Summary: A new study from the Toronto Adolescent and Youth (TAY) Cohort finds that roughly half of young people seeking specialized mental health care (about 49–50% in early data) show Psychosis Spectrum Symptoms (PSS). This unexpectedly high prevalence underscores the urgent need for better early detection, targeted assessment, and timely interventions for youth at risk of psychosis.
This research, led in part by Associate Professor Kristin Cleverley of the Lawrence S. Bloomberg Faculty of Nursing, integrates research assessments directly into clinical care and provides youth with a patient-facing dashboard of their results. The project is designed to identify early predictors of psychosis spectrum disorder, improve clinical decision-making, and guide interventions that could prevent progression to more severe illness.
Key findings:
- About half of the first 417 youth enrolled (ages 11–24) met a pre-established threshold for Psychosis Spectrum Symptoms, a prevalence higher than community-based estimates.
- The study emphasizes identifying early indicators and functional changes that might signal increased risk for psychosis, addressing the current low effectiveness (~5%) of typical identification methods.
- The longitudinal TAY Cohort aims to follow 1,500 young people over five years, using co-design with patients, caregivers, and clinicians to integrate research into routine clinical practice.
Source: University of Toronto
Study overview
The TAY Cohort Study recruits young people who are already seeking tertiary mental health services, offering an opportunity to characterize the clinical profiles and developmental trajectories of youth with complex presentations. Early analysis of 417 participants showed that these young people carried, on average, multiple psychiatric diagnoses—about 3.5—and most commonly anxiety and depressive disorders alongside PSS. Participants with PSS experienced greater functional impairment, more internalizing and externalizing symptoms, and higher rates of suicidality compared with those without PSS.
Associate Professor Kristin Cleverley, who also holds the CAMH Chair in Mental Health Nursing Research, highlights that conventional early psychosis care often begins only after clear, serious psychotic symptoms emerge—typically in later adolescence. By contrast, this study seeks to detect earlier, subtler changes in cognition, behavior, and functioning that could indicate higher risk and therefore present a window for more effective early intervention.
Psychosis Spectrum Disorder can cause major disability, cognitive decline, long-term functional impairment, and elevated suicide risk. Even when a full psychotic disorder is not present, psychosis-spectrum symptoms alone can substantially disrupt a young person’s functioning, academic performance, and social development.
Study design and clinical integration
The TAY Cohort is a longitudinal study that aims to enroll 1,500 youth aged 11–24 and follow them every six months for five years. The study collects detailed information on diagnoses, substance use, functioning, suicidal thoughts and behaviors, and health service utilization. Importantly, the project was co-designed with patients and caregivers and involved extensive clinician engagement to ensure that assessments are relevant and actionable within clinical settings.
Embedding research in routine care allows clinicians to use assessment results immediately to inform decisions about treatment plans, supports, and referrals. The patient-facing dashboard gives youth direct access to their research findings, increasing transparency and supporting collaborative care planning.
Implications and future directions
Early findings demonstrate the feasibility of comprehensive clinical phenotyping in youth who present for mental health care and reveal a higher-than-expected burden of psychosis spectrum symptoms in this clinical population. Tracking these youth over time will help clarify whether symptoms follow chronic or episodic patterns, how symptoms relate to developmental milestones and environmental stressors, and whether service changes influence outcomes.
The study’s goals are to refine strategies for early identification, to complement existing screening approaches, and to inform interventions that could reduce long-term disability and suicide risk. The cohort also creates opportunities for graduate students and researchers to develop targeted sub-studies that advance understanding of youth mental health and improve outcomes.
About this psychosis and neurodevelopment research news
Author: Rebecca Biason
Source: University of Toronto
Contact: Rebecca Biason – University of Toronto
Image credit: Neuroscience News
Original Research (open access): “The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality” by Kristin Cleverley et al., Biological Psychiatry.
Abstract (condensed)
Background
Psychosis spectrum symptoms appear in a substantial proportion of youth and are linked to poorer cognitive performance, reduced functioning, and greater suicidality. These symptoms may be more common among youth who already have other mental health diagnoses. The TAY Cohort Study aims to chart developmental trajectories in clinically referred youth and to examine how psychosis-spectrum symptoms relate to functioning and suicidality over time.
Methods
The TAY Cohort is a longitudinal study targeting 1,500 youths aged 11–24 who present to tertiary mental health services. The study uses comprehensive assessments of psychopathology, substance use, functioning, suicidality, and service use, with follow-up assessments every six months for five years. Early baseline data are presented from the first enrolled participants.
Results
Between May 4, 2021, and February 2, 2023, 417 participants were enrolled. On average participants met criteria for 3.5 psychiatric diagnoses, with anxiety and depressive disorders most common. Approximately 49% met the threshold for psychosis spectrum symptoms and showed greater functional impairment, more internalizing and externalizing symptoms, and higher suicidality than those without such symptoms.
Conclusions
Early results confirm that extensive clinical phenotyping in help-seeking youth is feasible and reveal a higher PSS prevalence than seen in community samples. These findings support the need for longitudinal study of clinical youth cohorts to better understand risk for psychosis, functional outcomes, and suicidality, and to develop improved early identification and intervention strategies.