Post-Secondary Students with Symptoms of Psychosis: A Mixed-Methods Systematic Review.


V. Sanderson, A. Vandyk, J-D. Jacob, S. Lightfoot, L. Sikora, M. Murawsky, I. Graham



Background: Post-secondary students are at a heightened risk for psychosis.
Purpose: To synthesize evidence on psychosis in post-secondary students, including student characteristics, overall prevalence within this population, risk factors associated with psychosis, interventions for psychosis in this population and their effectiveness, and reported experiences of students.
Methods: A mixed-methods systematic review using an integrated knowledge translation approach was conducted. Procedures were modeled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search in nine databases, and quality was assessed using JBI Critical Appraisal Tools. Data was pooled and analyzed according to objectives and reported using synthesis tables and narratives. This study also involved collaboration between researchers and Knowledge Users, including post-secondary students, to enhance relevance and meaningfulness of study objectives and findings.
Findings: 26 articles published between 2006-2018 were included. The average age of participants was 21 years, and most identified as female and Caucasian. Prevalence of psychosis was often measured in a way that limited comparison across studies, therefore was inconclusive. Risk factors strongly associated with symptoms of psychosis included substance use, depression, and younger age. Other associated risk factors included racial discrimination and anxiety, and protective factors included self-esteem and self-concept clarity. There were five intervention studies identified with mixed results, and only three studies were included on the experience of PS students. Knowledge Users provided insight and expertise regarding study implications for clinical practice, policy, education, and research.
Conclusions: Risk factors strongly associated with psychosis in post-secondary students included substance use, depression, and younger age, among other risk factors with weaker associations. While five promising interventions exist, inadequate testing and replication limits confidence in their effectiveness. There is a notable deficit in qualitative evidence exploring the experiences of these students. Further, as highlighted by our Knowledge Users, disclosing ones’ symptoms or having to navigate academic institutional policy while experiencing psychosis is challenging. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their healthcare while protecting their right to education.


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