The critical need for help-seeking controls in clinical high-risk research

Millman, Zachary B.; Gold, James M.; Mittal, Vijay A.; Schiffman, Jason

doi:10.1177/2167702619855660

Cited by 33Schizophrenia research and treatmentPsychopathy, Forensic Psychiatry, Sexual OffendingPsychology Research and Bibliometrics

The critical need for help-seeking controls in clinical high-risk research

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Millman, Zachary B., Gold, James M., Mittal, Vijay A., Schiffman, Jason·2019·Clinical Psychological Science

DOI 10.1177/2167702619855660PMC PMC7891463

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Abstract

Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy control participants in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.

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Risk factors found in non-clinical or community samples may generalize poorly to clinical or high-risk individuals seen by mental health providers.
“Furthermore, risk factors identified in non-clinical or community samples may be of limited generalizability to the clinical or high-risk individuals more often encountered by mental health care providers (for examples, see King, Berona, Czyz, Horwitz, & Gipson, 2015; Yen et al., 2013; for a related discussion, see Millman, Gold, Mittal, & Schiffman, 2019).”
From Sleep and suicide: A systematic review and meta-analysis of longitudinal studies (2020) · cites this paper as Millman, Gold, Mittal, & Schiffman, 2019

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Fusar - Poli P, Cappucciati M, Rutigliano G, Schultze - Lutter F, Bonoldi I, Borgwardt S, … Woods SW (2015). At risk or not at risk? A meta - analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry, 14(3), 322– 332. 26407788 PMC4592655
Millman ZB, & Schiffman J (2018). False positives and clinical heterogeneity among youth at clinical high-risk for psychosis: Clinical and ethical implications for assessment and treatment. Journal of Ethics and Mental Health, 10.

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Authors: Millman, Z. B., Gold, J. M., Mittal, V. A., & Schiffman, J.
Affiliations: University of Maryland, Baltimore County (US)
University of Maryland, Baltimore (US)
Northwestern University (US)
Corresponding author: Millman, Zachary B.
ORCID: Millman, Zachary B.
Gold, James M.
Mittal, Vijay A.
Schiffman, Jason
Venue: Clinical Psychological Science
Publisher: SAGE Publications
Published: 2019-09-23
Volume: 7
Issue: 6
Pages: 1171-1189
ISSN: 2167-7026 (ISSN-L)
2167-7034
DOI: 10.1177/2167702619855660
PMC: PMC7891463
OpenAlex: W2976385331
Semantic Scholar: 8dc1cdb5dfb2858cda0424d53ef2c5abbe8a310f
Cited by: 33
References: 169
Citations by year: 2026: 2 · 2025: 6 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 10 · 2020: 4 · 2019: 1
FWCI: 3.78
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Psychological Science (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R01-MH112545, R01-MH112612, R21-MH110374, R21-MH115321, R34-MH110506)
Maryland Department of Health and Mental Hygiene (14-13717G/M00B440214)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Social Sciences › Psychology › Experimental and Cognitive Psychology › Psychology Research and Bibliometrics
Keywords: psychosis, healthy controls, case-control study, research validity

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The critical need for help-seeking controls in clinical high-risk research

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