How Do Youth Interpret Self-Report Questions Screening for Psychosis? Insights From Cognitive Interviewing

Area of Science:

• Psychiatry
• Adolescent Medicine
• Mental Health Screening

Background:

• Early detection of psychosis is crucial for timely intervention and improved outcomes.
• Self-report psychosis screens can generate high false positive rates, potentially due to item misunderstanding.
• Cognitive interviews were used to explore item comprehension in youth who completed psychosis screens.

Purpose of the Study:

• To investigate item misunderstanding as a cause of false positive results in youth psychosis screening.
• To identify specific types of comprehension errors in self-report psychosis screening items.

Main Methods:

• Cognitive interviews were conducted with 13 racially and ethnically diverse patients (ages 14-21).
• Participants rated their understanding of screening items and explained item meaning in their own words.
• Independent raters analyzed participant understanding using deductive and inductive coding.

Main Results:

• Participants reported high confidence in understanding items (mean 8.1/10), yet actual understanding aligned with intended meaning only 42% of the time.
• Two primary categories of misunderstanding emerged: interpreting items as non-psychotic mental health experiences or as normative developmental/contextual experiences.
• These misunderstandings contribute to falsely endorsing screening items.

Conclusions:

• Misinterpretation of screening items by youth can lead to false positive results for psychosis risk.
• Clinical follow-up is essential to contextualize positive screens, considering individual medical, developmental, and social factors.
• Future research should focus on improving item clarity and developing strategies to minimize false positives in psychosis screening.