An Ecological Systems Perspective on the Clinical High Risk State Preceding Schizophrenia Onset

Developments in psychosis-risk assessment over recent decades have made it possible to identify a "clinical high risk" population that has a substantially elevated likelihood of developing a psychotic disorder relative to the general population. The expanding body of research on the clinical high risk population has identified risk and protective factors from a variety of environmental sources ranging from the immediate, such as social function and daily hassles, to the more distal, such as mental health policy and societal stigma. An ecological model of the psychosis-risk state would facilitate an understanding of the complex and interactive processes that contribute to the attenuated psychotic symptoms and decline in function that characterize someone as being at clinical high risk. The present article reviews clinical high risk research on social factors operating at various levels within the ecological systems framework, as defined by Bronfenbrenner (1977). An ecological model allows integration across levels of social influences that may directly or indirectly serve as risk or protective factors for the individual, thereby contributing to the onset or prevention of a full psychotic disorder.