Community Messages and Help-Seeking Among Young Adults at Clinical High-Risk for Developing Psychosis

Background and Purpose: There are low rates of service utilization among young adults at clinical-high risk for developing psychosis (Addington et al., 2002). Recent theoretical work has emerged suggesting that community and social messages play an important role in help-seeking (Munson et al., 2012). There is an increased risk for psychosis among ethnic minorities and immigrant populations, and research has found longer durations of untreated psychosis in certain racial/ethnic communities (e.g. African Americans), which leads to worse outcomes (Morgan et al, 2010; Merrit-David & Keshavan, 2006). Stigma and mistrust among minority communities has been shown to impact help-seeking (Scott et al., 2011; Ferrari et al., 2017). This study examined help-seeking messages that young adults at clinical high-risk for developing psychosis received from their communities.

Methods: In-depth interviews were conducted with young adults (aged 18 to 30) identified as clinical high-risk for developing psychosis in a clinic serving prodromal clients. Recruitment techniques included purposive and theoretical sampling. Open-ended face-to-face interviews typically lasted one hour and were audiotaped and transcribed. Example questions included, 1) What brought you to this clinic? and, 2) What messages did you receive from others about attending this clinic? Applying a grounded theory approach (Charmaz, 2006), two analysts used open coding (with some sensitizing concepts) and constant comparison on a subset of interviews (N=5). Additional transcripts were analyzed developing a codebook, adding and modifying codes as needed. Analysts utilized consensus to deal with discrepancies. The remaining cases were analyzed and discussed by three analysts.

 Findings: The sample included 29 young adults (mean age 23, 61% male, 34% White, 21% Bi-Racial, 21% Black, 21% Hispanic, 3% Asian). Seventeen percent were immigrants (e.g. Africa, Caribbean, Eastern Europe). A third of the participants reported that they received messages (positive and negative) about help-seeking from community members. Some participants received stigmatizing messages. For example, African American participants received negative messages (“mental health services are for White people only”, “most black people can’t afford to see a psychiatrist”, “you don’t need to … seek help you just need good friend or family to talk to”, “you need to push those things down and move forward”). Black participants were oversampled and negative community messages emerged from most of the African American participants. Participants from Eastern European communities also endorsed stigmatizing messages (“Russian parents use this idea of you need to seek help as this derogatory thing”). Another negative message came from a Dominican participant (he is a traditional Dominican dad, he is like … don't tell people, they're going to think you're crazy”). In comparison, other participants (e.g. White, Asian, and Black Caribbean) reported receiving more positive messages from their communities (“to seek some sort of mental health professional’s kind of normal”). 

Conclusions and Implications: There is important variation in messages young adults are receiving from their communities about help-seeking. Future research should seek to clarify specific messages that may vary by culture to devise interventions to reduce stigma and mistrust and increase mental health service use among those at high-risk for psychosis.