Moving from risk to resilience in psychosis research

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. Psychosis research has traditionally focused on vulnerability and the detrimental outcomes of risk exposure. In this Review, Thakkar et al. consider an alternative resilience-based approach focused on resources and strengths that might help protect against negative illness course among people at risk.