Comparisons between self-reported and interview-verified psychotic-like experiences in adolescents

Mental Health Literacy Buffers the Association Between Nightmare Distress and Psychotic-Like Experiences Among College Students

BACKGROUND

Nightmares may lead to psychotic-like experiences (PLEs). The present study aimed to examine the potential moderating and mediating effects of mental health literacy (MHL) on the association between nightmare distress (ND) and PLEs among Chinese college students.

METHODS

A total of 4000 college students who have had nightmares in the past year were assessed using the Chinese version of the nightmare distress questionnaire (NDQ-CV), mental health knowledge questionnaire (MHKQ), 15-item positive subscale of the community assessment of psychic experiences (CAPE-P15), 2-item insomnia questionnaire, 2-item patient health questionnaire (PHQ-2), and a self-compiled sample characteristics questionnaire.

RESULTS

Greater ND and lower MHL were associated with an elevated risk of PLEs among college students when adjusting for sample characteristics, insomnia and depressive symptoms. Moderation analysis indicated that MHL buffers the association between ND and PLEs, such that a higher level of MHL attenuates the positive effect of ND on PLEs to a greater extent.

CONCLUSIONS

These findings strongly stressed the urgent need for early intervention in college students with ND. Strategies should prioritise treating ND and enhancing MHL, as these may be effective approaches to preventing and reducing PLEs.

A longitudinal network of psychotic-like experiences, depressive and anxiety symptoms, and adverse life events: a cohort study of 3,358 college students

AIMS

Psychotic-like experiences (PLEs), especially for persistent PLEs, are highly predictive of subsequent mental health problems. Hence, it is crucial to explore the psychopathological associations underlying the occurrence and persistence of PLEs. This study aimed to explore the above issues through a longitudinal dynamic network approach among PLEs and psychological and psychosocial factors.

METHODS

A total of 3,358 college students completed two waves of online survey (from Oct 2021 to Oct 2022). Socio-demographic information was collected at baseline, and PLEs, depressive and anxiety symptoms, and adverse life events were assessed in both waves. Cross-lagged panel network analyses were used to establish networks among individuals with baseline PLEs as well as those without.

RESULTS

At baseline, 455(13.5%) students were screened positive for PLEs. Distinct dynamic network structures were revealed among participants with baseline PLEs and those without. While 'psychomotor disturbance' had the strongest connection with PLEs in participants with baseline PLEs, 'suicide/self-harm' was most associated with PLEs in those without. Among all three subtypes of PLEs, bizarre experiences and persecutory ideation were the most affected nodes by other constructs in participants with baseline PLEs and those without, respectively. Additionally, wide interconnections within the PLEs construct existed only among participants without baseline PLEs.

CONCLUSIONS

The study provides time-variant associations between PLEs and depressive symptoms, anxiety symptoms, and adverse life events using network structures. These findings help to reveal the crucial markers of the occurrence and persistence of PLEs, and shed high light on future intervention aimed to prevent and relieve PLEs.

Characteristics and factors associated with psychotic-like experiences in remission: a cross-sectional study of 4208 college students in China

OBJECTIVES

Previous research has extensively explored the factors associated with psychotic-like experiences (PLEs). However, the characteristics and associated factors of remitted PLEs, which refer to the absence of current PLEs following previous PLEs, remain unclear. Therefore, this study aims to describe the characteristics of adolescents who reported remitted PLEs.

DESIGN

Cross-sectional study.

SETTING

The survey was conducted from October to December 2020 in three colleges located in Guangzhou, China.

PARTICIPANTS

A total of 4208 college freshmen aged from 15 to 24 participated in our survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The 15-item positive subscale of the Community Assessment of the Psychic Experience was used to assess both lifetime and current PLEs. Multivariate logistic regression models were used to examine the associations between remitted PLEs and a range of demographic factors, lifestyle, psychosocial factors, lifetime affective symptoms and sleep problems.

