of guilt, shame, or a heavy burden of responsibility [10].…”

Ethical considerations for precision psychiatry: A roadmap for research and clinical practice

“…For example, community mental health services for the prevention of psychosis offer mental health literacy packages around vulnerability to the disorder and its implication on the individual as family, thus supporting the active alliance between patients, their families and clinicians( Estradé et al, 2022 ;Fusar-Poli et al, 2020c ;Kotlicka-Antczak et al, 2020 ;Salazar de Pablo et al, 2021a ). There is also evidence that educating teenagers about gene-environment interactions facilitates the translational efforts of precision psychiatry( Sabatello et al, 2021a ). To address these issues, future research should carefully assess how precision psychiatry models reconfigure the alliance between patients, families and healthcare providers.…”