About

Nicholas Breitborde, PhD, is a psychologist and professor at Ohio State University Wexner Medical Center, specializing in the development, delivery, and dissemination of specialized clinical interventions for youth and young adults experiencing early in the course of a psychotic disorder or early warning signs of a burgeoning psychotic disorder. He established and directs the Ohio State Early Psychosis Intervention Center (EPICENTER), which is one of the largest specialized clinical programs for individuals with first-episode psychosis in the United States. His research focuses on schizophrenia, unipolar depressive disorders, major depressive disorder, bipolar affective disorder, and all-cause mortality for the Global Burden of Disease (GBD) Study. Dr. Breitborde is a content area expert in psychotic disorders and has been involved in national efforts such as the American Psychological Association Task Force on Serious Mental Illness and Severe Emotional Disturbances. His work has been cited more than 21,000 times and has received funding from agencies including the National Institute for Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA). He earned his Doctor of Philosophy degree from the University of California Los Angeles and is committed to advancing mental health treatment and research.

Research topics

• Medicine
• Environmental health
• Demography
• Political Science
• Economics
• Business
• Gerontology
• Geography
• Psychology
• Economic growth
• Virology
• Nursing

Selected publications

• Incidence of First-Episode Psychosis Among Privately Insured Individuals

  Psychiatric Services · 2026-01-15 · 1 citations

  article1st authorCorresponding

  OBJECTIVE: Accurate estimates of incidence rates of first-episode psychosis (FEP) are needed to support coordinated specialty care (CSC) programs in determining the staffing and resources needed to meet the local demand for care. The goal of this study was to examine incidence rates of FEP among privately insured individuals. METHODS: The authors examined data from IBM MarketScan to identify individuals with a FEP diagnosis between 2013 and 2021 (N=86,695). RESULTS: Between 2013 and 2021, the median annual incidence rate of FEP was 80.54 per 100,000 individuals ages 15-40, with a higher incidence rate among men than women. However, incidence rates for women increased significantly between 2013 and 2021, whereas rates for men did not. CONCLUSIONS: Despite the finding of a lower incidence rate of FEP than previously reported, when compared with national enrollment data for CSC teams, these data suggest that >90% of Americans with FEP do not access CSC.

  PublisherDOI

• Psychiatric Hospitalization After Enrollment in Coordinated Specialty Care: Unexpected Gender- and Age-Related Disparities

  Schizophrenia Bulletin · 2025-06-20

  articleOpen access

  BACKGROUND AND HYPOTHESES: Hospitalization is common during first-episode psychosis (FEP) and is linked to functional decline, stigma, and healthcare burden. Coordinated Specialty Care (CSC) programs aim to reduce hospitalization and improve outcomes through early, multidisciplinary intervention. This study examined hospitalization outcomes and predictors among participants in the Academic Community Early Psychosis Intervention Network that included 6 CSCs in the United States. STUDY DESIGN: Participants with FEP (N = 701; mean age = 21.6 years, 64% male) were followed after CSC admission, with analyses restricted to the first 24 months. Primary outcomes included time to first hospitalization, number of hospitalizations, and length of stay (LOS). Kaplan-Meier survival and multivariable Cox regression examined predictors of time to first hospitalization, while negative binomial regression assessed hospitalization frequency and LOS. STUDY RESULTS: Hospitalization rates declined after CSC enrollment. Females had shorter time to first hospitalization (HR = 2.79, 95% CI, 1.16-6.74) and more frequent admissions (IRR = 1.43, 95% CI, 1.10-1.85) than males. Younger age also predicted earlier (HR = 0.80, 95% CI, 0.67-0.95) and more frequent hospitalizations (IRR = 0.70 per 5 years, 95% CI, 0.58-0.84). Prior hospitalization predicted more admissions (IRR = 4.89, 95% CI, 3.32-7.19) and longer LOS (RR = 10.54, 95% CI, 6.70-16.59). Black/African American participants had longer LOS than White participants (RR = 1.59, 95% CI, 1.08-2.34). CONCLUSIONS: While hospitalization declined after CSC entry, females, younger individuals, and those with prior admissions remain at elevated risk. These findings underscore the need for tailored strategies to mitigate disparities and optimize early psychosis care.

  PublisherOA PDFDOI

• Baseline Clinical Characterization of Participants in the Accelerating Medicines Partnership Schizophrenia Program

  Schizophrenia Bulletin Open · 2025-01-01

  articleOpen access

  Background: This paper focuses on the baseline clinical characterization of the participants in the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program. The AMP SCZ program is designed to investigate a wide array of clinical variables and biomarkers in a total of 2040 clinical high-risk (CHR) participants and 652 community control (CC) participants. Methods: The dataset analyzed includes 1642 individuals at clinical high risk for psychosis and 519 CCs. Key measures include the Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the Structured Interview for Psychosis-Risk Syndromes, which determined CHR criteria and the severity of attenuated psychotic symptoms (APS). Other measures included the Structured Clinical Interview for DSM-5, scales to assess negative symptoms, depression, suicidal ideation, substance use, social and role functioning, and a selection of patient-reported outcomes. Results: CHR participants presented with more severe ratings on all clinical measures and poorer functioning relative to the CC. There were a few significant small associations between measures of APS and other clinical measures. Conclusion: The results from this study support previous research indicating that CHR individuals face serious clinical challenges beyond the risk of developing psychosis. Findings indicate significant associations among various clinical measures, underscoring the complex nature of the CHR population. Limitations are acknowledged, including the preliminary nature of the data and the need for more in-depth analyses from AMP SCZ papers already in progress. Future work will focus on longitudinal data and further exploration of clinical variables and their relationship with biomarkers.

