Polygenic risk scores (PRS) can be used to estimate a person’s relative genetic risk for health conditions like psychiatric disorders, which involve many regions of the genome. PRS could potentially be useful in psychiatry, and specifically child and adolescent psychiatry, as they may help identify people at increased risk for a psychiatric condition and lead to interventions that could help prevent, delay onset, or mitigate the effects of mental illness. However, the potential for genetic discrimination, exacerbation of mental illness stigma, and the unknown impact of disclosing PRS to patients at increased risk for psychiatric disorders have been cited as concerns with integrating PRS into psychiatry. Given the potential utility of PRS, their documented presence in U.S. psychiatric clinical care settings, and the large investment in many predictive psychiatry tools, it is critical to analyze the perspectives of stakeholders like child and adolescent psychiatrists (CAP) as likely gatekeepers and interpreters of psychiatric PRS results. We conducted thematic content analysis of 23 interviews with CAP focused on PRS application now and in the future. CAP (11/23) emphasized that they would need to see improved accuracy and/or evidence of utility of psychiatric PRS before implementation. When prefaced with a future-oriented scenario in which PRS are accurate and applicable across ancestral groups, clinicians thought they would use PRS for complex cases where diagnosis is uncertain (6/23), but also anticipated negative impacts to arise from clinician misunderstanding and misuse (13/23), and felt that clinician education is critical to ensuring PRS are managed responsibly (8/23).
Authors: Page Trotter, Center for Medical Ethics and Health Policy, Baylor College of Medicine; Amanda Merner, Center for Bioethics, Harvard Medical School; Lauren Ginn, Rice University; Abigail Celeste Martinez, Center for Medical Ethics and Health Policy, Baylor College of Medicine; Ana Lucía Battaglino, Center for Bioethics, Harvard Medical School; Tiffany Campbell, Center for Bioethics, Harvard Medical School; Takahiro Soda, Department of Psychiatry, University of Florida; Eric Storch. Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine; Stacey Pereira, Center for Medical Ethics and Health Policy, Baylor College of Medicine; Gabriel Lázaro-Muñoz, Center for Bioethics, Harvard Medical School
