Changes in Self-concept and Risk of Psychotic Experiences in Adolescence: a Longitudinal Population-based Cohort Study

Background: Psychotic experiences (PEs) are commonly reported in adolescence and are associated with a range of negative outcomes. Few targets for intervention for PEs have been identified. One potential target is self-concept: an individual's beliefs about his/her personal attributes. Improvements in self-concept have been shown to reduce psychotic symptoms in patients with schizophrenia but no study has investigated the relationship between changes in self-concept and risk of PEs in the general population. We aimed to investigate: (a) the relationship between child and adolescent self-concept and adolescent PEs; and (b) whether changes in self-concept between childhood and adolescence were associated with risk of adolescent PEs.

Method: Using data from age 9 and age 13 (n = 7,423) of the child cohort (Cohort'98) from the Growing Up in Ireland study we investigated the relationship between self-concept at age 9 and age 13 and PEs at age 13. PEs were measured using the Adolescent Psychotic Symptoms Screener and self-concept was measured using the Piers Harris-II. Using a stratified analysis, we investigated the relationship between change in self-concept between age 9 and age 13 and the risk of PEs at age 13. Additionally we investigated changes across the six self-concept subscales.

Results: Psychotic experiences were reported by 13% of participants at age 13. 'Very low' self-concept at age 9 was associated with an increased risk of PEs at age 13 (Adjusted-OR: 2.74, CI: 1.80-4.19), and 'High' self-concept at age 9 was associated with a decreased risk of PEs at age 13 (Adjusted-OR: 0.77, CI: 0.60-0.97). The stratified analysis indicated that improvements in self-concept reduced the odds of adolescent PEs and decline in self-concept increased the odds of adolescent PEs. This effect was noted across the majority of the self-concept subscales.

Conclusions: There is a strong relationship between self-concept and PEs. The antecedents of low self-concept may be a useful target for preventative psychiatry. Broad-spectrum interventions targeting self-concept in childhood may help to reduce the incidence of PEs in adolescence.