RESULTS

Three groups of PLEs were observed: non-PLEs (47.27% of the sample), remitted PLEs (40.42%) and current PLEs (12.31%). Several factors have been identified as shared correlates of remission and absence of PLEs, including fewer recent adverse life events, greater resilience, fewer symptoms of depression and anxiety, and early waking. Furthermore, higher levels of social support (OR 1.48, 95% CI 1.01 to 2.17; OR 1.53, 95% CI 1.18 to 1.97) was a specific factor associated with the remission of PLEs. Compared with individuals without PLEs, those with remitted PLEs were more likely to be female (OR 1.50, 95% CI 1.28 to 1.75), less likely to be younger (OR 0.88, 95% CI 0.81 to 0.95) and prone to have more chronic physical illness (OR 1.67, 95% CI 1.29 to 2.16), habitual alcohol intake (OR 1.85, 95% CI 1.19 to 2.88), more childhood trauma (OR for low vs high=0.72, 95% CI 0.57 to 0.91) and the sleep problems of waking up easily (OR 1.36, 95% CI 1.12 to 1.65).

CONCLUSION

These findings suggest that remitted PLEs play a vital, unique role among three groups and provide preliminary targets for the intervention for adolescents at risk of mental health problems. Further investigation may shed light on the causality of the relationship between remitted PLEs and associated factors.

Internet addiction and suicidal ideation among Chinese college students: the mediating role of psychotic-like experiences

Background

Individuals with Internet addiction (IA) are at significant risk of suicide-related behaviors. This study aimed to investigate the relationships among IA, psychotic-like experiences (PLEs), and suicidal ideation (SI) among college students.

Methods

A total of 5,366 college students (34.4% male, mean age 20.02 years) were assessed using the self-compiled sociodemographic questionnaires, Revised Chinese Internet Addiction Scale (CIAS-R), 15-item Positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15), Self-rating Idea of Suicide Scale (SIOSS), and 2-item Patient Health Questionnaire (PHQ-2).

Results

The prevalence of IA and SI were 9.3 and 12.1% among Chinese college students, respectively. There were direct effects of IA and PLEs on SI. The total effect of IA on SI was 0.18 (p < 0.001). PLEs mediated the relationship between IA and SI (Indirect effect = 0.07).

Conclusion

IA had both direct and indirect effects on SI. These findings enable us to elucidate the mechanism of how IA influences individual SI, which can provide vital information for developing and implementing targeted interventions and strategies to alleviate SI among Chinese college students.

The predictive role of psychotic-like experiences in suicidal ideation among technical secondary school and college students during the COVID-19 pandemic

BACKGROUND

Previous research has shown the strong association between psychotic-like experiences (PLEs) and suicide. However, the predictive role of PLEs in suicidal ideation (SI) during the COVID-19 pandemic remains unclear.

AIMS

This study aimed to explore the association between PLEs before the pandemic and SI during the pandemic among late adolescents.

METHODS

A total of 938 technical secondary school and college students completed both waves of the online survey before and during the pandemic. PLEs were assessed through the 15-item Positive Subscale of the Community Assessment of Psychic Experiences. SI was evaluated by the frequency of SI during the pandemic.

RESULTS

In early stage of the pandemic, most students had low frequent SI, and only 3.3% students showed high frequent SI. Compared to the low frequent group, the high frequent group exhibited significantly higher levels of PLEs (p < 0.001) and scored lower in resilience (p = .001) and perceived social support (p = .008) across the two timepoints. PLEs were significantly associated with higher risk of high frequent SI (OR = 2.56, 95%: 1.07-6.13), while better resilience (OR: 0.93, 95% CI: 0.88-0.99) and stronger perceived social support (OR: 0.96, 95% CI: 0.93-0.99) appeared to be protective factors. No interactions were found among PLEs and other psychosocial and psychological factors.

CONCLUSIONS

PLEs may increase the risk of SI in early stage of the pandemic, while good resilience and adequate social support can help weaken the risk.

EMDR versus waiting list in individuals at clinical high risk for psychosis with post-traumatic stress symptoms: A randomized controlled trial

BACKGROUND

Post-traumatic stress disorder (PTSD) is highly prevalent in the individuals at clinical-high risk for psychosis (CHR). The aim of this study was to examine the efficacy and safety of Eye Movement Desensitization and Reprocessing (EMDR) in individuals at CHR with comorbid PTSD or subthreshold PTSD in a randomized controlled trial.

METHODS

Fifty-seven individuals at CHR with PTSD or subthreshold PTSD formed the study sample. The eligible participants were randomly assigned to a 12 weeks EMDR treatment (N = 28) or a waiting list condition (WL, N = 29). The structured interview for psychosis risk syndrome (SIPS), the clinician administered post-traumatic stress disorder scale (CAPS) and a battery of self-rating inventories covering depressive, anxiety and suicidal symptoms were administered.

