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April 1, 2020

Going Upstream to Advance Psychosis Prevention and Improve Public Health

Author Affiliations
  • 1The City College, Graduate Center of New York, City University of New York, New York
  • 2School of Public Health, Boston University, Boston, Massachusetts
  • 3University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Psychiatry. 2020;77(7):665-666. doi:10.1001/jamapsychiatry.2020.0142

The idea that we can reduce the incidence of psychotic disorders through detection and intervention in the prodromal stage of illness has generated increasing enthusiasm and research over the past 2 decades. This work has sought largely to identify individual-level changes in subjective experience, functioning, or brain volume or activity that immediately precede acute symptom onset. However, mental illnesses, including psychotic disorders, are particularly sensitive to the social, political, cultural, and economic context within which an individual lives.1 Prioritizing approaches to psychosis prevention that fail to give these social determinants a central role ignores compelling evidence and misses an opportunity to identify specific ways to help vulnerable youth.

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