Clinical symptoms of the prodromal stage preceding serious mental illness in Taiwanese young adults: a qualitative study.

Abstract

Background: Serious mental illnesses significantly contribute to the global health burden. The prodromal stage, marked by subclinical symptoms that impair daily functioning but do not meet full diagnostic criteria, often precedes the onset of serious mental illness. This stage can vary across regions, cultures, and demographics. High false-positive rates and low conversion rates to diagnosed mental disorders may increase stigmatization and delay timely care. This study aimed to explore the prodromal symptoms preceding serious mental illness in Taiwanese young adults.

Methods: A qualitative research design was employed, with semi-structured interviews conducted every three months until illness onset. Thirty-six individuals (aged 16-35) identified as ultra-high risk for psychosis were recruited from a psychiatric outpatient unit in central Taiwan over a two-year recruitment period. Among them, 24 participants who had developed a serious mental illness (9 with schizophrenia, 5 with bipolar disorders, and 10 with major depressive disorder) were included in the analysis. Data from these participants were analyzed using qualitative content analysis to explore their prodromal experiences and symptoms. The study adhered to the trustworthiness criteria, including credibility, transferability, dependability, and confirmability.

Results: The 24 participants had an average age of 22.83 years, including 8 males and 16 females. Analysis of 52 interviews identified five primary themes and 16 sub-themes: sleep disturbances leading to fatigue, terror caused by confusion between reality and hallucinations, indecision due to cyclic fluctuations in control, gradual loss in sadness and despair, and experiences of self-denial and uncertainty. This study provides valuable insights for the early screening of prodromal symptoms of serious mental illness in Taiwan.

Conclusions: The findings may assist early detection, support interventions to prevent or delay the onset of serious mental illness, and reduce the individual, familial, and societal burdens associated with mental disorders.

Clinical trial number: Not applicable.