The ENTER Study (E-DetectioN Tool for Emerging Mental DisoRders): General Population Recruitment and Data Integrity in Online Screening for Psychosis Risk

Phoebe Wallman^1*Andrés Estradé¹Matilda Azis¹Kate Haining²Xinyi Liang¹Thomas John Spencer^1,3Kelly Diederen¹Umberto Provenzani⁴Peter J Uhlhaas^5,6Paolo Fusar-Poli^1,3,4

• ¹Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
• ²School of Psychology and Neuroscience, Glasgow, United Kingdom
• ³Outreach and Support in South-London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
• ⁴Department of Brain and Behavioral Sciences, Università di Pavia, Pavia, Italy
• ⁵Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
• ⁶School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom

Introduction: Effective detection of young people at clinical high-risk for psychosis (CHR-P) is one of the rate-limiting steps in improving outcomes through preventive treatment. ENTER (E-DetectioN Tool for Emerging Mental DisoRders) was developed to refine and increase the specificity of e-detection strategies to identify young people in the community who might be exhibiting emerging symptoms of psychosis. The paper aimed to outline the ENTER procedure, data validation process and characteristics of the self-selected sample. Methods: The ENTER study was conducted across sites in London, Glasgow (UK) and Pavia (Italy). Participants aged 12-35 in the general population were recruited through universities, colleges, flyers and social media. The online screener collected data on demographics, cognition, speech, environmental risk and protective factors and frequent subthreshold features which characterise emerging psychotic disorders. Results: A total of 8,009 participants completed the screener over a period of three years. However, only 2,540 responses (32%) were deemed valid. The mean age of participants was 23 years old. The majority were female (77%), identified as white (70%), and had some experience in higher education (82%). Nearly half of the valid sample (48%) scored ≥6 on the Prodromal Questionnaire (PQ-16). Discussion: The proportion of participants scoring ≥6 on the PQ-16 is consistent with findings from other European studies in general population and outpatient mental health settings. The procedures and sample characteristics reported here provide context for further analyses using the ENTER tool. Additionally, the findings highlight the considerable challenge of fraudulent and inauthentic responses in online research—an issue that may have been amplified by the use of financial incentives and recruitment via social media.