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Psychosis symptoms in youth linked to 2-fold higher risk of later mental health disordersPsychosis symptoms in youth linked to later mental health disorders

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Key Takeaway
Consider psychosis spectrum symptoms as a risk marker for later mental health disorders in youth, but interpret associational findings cautiously.

This meta-analysis examined the longitudinal association between psychosis spectrum symptoms (PSS) and subsequent mental health disorder diagnoses in children and youth under 25 years without an identified mental health diagnosis at baseline. The analysis included studies from clinical or community settings with a minimum follow-up of 1 year.

The primary outcome was any mental health disorder diagnosis. The pooled analysis showed a 2-fold increased risk (OR=2.07, CI=1.61-2.66, p<0.0001) among those with PSS. For the secondary outcome of psychotic disorder diagnosis, the risk was 3-fold higher (OR=3.11, CI=2.11-4.58, p<0.0090). Heterogeneity was substantial (I2=86.92% for any disorder, 60.93% for psychotic disorder).

The authors note that heterogeneity in psychotic disorder outcomes was influenced by study quality and sample size. The study design precludes causal inference; the association does not imply causation. Self-report measures of PSS may help identify at-risk youth, but future studies with improved design are needed to increase confidence in the associations.

How this fits prior evidence

This meta-analysis extends prior coverage of mental health risk factors by quantifying the longitudinal risk associated with psychosis spectrum symptoms in youth. It complements findings on child maltreatment in Ethiopia (38% prevalence) and the demand gap in German schools by identifying PSS as an early marker. The 2-fold increased risk for any disorder and 3-fold risk for psychotic disorder provide specific effect sizes that were previously lacking in this population.

A new analysis of multiple studies suggests that children and young people who report mild psychosis-like symptoms may be at higher risk for developing a mental health disorder later on. The analysis looked at data from studies that followed children and youth under 25 who did not have a mental health diagnosis at the start. Researchers found that those who reported psychosis spectrum symptoms (PSS) had about twice the risk of being diagnosed with a mental health disorder later, compared to those without such symptoms. The risk was even higher for a psychotic disorder specifically, with about a three-fold increase.

The findings come from a meta-analysis that combined results from several studies. However, the studies varied widely, which weakens the strength of the conclusions. The analysis cannot prove that PSS causes later disorders, only that there is a link. The researchers note that self-report measures of PSS might help identify youth who could benefit from monitoring or early support, but more research is needed.

For parents and caregivers, this does not mean that every child with unusual thoughts or experiences will develop a mental health disorder. Many children have such experiences without any problems. The findings highlight a potential early warning sign, but they are not a diagnosis. If you have concerns about your child's mental health, talk to a doctor or mental health professional.

What this means for you:
Psychosis-like symptoms in youth are linked to higher risk of later mental health disorders, but more research is needed.

Common questions

What are psychosis spectrum symptoms (PSS)?

Psychosis spectrum symptoms include mild or brief experiences like unusual thoughts, suspiciousness, or hearing things that aren't there. They are not the same as a full psychotic disorder, and many people have them without developing a mental illness.

Does this mean my child will develop a mental health disorder?

No. The study found a link, not a guarantee. Many children with PSS do not develop a disorder. The findings suggest PSS may be a risk factor, but more research is needed to understand who is most at risk.

How strong is the evidence?

The evidence comes from a meta-analysis of multiple studies, but the studies varied a lot, which lowers confidence. The results show an association, not cause and effect. Future studies are needed to confirm and improve these findings.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Objective Psychosis spectrum symptoms (PSS) are common among children and youth. These symptoms may be clinically significant as studies indicate a heightened risk of mental health disorders, in general, as well as psychotic disorders, specifically, in youth that endorse PSS. This systematic review and meta-analysis investigates the longitudinal association between PSS in children and youth and subsequent mental health diagnosis. Methods A comprehensive search of Ovid Medline, PsycINFO, and EMBASE databases was conducted to identify longitudinal studies that: (i) assess PSS at a baseline timepoint, (ii) in individuals under 25 years, and (iii) assess mental health disorder diagnosis using a structured assessment at a later time point in the same sample. We conducted a meta-analysis and calculated pooled odds ratios (ORs) for mental health and psychotic disorders using random-effects models. Post-hoc meta-regressions were performed to examine the influence of a number of moderators on the relationship between earlier recorded PSS and subsequent mental health disorders or psychotic disorders. Results The search yielded 41 eligible studies of which 25 were included in the meta-analysis. Most included studies assessed PSS using brief self-report measures and recruited their samples from clinical or community settings. Among children and youth without an identified mental health diagnosis at baseline assessment, baseline PSS were associated with a 2-fold (OR = 2.07, CI = 1.61 - 2.66, I2 = 86.92%, p < 0.0001) increased risk of meeting diagnostic criteria for subsequent mental health disorder diagnosis and a 3-fold increased risk (OR = 3.11, CI = 2.11 - 4.58, (I2 = 60.93%, p < 0.0090) of meeting diagnostic criteria for a subsequent psychotic disorder diagnosis with a minimum 1 year follow-up time from baseline assessment. Meta-regression analysis indicated that study quality and sample size explained a substantial proportion of between-study heterogeneity for psychotic disorder outcomes. Conclusions Our results suggest that administration of simple self-report measures of PSS in both clinical and community settings may be helpful to identify children and youth at higher risk of subsequently meeting criteria for a mental disorder generally, and for a severe mental illness (i.e., psychotic disorder), specifically. Future longitudinal studies should focus on improving study design characteristics to increase confidence in identified longitudinal associations. The results of our work suggests that integration of self-report measures of PSS may be useful in a variety of settings to identify youth at increased risk of subsequent mental illness.
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