Social Determinants and Mental Health Care Utilization Among Individuals at Clinical High Risk for Psychosis

Clinical high risk for psychosis (CHR-P) is associated with distress, impairment, and elevated risk for developing full-threshold psychosis. Early intervention can improve prognostic outcomes, but limited research has investigated associations between social determinants and mental health care utilization among people at CHR-P. The authors aimed to explore whether distressing positive symptoms, race-ethnicity, immigration, racial discrimination, and social support correlate with mental health care utilization in this population.

Data were drawn from a parent study in which community-based participants completed questionnaires and clinical interviews. Participants included in the present analyses were ages 16-30 and met interview-based criteria for CHR-P (N=171).

Asian and Black participants were significantly less likely than White participants to report past use of mental health care. Black participants were significantly less likely than White participants to report current use of services. Differences in past service use for Asian and Black participants versus Hispanic/Latinx participants and in current service use for Asian versus White participants approached statistical significance. Trend-level associations suggesting a lower likelihood of service use among immigrant participants were attenuated when household income was accounted for. Across the full sample, distressing positive symptoms significantly predicted current use of services.

Associations between self-reported race-ethnicity and mental health care utilization persisted even when analyses accounted for distressing positive symptoms, social support, and discrimination. As CHR-P research and practice increasingly focus on early intervention, study findings underscore the importance of better understanding contextual factors and social determinants that are associated with mental health service use among youths at CHR-P.