RESULTS

Twenty-six participants in the EMDR group and all the participants in the WL group completed the study. The analyses of covariance revealed greater reduction of the mean scores on CAPS (F = 23.2, Partial η² = 0.3, P < 0.001), SIPS positive scales (F = 17.8, Partial η² = 0.25, P < 0.001) and all the self-rating inventories in the EMDR group than in the WL group. Participants in the EMDR group were more likely to achieve remission of CHR compared to those in the WL group at endpoint (60.7 % vs. 31 %, P = 0.025).

CONCLUSIONS

EMDR treatment not only effectively improved traumatic symptoms, but also significantly reduced the attenuated psychotic symptoms and resulted in a higher remission rate of CHR. This study highlighted the necessity of adding a trauma-focused component to the present approach of early intervention in psychosis.

Urinary exosomal microRNAs as predictive biomarkers for persistent psychotic-like experiences

Psychotic-like experiences (PLEs) occur occasionally in adolescence and mostly disappear with increasing age. Their presence, if persistent, is considered a robust risk factor for subsequent psychiatric disorders. To date, only a few biological markers have been investigated for persistent PLE prediction. This study identified urinary exosomal microRNAs that can serve as predictive biomarkers for persistent PLEs. This study was part of a population-based biomarker subsample study of the Tokyo Teen Cohort Study. A total of 345 participants aged 13 (baseline) and 14 (follow-up) years underwent PLE assessments by experienced psychiatrists using semi-structured interviews. We defined remitted and persistent PLEs based on longitudinal profiles. We obtained urine at baseline and the expression levels of urinary exosomal miRNAs were compared between 15 individuals with persistent PLEs and 15 age- and sex-matched individuals with remitted PLEs. We constructed a logistic regression model to examine whether miRNA expression levels could predict persistent PLEs. We identified six significant differentially expressed microRNAs, namely hsa-miR-486-5p, hsa-miR-199a-3p, hsa-miR-144-5p, hsa-miR-451a, hsa-miR-143-3p, and hsa-miR-142-3p. The predictive model showed an area under the curve of 0.860 (95% confidence interval: 0.713-0.993) for five-fold cross-validation. We found a subset of urinary exosomal microRNAs that were differentially expressed in persistent PLEs and presented the likelihood that a microRNA-based statistical model could predict them with high accuracy. Therefore, urine exosomal miRNAs may serve as novel biomarkers for the risk of psychiatric disorders.

Psychotic-like experiences as a co-occurring psychopathological indicator of multi-dimensional affective symptoms: Findings from a cross-sectional survey among college students

BACKGROUND

Although connections between psychotic-like experiences (PLEs) and a series of non-psychotic disorders have been widely explored in previous research, it is unclear whether PLEs could act as a co-occurring psychopathological indicator of multi-dimensional affective symptoms.

METHODS

A total of 4761 students took part in an online survey which assessed the frequency of PLEs and three types of affective symptoms over lifetime. Binary logistic regression models were used to examine associations between PLEs and each type of affective symptom. Network analysis was conducted to explore the relationship among three subtypes of PLEs - persecutory ideation (PI), bizarre experiences (BEs) and perceptual abnormalities (PAs), and different types of affective symptoms.

RESULTS

The results showed that compared with the non-PLEs group, the PLEs group suffered significantly higher risk of experiencing three types of affective symptoms, including manic symptoms [adjusted odds ratio (aOR) 11.50, 95 % confidence interval (CI) (4.59-28.81)], depressive symptoms [aOR 7.28, 95 % CI (4.98-10.66)] and anxiety symptoms [aOR 4.47, 95 % CI (3.10-6.43)]. In the network model, bizarre experiences were the most critical central symptom. Both depressive and anxiety symptoms were most strongly associated with persecutory ideation while manic symptoms were most closely related to bizarre experiences.

LIMITATIONS

Cross-sectional data and self-reported symptoms.

CONCLUSIONS

These findings suggest that PLEs are a vital co-occurring indicator of multi-dimensional affective symptoms and show its enormous potential as a target for a host of mental health problems. Further investigation may shed light on the aetiology of the relationship between different subtypes of PLEs and affective symptoms.

Psychotic-like experiences during COVID-19 lockdown among adolescents: Prevalence, risk and protective factors

OBJECTIVE

Although plenty of evidence has shown the huge negative impact of COVID-19 on individuals' mental health conditions, little is known about its impact on the psychotic-like experiences (PLEs) in the general population. We aim to explore the prevalence of PLEs and relevant influential factors among adolescents during COVID-19 lockdown.

