Exploring the acceptability, barriers, and facilitators to psychosis screening in the integrated behavioral health primary care setting: a qualitative study.

BACKGROUND: A longer duration of untreated psychosis (DUP) is associated with poorer treatment outcomes. Screening for psychosis spectrum disorders in the primary care setting could help support the earlier detection and treatment of individuals in need. However, the acceptability of screening for psychosis in this setting as part of routine care is currently unknown. METHODS: We conducted a qualitative interview study with providers and service users who participated in an early psychosis screening program conducted in an integrated behavioral health primary care (IBH-PC) setting. Interviews were recruited from one of eight WellSpace Federally Qualified Health Center IBH-PC clinics in the Sacramento, CA area. Transcripts of the recorded interviews were analyzed using thematic analysis. RESULTS: In total, 12 providers and eight service users participated in the interviews. Most service user and provider participants were supportive of psychosis screening in an IBH-PC setting, but not as part of the general practitioner consultation due to the brief, non-behavioral health nature of many of the appointments, and the expected low prevalence of psychosis in this population. The support of leadership, adequate training and support, staff turnover, and organizational changes were all seen to impact the successful implementation of the program. Different barriers and facilitators were considered important at each stage of the process from introducing the screening procedures to service users; to determining when, where, and how to screen; and how to effectively manage the referral and post-referral stages. CONCLUSIONS: Despite the additional challenges of screening in an IBH-PC setting relative to secondary mental health services, the process was considered acceptable and feasible to providers and service users. Services that plan to conduct psychosis screening in their clinics need to consider the challenges and their potential solutions to implementation at each stage of the screening process.

Effects of racial discrimination on stress, negative emotions, and alcohol craving: A registered report of a virtual reality experiment.

OBJECTIVES: Racial discrimination experiences contribute to health disparities and can influence individuals' health. Yet, pathways by which discrimination-related experiences affect alcohol craving remain understudied using experimental designs. Additionally, limited research has examined possible differential effects of "major" discrimination and microaggression experiences in everyday life on alcohol craving. This between-groups experiment examined causal effects of everyday racial discrimination on stress, negative emotions, and alcohol craving. We also tested indirect pathways by which discrimination-related experiences were linked to alcohol craving via stress and negative emotions. METHOD: People of color and Indigenous peoples participated in the study (N = 184; Mage = 23.90; 47.8% women; 48.9% community adults). Participants were randomized to one of four experimental conditions, in which they experienced in virtual environments either "major" discrimination, microinsult, microinvalidation, or daily hassles unrelated to race/racism. Participants' levels of stress, negative emotions, and alcohol craving were assessed immediately before and after experimental simulations. RESULTS: Compared to daily hassles unrelated to race/racism, simulated racial discrimination elicited greater stress and negative emotions. Daily hassles caused greater alcohol craving among those who endorsed higher levels of coping motives for drinking. We observed minimal differences in stress and negative emotions across the three racial discrimination conditions, and found no evidence supporting indirect links between racial discrimination and alcohol craving via stress and negative emotions. CONCLUSION: Everyday racial discrimination-regardless of intensity level-is more stressful than daily hassles unrelated to race/racism. Future research should examine cumulative effects of racial discrimination, and understanding individual difference factors that moderate its immediate and delayed effects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Open science and multicultural research: Some data, considerations, and recommendations.

OBJECTIVES: There are two potentially useful but nonintersecting efforts to help ensure that psychological science produces valid and credible information and contributes to the understanding of diverse human experiences. Whereas North American ethnic minority psychology research/cultural diversity science (EM/D) emphasizes cultural competency to yield contextualized psychological understanding of understudied and underserved minority populations, current open science (OS) approaches emphasize material and data sharing, and statistical proficiency to maximize the replicability of mainstream findings. To illuminate the extent of and explore reasons for this bifurcation, and OS's potential impact on EM/D, we conducted three studies. METHOD AND RESULTS: In Study 1, we reviewed editorial/publishing policies and empirical articles appearing in four major EM/D journals on the incentives for and use of OS. Journals varied in OS-related policies; 32 of 823 empirical articles incorporated any OS practices. Study 2 was a national mixed-methods survey of EM/D scholars' (N = 141) and journal editors' (N = 16) views about and experiences with OS practices. Emerged themes included beliefs about the impact of OS on scientific quality, possible professional disadvantages for EM/D scholars, and concerns about the welfare of and ethical risks posed for communities of color. In Study 3, we explored community research participants' beliefs about data sharing and credibility of science/scientists (N = 1,104). Participants were receptive of data sharing and viewed psychological science favorably. CONCLUSIONS: We provide data-driven recommendations for researchers to assemble the best tools for approaching the knowledge-production process with transparency, humility, and cultural competency. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The diagnostic accuracy of screening for psychosis spectrum disorders in behavioral health clinics integrated into primary care.

Screening for psychosis spectrum disorders in primary care could improve early identification and reduce the duration of untreated psychosis. However, the accuracy of psychosis screening in this setting is unknown. To address this, we conducted a diagnostic accuracy study of screening for psychosis spectrum disorders in eight behavioral health services integrated into primary care clinics. Patients attending an integrated behavioral health appointment at their primary care clinic completed the Prodromal Questionnaire - Brief (PQ-B) immediately prior to their intake assessment. This was compared to a diagnostic phone interview based on the Structured Interview for Psychosis Risk Syndromes (SIPS). In total, 145 participants completed all study procedures, of which 100 screened positive and 45 negative at a provisional PQ-B threshold of ≥20. The PQ-B was moderately accurate at differentiating psychosis spectrum from no psychosis spectrum disorders; a PQ-B distress score of ≥27 had a sensitivity and specificity of 71.2 % and 57.0 % respectively. In total, 66 individuals (45.5 %) met criteria for a psychosis spectrum disorder and 24 (16.7 %) were diagnosed with full psychosis, indicating a high prevalence of psychosis in the sample. Overall, screening for psychosis spectrum disorders in an IBH primary care setting identified a relatively high number of individuals and may identify people that would otherwise be missed. The PQ-B performed slightly less well than in population-based screening in community mental health settings. However, the findings suggest this may represent an effective way to streamline the pathway between specialty early psychosis programs and primary care clinics for those in need.

Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis: A Cluster Randomized Clinical Trial.

Importance: Reducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days. Objective: To determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone. Design, Setting, and Participants: This cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021. Interventions: All sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire-Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone. Main Outcomes and Measures: Primary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview. Results: Twenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P < .001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P = .03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]). Conclusions and Relevance: In this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact. Trial Registration: ClinicalTrials.gov Identifier: NCT02841956.