Post‐secondary students with symptoms of psychosis: A mixed‐methods systematic review

Abstract

Post‐secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed‐methods systematic review of psychosis among post‐secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self‐esteem and self‐concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.

Engaging Knowledge Users with Mental Health Experience in a Mixed-Methods Systematic Review of Post-secondary Students with Psychosis: Reflections and Lessons Learned from a Master’s Thesis

“…KUs played an active role in interpreting the findings and how study results may benefit clinicians, students, educators, and others involved with PS students with symptoms of psychosis. For example, they highlighted clinically relevant risk factors related to psychosis that were reported in the systematic review, such as depression and substance use, but also highlighted important risk factors that were inconclusive in the systematic review, such as anxiety, trauma, sleep dysfunction, and family history of mental illness, 12 which they routinely flag when working with students. Overall, KUs emphasized the importance of clinicians performing routine risk assessments when working with PS students experiencing symptoms of psychosis.…”

“…This intervention was identified in the systematic review, however it warrants further testing to determine its efficacy in assisting students with psychosis. 12 KUs also highlighted that 'system navigators' is an intervention that has been implemented within PS institutions to assist students in navigating PS institution political structures, and academic and health issues. This intervention was not identified in our systematic review, therefore without KUs bringing up this potentially promising intervention, it would otherwise have gone unreported.…”

“…Further details on systematic review results can be found elsewhere. 12 These are a few examples to demonstrate the value of KU knowledge and how it can nuance and clarify synthesis findings -perhaps one of the most important take home messages for researchers using this approach. KUs also provided ideas for dissemination of the research results.…”

“…They suggested connecting with PS programs that provide mental health training for faculty and students, disseminating results through conferences, mental health forums, or online platforms, and soliciting a podcast host to speak about mental health issues in PS students informed by our study findings. Although dissemination is an on-going process, thus far, one article has been published to showcase systematic review results, 12 and the PI presented the research study via a poster presentation at a conference recommended by a KU. The 6 KU team members who comprised the advisory panel have also been involved in writing a discussion article (in progress).…”

“…11 The purpose of this article is to describe how iKT was embedded within a mixed-methods systematic review. 12 The mixed-methods systematic review was a master's thesis project. We outline various KU engagement activities employed throughout the systematic review process, reflect on lessons learned, and provide suggestions for students conducting iKT-informed research projects.…”