Journal article
Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis
Harvard review of psychiatry, Vol.34(1), pp.23-43
01/2026
DOI: 10.1097/HRP.0000000000000419
PMID: 40095846
Abstract
Learning Objectives:
After participating in this CME activity, the psychiatrist should be better able to:
Describe the prevalence and relevance of PE, CHR-P, and psychotic disorders.
Explain screening tools, cut-off scores, and integration into general mental health care.
Background:
The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings.
Methods:
PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model.
Results:
The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8–52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0–32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3–9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type.
Conclusions:
The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.
Details
- Title: Subtitle
- Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis
- Creators
- Jacqueline A. Clauss - University of Maryland, BaltimoreCheryl Y.S. Foo - Integrated Statistics (United States)Catherine J. Leonard - Integrated Statistics (United States)Katherine N. Dokholyan - Integrated Statistics (United States)Corinne Cather - Integrated Statistics (United States)Daphne J. Holt - Integrated Statistics (United States)
- Resource Type
- Journal article
- Publication Details
- Harvard review of psychiatry, Vol.34(1), pp.23-43
- DOI
- 10.1097/HRP.0000000000000419
- PMID
- 40095846
- NLM abbreviation
- Harv Rev Psychiatry
- ISSN
- 1067-3229
- eISSN
- 1465-7309
- Number of pages
- 21
- Grant note
- R01MG127265; R01MH125426; R01MH122371 / National Institute of Mental Health (http://data.elsevier.com/vocabulary/SciValFunders/100000025) National Institute of Mental Health (http://data.elsevier.com/vocabulary/SciValFunders/100000025) Chen Institute Mass General Neuroscience Massachusetts Department of Mental Health (http://data.elsevier.com/vocabulary/SciValFunders/100020336)
- Language
- English
- Date published
- 01/2026
- Academic Unit
- Psychiatry
- Record Identifier
- 9985223620702771
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