Describing Psychotic Experiences Through Online Psychosis Screens: A Content Analysis

Area of Science:

• Psychiatry
• Psychology
• Public Health

Background:

• Population surveys often use brief screening tools for psychotic experiences, which can lead to high false-positive rates.
• These tools may capture non-psychotic phenomena like culturally sanctioned beliefs or normative distress.
• Qualitative data from free-text responses are underutilized despite their potential to contextualize screening results.

Purpose of the Study:

• To analyze qualitative free-text responses from a psychosis screening tool to differentiate between psychotic and non-psychotic experiences.
• To assess the utility of qualitative data in improving the precision of psychosis screening instruments.

Main Methods:

• Adult respondents from a US online survey who endorsed items on the abbreviated World Health Organization Composite International Diagnostic Interview (WHO CIDI) psychosis screen provided open-ended descriptions of their experiences.
• Reflexive thematic analysis was employed by three coders to develop and categorize themes, classifying responses as probably psychotic, probably not psychotic, or unclear.

Main Results:

• Thirteen thematic categories were identified, including hallucinations, paranoia, emotional distress, and spiritual beliefs.
• Nearly half of the responses were classified as unlikely to be psychotic, with approximately 9% deemed probably psychotic and 41% unclear.
• Many responses indicated affective distress, stress, grief, or ambiguous experiences rather than clear psychotic phenomena.

Conclusions:

• Brief qualitative descriptions offer valuable context to clarify whether reported experiences are clinically significant psychotic phenomena or normative.
• Integrating qualitative free-response fields can enhance the interpretability and precision of psychosis screening.
• This approach may aid early detection efforts and minimize over-pathologization of normative experiences.