• coping;
  • psychosis prodrome;
  • psychosocial functioning;
  • ultra high risk



There is a wealth of evidence suggesting that patients with schizophrenia tend to respond to life stressors using less effective coping skills, which are in turn related to poor outcome. However, the contribution of coping strategies to outcome in youth at clinical high risk (CHR) for developing psychosis has not been investigated.


This longitudinal study followed CHR youth over a 12-month period, using the Brief COPE questionnaire. CHR subjects (n = 88) were compared at baseline with a healthy control sample (n = 53), and then mixed models were used to explore the relationship of coping strategies to clinical and psychosocial outcomes in CHR subjects over time (n = 102).


Cross-sectional analyses revealed that, in comparison with healthy controls, CHR youth reported using more maladaptive coping strategies (P < 0.001) and fewer adaptive coping strategies (P < 0.01). Longitudinal analyses within the CHR group showed significant decreases in maladaptive coping and symptom severity over time, with corresponding improvements in social and role functioning. Adaptive coping was associated with better concurrent social functioning and less severe symptomatology (both P < 0.001). Over time, more maladaptive coping was associated with more severe positive and negative symptoms (both P < 0.005).


Youth at risk for psychosis report using fewer adaptive and more maladaptive coping strategies relative to healthy controls. Over 1-year follow-up, more adaptive coping styles are associated with less severe clinical symptomatology and better social functioning. These findings suggest that teaching adaptive coping styles may be an important target for intervention in youth at high risk for psychosis.