Psychotic Experiences Among Transition-Age Youth and Young Adults Attending an Outpatient Clinic in a Low-Resourced Community

Background and introduction: While there has been an increase in funding for early intervention and specialized services for psychosis, they are limited to a small group of youth and young adults (YYAs), both due to access and strict inclusion criteria. There is limited research assessing for psychotic experiences among transition-age YYAs with mental health conditions, who are predominately low-income, minority, and system involved. Studies have shown that these YYA face structural barriers like poverty, underemployment, poor education, elevated mental health conditions, and lower rates of service use. The aims of the present mixed-method study were twofold. First, to investigate whether YYAs who attend an outpatient clinic in a low-resourced community reported experiencing psychosis, and how they and their supports managed the positive symptoms. Second, to validate these experiences by comparing it to psychotic symptoms items from the Colorado Symptom Index (CSI).

Methods: Data was collected as part of a developmental trial examining the feasibility of a multi-component psychosocial intervention for low-income YYAs with mental health conditions between the years 2015-2017 (Munson et al., 2016). Fifty-eight participants were recruited, between the ages 16-20, and receiving services for a mental health disorder at a community-based outpatient clinic. Youth that reported psychotic experiences answered the following questions: 1) How did you and those who lived with you deal with you experiencing psychosis? and 2) How have you and your team of supports dealt with psychosis? Applying thematic analysis techniques, two analysts independently went through the responses and identified themes. Authors sought out to corroborate those youth that reported experiencing psychosis with CSI psychosis items, a self-report measure of psychiatric symptomatology. Finally, a t-test compared means on the CSI between those that reported psychosis with those that did not.

Results: Sample characteristics include mean age 17.8 (1.1), 63% female, 34% White, 20% Black, 14% Latino, 19% Biracial, 7% Asian, 4% Middle Eastern, and 2% Other. Seventy% of the YYAs were on Medicaid and all others deemed low-income by Clinic Director, 14% in child welfare, and 19% in special education. Twenty-nine% of the youth reported experiencing psychosis. Interestingly, 59% of the youth reported psychosis items on the CSI but did not report experiencing psychosis. There was a significant difference in the CSI scores for YYAs reporting experiencing psychosis (M=24.8, SD=8) and those YYAs that did not report experiencing psychosis (M=17.22, SD=8.6); t (55) = -.3, p = 0.003.  Common themes that emerged from the qualitative data included youth reporting lack or delayed disclosure, “nobody knew, but me. I basically ignored it”, negative emotions (e.g. scared, shame), negative messages from people in their lives, “mom would not pay no mind to it, say I was stupid, you’re buggin out”, and coping mechanisms that ranged from avoidance, music, breathing techniques, discussion with their providers, and medication.  

Conclusions and implications: This study emphasizes the importance of having multiple methods to identify YYAs that may be experiencing psychosis.  It also suggests the need for more training on both referral and treatment for psychosis in community-based settings.