The clinical high-risk state for psychosis syndrome (CHR) offers substantial potential benefits in identifying and treating at-risk youth at the earliest signs of psychosis. Early treatment might lead to decreased symptoms, thus reducing stigma related to symptoms. However, stigma of the CHR state for psychosis designation could initiate further stigma through the label of risk for psychosis among identified young people. Dr. Yang and his colleagues studied 170 CHR state for psychosis individuals in a major, NIH-funded longitudinal study at 3 US centres from 2012 to 2017. Labeling-related measures of stigma (e.g., “shame of being identified as at psychosis-risk”) adapted to the CHR group, and a parallel measure of symptom-related stigma (e.g., “shame of the symptoms associated with CHR”) were administered. These measures were examined in relation to outcomes such as self-esteem, quality of life, social functioning and loss of social networks. The conventional wisdom was confirmed that stigma related to symptoms was somewhat more strongly associated with most outcomes when compared with stigma related to the risk-label. Stigma related to symptoms remained a significant predictor of self-esteem, quality of life, and social network loss even after accounting for stigma related to the risk-label and the effects of covariates. Yet stigma related to the risk-label was still associated with several outcomes once we factored in stigma related to symptoms.

This lecture will place this study in the context of the knowns of stigma research. Specifically, this study’s findings indicate that CHR services should address stigma associated with symptoms quickly at first identification, given their negative impacts on outcomes. Dr. Yang will lead a discussion on how we might integrate best evidence into designing services for young people who may develop psychosis.

Presenter: 

Dr. Lawrence Yang is Vice Chair and Associate Professor of the Department of Social and Behavioral Sciences at NYU- School of Global Public Health. Dr. Yang also is Founding Director of the Global Mental Health and Stigma Program where he administers a generous donor gift from the Li Ka Shing Foundation, and is Associate Director for the University-Wide Global Center for Implementation Science at NYU. He is also an Adjunct Associate Professor of Epidemiology at Columbia University. Dr. Yang received his Ph.D. in clinical psychology from Boston University and completed his clinical training at Harvard Medical School/Massachusetts Mental Health Center. He received a T32 NIMH-sponsored post-doctoral fellowship at Columbia University in psychiatric epidemiology. Dr. Yang’s research focuses on two main areas: 1) Global Mental Health, Implementation Science and Stigma; and 2) Cognition of Untreated Psychosis. Dr. Yang is currently PI of two separate R01’s and a 3-year Supplement in China, which seek to examine the cognition in the ‘natural state’ of psychosis in a large untreated, community sample of individuals with psychosis (n=400), who have not yet received any antipsychotic medications, compared with a treated sample (n=400) and healthy controls (n=400) in China. He also is PI of a third R01 implementing task sharing measures for global mental health which seeks to validate a newly-developed multi-dimensional measure that enables rapid assessment of modifiable critical factors that affect the implementation of task sharing mental health strategies. In his presentation, Dr. Yang (PI) will describe results from a recently-completed 5-year NIMH R01 grant examining the stigma associated with the "clinical high risk state for psychosis" designation, a potentially transformative new syndrome to detect psychotic signs before symptoms develop into a full psychotic disorder. Dr. Yang has over 125 peer-reviewed publications, including publications in the JAMA Psychiatry, British Journal of Psychiatry and The Lancet. Dr. Yang has received seven national awards, most recently the 2021 Maltz Prize for Innovative and Promising Schizophrenia Research from the Brain and Behavioral Research Foundation, for his work.