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Moving from risk to resilience in psychosis research

Nature Reviews Psychology volume 2, pages 537–555 (2023)Cite this article

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Abstract

Psychosis research has traditionally focused on vulnerability and the detrimental outcomes of risk exposure. However, there is substantial variability in psychological and functional outcomes for those at risk for psychosis, even among individuals at high risk. Comparatively little work has highlighted the factors associated with resilience and the processes that might avert serious mental illness and promote positive outcomes. In this Review, we first discuss the prevailing risk-based approach to psychosis. We then outline a resilience-based approach by defining multisystemic mental health resilience and considering what constitutes a positive outcome. We examine evidence of biological, psychological, social and environmental protective and promotive factors that might confer resilience in the context of psychosis risk. A greater understanding of the factors and processes implicated in resilience has the potential to inform psychosis intervention and prevention efforts at multiple levels, including individuals, institutions and policy-making.

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Fig. 1: Trajectories of psychosis risk and resilience.
Fig. 2: Protective and promotive factors across the biopsychosocial–ecological system.

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Acknowledgements

The authors would like to thank J. Bao and J. Fattal for their help with the literature search.

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Authors and Affiliations

  1. Department of Psychology, Michigan State University, East Lansing, MI, USA

    Katharine N. Thakkar, William J. Chopik & S. Alexandra Burt

  2. Department of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA

    Katharine N. Thakkar

  3. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA

    Amanda McCleery

  4. Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA

    Amanda McCleery

  5. Semel Institute for Neuroscience and Human Behavior, University of California — Los Angeles, Los Angeles, CA, USA

    Amanda McCleery

  6. Department of Psychology, Indiana University — Purdue University Indianapolis, Indianapolis, IN, USA

    Kyle S. Minor

  7. Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Junghee Lee

  8. Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Junghee Lee

  9. Department of Psychology, University of York, York, UK

    Clara S. Humpston

  10. Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom

    Clara S. Humpston

  11. Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI, USA

    Amber L. Pearson

  12. Department of Public Health, University of Otago, Wellington, New Zealand

    Amber L. Pearson

  13. Resilience Research Centre, Dalhousie University, Halifax, Canada

    Michael Ungar

  14. Department of Psychology, Vanderbilt University, Nashville, TN, USA

    Sohee Park

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  1. Katharine N. Thakkar
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Contributions

K.N.T., A.McC., K.S.M., C.S.H. and S.P. wrote the article. All authors researched data for the article, contributed substantially to discussion of the content, and reviewed and/or edited the manuscript before submission.

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Correspondence to Katharine N. Thakkar.

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Nature Reviews Psychology thanks Thomas Kwapil and Angus Macbeth for their contribution to the peer review of this work.

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Thakkar, K.N., McCleery, A., Minor, K.S. et al. Moving from risk to resilience in psychosis research. Nat Rev Psychol 2, 537–555 (2023). https://doi.org/10.1038/s44159-023-00205-9

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