Caregiver causal attributions in youth psychosis

Caregiver causal attributions influence patient and caregiver reactions to psychosis. The current study describes common caregiver causal attributions about psychosis onset in youth, including a subset of first-episode psychosis patients, and the patient and caregiver characteristics that influence these attributions. It also examines if caregiver views are affected by contact with youth mental health services.

Fifty-one caregivers of 50 youth patients with a diagnosed Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) psychotic disorder were interviewed about their causal attributions. Patient and caregiver demographic and clinical predictors were also collected.

Caregivers most highly endorsed substance use, genetics, negative peer influences and school stress as individual causes. These findings were consistent across the total sample. Principal components analysis derived three causal categories. Caregivers most frequently endorsed a biological and substance use lifestyle causal category, followed by psychological vulnerability and stress-reactivity causal categories. There was evidence that caregiver and patient factors, as well as contact with youth mental health services, influenced the causal attributions caregivers made about the onset of psychosis.

Caregivers of youth with psychosis are making causal attributions that are consistent with current aetiological theories of psychosis in youth. The study showed that caregivers are particularly cognizant of genetic and substance use factors in the development and maintenance of psychosis. However, youth mental health services may need to particularly focus on increasing caregiver understanding of the dynamics of stress factors as symptoms, and not causes, of psychosis early in the illness course.