METHODS

A total of 3234 students completed one online survey between April to May 2020. PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Resilience, social support, childhood trauma, and a series of socio-demographic factors were also evaluated.

RESULTS

In this sample, 51.4 % adolescents reported having at least one PLE, while 11.6 % experienced PLEs frequently during COVID-19 lockdown. Senior high school students showed more frequent PLEs than college students (p < 0.001). Female gender (OR = 1.77), history of mental disorders (OR = 3.07) or chronic physical illness (OR = 2.04), having relatives or friends being infected with COVID-19 (OR = 3.12), longer daily exposure to media coverage of the COVID-19 (OR = 1.60), and more childhood trauma (OR = 1.54-3.49) were correlated with more frequent PLEs, while higher resilience (OR = 0.35-0.54) and more perceived social support (OR = 0.63-0.72) were associated with decreased odds for frequent PLEs. Additionally, there were several differences among the influential factors between senior high school and college students.

CONCLUSIONS

PLEs were relatively common among Chinese adolescents, with higher prevalence among senior high school students during COVID-19 lockdown. Adolescents with specific characteristics should receive more attention in the development of intervention measures in mental health during pandemic lockdown.

The Unique Contribution of Past Bullying Experiences to the Presence of Psychosis-Like Experiences in University Students

OBJECTIVES

Both bullying and psychosis-like experiences (PLEs) have gained much attention in recent years, but their interactions are not fully unraveled. The aim of the current study was to validate the Chinese version of Bullying Scale for Adults (C-BSA), and to investigate whether past bullying experiences independently predict the presence of PLEs in university students.

METHODS

The validity and reliability of the C-BSA were determined in two independent samples. A battery of psychological inventories was also administered to assess the presence of PLEs, maltreatment history in the family, and current depression and anxiety, including the 15-item positive subscale of the community assessment of psychic experiences (CAPE-p15), the Chinese version of the Childhood Trauma Questionnaire (CTQ), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS).

RESULTS

In the construction sample (N = 629), a Cronbach's α of 0.921 indicated a good internal consistency of C-BSA. The exploratory factor analysis (EFA) yielded a four-factor model and a three-factor model, and both were verified by using the confirmatory factorial analysis (CFA) in the validation sample (N = 629). The total scores of C-BSA were significantly correlated with that of CTQ, CAPE-p15, SDS, and SAS. Multivariate logistic regression revealed that bullying was associated with 2.0 or 3.7 times of risk for the presence of PLEs (numbers of bullying types < = 3 or > 3, respectively) after controlling for CTQ, SDS, and SAS scores.

CONCLUSIONS

C-BSA has shown good psychometric properties in college students. The contribution of past bullying experiences to the present PLEs seems to be independent of other childhood trauma, current depression, and anxiety.

The Bidirectional Associations Between Insomnia and Psychotic-Like Experiences Before and During the COVID-19 Pandemic

STUDY OBJECTIVES

Previous literature supports that insomnia is predictive of subsequent psychotic-like experiences (PLEs) in the general population. However, there is a lack of empirical data on the reverse causality between the two variables and on the correlation between the symptom severity of insomnia and PLEs. This study aimed to explore the bidirectional associations between insomnia and PLEs before and during the COVID-19 pandemic.

METHODS

A total of 938 students aged 14-25 years completed both waves of the survey before and during the pandemic (the first wave: October 2019 to November 2019; the second wave: April 2020 to May 2020). PLEs were assessed using the 15-item positive subscale of the community assessment of psychic experiences (CAPE-P15), and insomnia was assessed using three questions on difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening.

RESULTS

Students with baseline insomnia were more likely to exhibit new-onset PLEs during the pandemic (OR: 5.13, 95% CI: 2.54-10.38), while no significant predictive effect of insomnia was found for the persistence and severity of PLEs. Meanwhile, baseline PLEs not only predicted the presence of insomnia during the pandemic (OR: 2.14, 95% CI: 1.25-3.65) but also correlated with its severity (B: 0.89, 95% CI: 0.47-1.31).

CONCLUSION

The study provides the first piece of evidence for the bidirectional association between insomnia and PLEs in the general population. However, although insomnia has an important predictive role in the occurrence of PLEs, it does not predict the persistence and development of PLEs, suggesting that there is a more complex mechanism underlying the process.