Post-secondary students with symptoms of psychosis: A mixed-methods systematic review

Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.