Details of male and female experiences of subclinical psychosis and their engagement with GP and counseling/therapy services are presented in . There were no sex differences identified in relation to experiences of subclinical mania, thought control, strange experiences, or hallucinations. Males, however, were significantly more likely to experience subclinical paranoia than females (χ2 = 7.01, df = 1, P = .01). In relation to help-seeking, females were significantly more likely to attend their GP for both emotional problems (χ2 = 94.02, df = 1, P = .00) and physical problems (χ2 = 23.62, df = 1, P = .00) and were also more likely to seek counseling/therapy (χ2 = 3.83, df = 1, P = .03).
Prevalence Estimates of Subclinical Psychosis and Help-Seeking Behavior
Cross-tabulations between the subclinical psychosis variables and help-seeking variables are presented in . The χ2 tests showed that subclinical mania was significantly related to GP attendance for emotional problems only, while thought control was significantly related to each of the help-seeking variables. Subclinical paranoia, strange experiences, and hallucinations were each associated with GP attendance for emotional problems and with counseling/therapy but not with GP attendance for physical problems.
Associations Between Help-Seeking Behavior Variables and Subclinical Psychosis Symptoms
A hierarchical multivariate logistic model was specified and estimated. Mplus 5.2119
was used to estimate the model parameters using robust full information maximum likelihood. This method allowed parameters to be estimated using all available information and has been found to be superior to alternative methods such as listwise deletion.20,21
The first model included all external constraint factor variables as predictors in the first block and the 3 help-seeking variables as the dependent variables. The second block included the mental state variables, and the third block included the subclinical psychosis symptom variables as predictors. The likelihood ratio χ2
for the first block was significant (χ2
= 591.66, df
= 18, P
< .01), and the addition of the second block resulted in an improved model (Δ
= 1301.66, Δdf
= 9, P
< .01). The addition of the third block also significantly improved the model (Δ
= 61.56, Δdf
= 15, P
< .01). The results of the analysis are reported in .
Associations Between Help-Seeking Behavior Variables, Help-Seeking Correlates, and Subclinical Psychosis Symptoms
The results of the analysis revealed that individuals who were female, younger, unqualified, non–English speaking, and substance dependent were more likely to attend their GP for emotional, nervous, or mental problems. Individuals attending a GP for emotional, nervous, or mental problems were also more likely to have been diagnosed with a neurotic disorder and to have poorer self-perceived general health. In relation to psychosis, subclinical experiences of thought control (OR = 2.37), paranoia (OR = 2.05), and strange experiences (OR = 1.70) predicted this form of help-seeking. Older unqualified females, who were more likely to have been diagnosed with a neurotic disorder and to have poorer self-perceived general health, were characteristic of those individuals who attended GP practices for a physical illness or complaint. This form of help-seeking, however, was not predicted by subclinical psychosis. Finally, individuals who were younger, unqualified, and unemployed, who had been diagnosed with a neurotic disorder, and who had poorer self-perceived general health were more likely to attended therapy/counseling. Those individuals who experienced subclinical paranoia were also more likely (OR = 2.92) to seek this form of help.
To test whether there was a cumulative effect of subclinical psychosis symptoms on help-seeking behavior, a second multivariate logistic model was specified and estimated. This model also included the demographic and clinical variables as predictors; however, subclinical psychosis symptoms in this model were measured cumulatively (0 symptoms to 3 symptoms or more). The 3 help-seeking variables were once again specified as outcome variables. The results of the analysis revealed that cumulative symptom experience was associated with a higher probability of GP attendance for emotional problems (highest probability for those experiencing 2 symptoms) and a higher probability also for seeking counseling/therapy (highest probability for those experiencing 3 or more symptoms). The results of this analysis are reported in .
Cumulative Subclinical Psychosis Symptom Experience and Help-Seeking Behavior