Youth psychotic experiences: psychometric evaluation and diagnostic associations of the CAPE-16 in adolescents from the Norwegian Mother, Mather and Child Cohort.

Abstract

BACKGROUND Adolescent self-reported psychotic experiences are associated with mental illness and could help guide prevention strategies. Youth report substantially more experiences than adults. However, with large societal changes like the digital revolution and COVID-19 pandemic, existing questionnaires may no longer accurately capture youth experiences. We aimed to determine the ability of the CAPE-16 questionnaire in capturing psychotic experiences across contexts (biological sex and COVID-19 response) and generations, thereby validating important psychometric aspects of the tool in modern adolescents. METHODS We used data from the Norwegian Mother, Father and Child Study (MoBa), a population-based pregnancy cohort. Adolescents responded to the CAPE-16 questionnaire (n = 18,835). For a comparison between age groups, we included adult men from the parent generation who responded to the CAPE-9 (n = 28,793). We investigated the psychometric properties of CAPE-16 through confirmatory factor analyses, measurement invariance testing across biological sex, response before/during the COVID-19 pandemic, and generations (adolescents and fathers), and examined subscale and item-level associations with subsequent registry-based psychiatric diagnoses (average time between CAPE and last registry update: 3.68 ± 1.34 years). RESULTS Out of 18,835 adolescents, 33.2% reported lifetime psychotic experiences. We confirmed a three-factor structure (paranoia, bizarre thoughts, and hallucinations) and good subscale reliability (ω = .86 and .90). CAPE-16 scores were stable across biological sex and pandemic status. CAPE-9 response patterns were non-invariant across adolescents and adult men, with an item related to digital technology particularly prone to bias. CAPE-16 subscales were associated with subsequent psychiatric diagnoses, especially psychotic disorders. CONCLUSIONS CAPE-16 is a reliable measure of psychotic experiences across sex and a major societal stressor in adolescents. More frequent and distressing experiences increase the risk of subsequent psychiatric diagnoses. Different response patterns between adults and adolescents for items related to digital technology suggest differences in interpretation. Hence, certain items may benefit from revisions.