  PublisherDOI

• The electroencephalography protocol for the Accelerating Medicines Partnership® Schizophrenia Program: Reliability and stability of measures

  UNC Libraries · 2025-12-05

  articleOpen access

  Individuals at clinical high risk for psychosis (CHR) have variable clinical outcomes and low conversion rates, limiting development of novel and personalized treatments. Moreover, given risks of antipsychotic drugs, safer effective medications for CHR individuals are needed. The Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ) Program was launched to address this need. Based on past CHR and schizophrenia studies, AMP SCZ assessed electroencephalography (EEG)-based event-related potential (ERP), event-related oscillation (ERO), and resting EEG power spectral density (PSD) measures, including mismatch negativity (MMN), auditory and visual P300 to target (P3b) and novel (P3a) stimuli, 40-Hz auditory steady state response, and resting EEG PSD for traditional frequency bands (eyes open/closed). Here, in an interim analysis of AMP SCZ EEG measures, we assess test-retest reliability and stability over sessions (baseline, month-2 follow-up) in CHR (n = 654) and community control (CON; n = 87) participants. Reliability was calculated as Generalizability (G)-coefficients, and changes over session were assessed with paired t-tests. G-coefficients were generally good to excellent in both groups (CHR: mean = 0.72, range = 0.49–0.85; CON: mean = 0.71, range = 0.44–0.89). Measure magnitudes significantly (p < 0.001) decreased over session (MMN, auditory and visual target P3b, visual novel P3a, 40-Hz ASSR) and/or over runs within sessions (MMN, auditory/visual novel P3a and target P3b), consistent with habituation effects. Despite these small systematic habituation effects, test-retest reliabilities of the AMP SCZ EEG-based measures are sufficiently strong to support their use in CHR studies as potential predictors of clinical outcomes, markers of illness progression, and/or target engagement or secondary outcome measures in controlled clinical trials.

  PublisherDOI

• Cognitive assessment in the Accelerating Medicines Partnership® Schizophrenia Program: harmonization priorities and strategies in a diverse international sample

  UNC Libraries · 2025-12-05

  articleOpen access
  PublisherDOI

• Ecological Momentary Assessment of Emotion Regulation and Suicidal Ideation in First-Episode Psychosis

  Schizophrenia Bulletin · 2025-03-11 · 3 citations

  articleOpen access

  Individuals with first-episode psychosis (FEP) are at increased risk for suicide, though few studies have examined the extent to which emotion regulation abnormalities contribute to this risk. The current study sought to address this gap by examining which stages of emotion regulation (ie, identification, selection, implementation) are related to suicidal ideation among individuals with FEP. Forty-one participants completed 28 days of ecological momentary assessment to assess suicidal ideation, negative affect, and emotion regulation in real-time. Results indicated that all 3 stages of emotion regulation were related to suicidal ideation in FEP. Specifically, within-person emotion regulation interacted with between-person negative affect to predict concurrent suicidal ideation (identification stage). Additionally, decreased use of adaptive strategies and increased use of maladaptive strategies were associated with more severe suicidal ideation (selection stage). Finally, decreased emotion regulation effectiveness was associated with more severe suicidal ideation (implementation stage). These findings suggest that emotion regulation difficulties might contribute to the high rates of suicide risk among individuals with FEP. Additional research is needed to determine whether these emotion regulation difficulties are unique to FEP or if they also appear in other high-risk groups.

  PublisherOA PDFDOI

• Psychiatric Hospitalization After Enrollment in Coordinated Specialty Care: Unexpected Gender and Age Related Disparities

  medRxiv · 2025-11-06

  preprintOpen access

  ABSTRACT Background and hypotheses Hospitalization is common during first-episode psychosis (FEP) and is linked to functional decline, stigma, and healthcare burden. Coordinated Specialty Care (CSC) programs aim to reduce hospitalization and improve outcomes through early, multidisciplinary intervention. This study examined hospitalization outcomes and predictors among participants in the Academic Community Early Psychosis Intervention Network (AC-EPINET), a multisite CSC hub in the United States. Study design Participants with FEP (N = 701; mean age = 21.6 years, 64% male) were followed after CSC admission, with analyses restricted to the first 24 months. Primary outcomes included time to first hospitalization, number of hospitalizations, and length of stay (LOS). Kaplan-Meier survival and multivariable Cox regression examined predictors of time to first hospitalization, while negative binomial regression assessed hospitalization frequency and LOS. Study results Hospitalization rates declined after CSC enrollment. Females had shorter time to first hospitalization (HR = 2.96, 95% CI [1.24–7.10]) and more frequent admissions (IRR = 1.38, 95% CI [1.06–1.79]) than males. Younger age also predicted earlier (HR = 0.80, 95% CI [0.67–0.95]) and more frequent hospitalizations ( IRR = 0.70 per 5 years, 95% CI [0.58–0.84]). Prior hospitalization predicted more admissions (IRR = 4.83, p < .0001) and longer LOS (RR = 10.72, p < .0001). Black/African American participants had longer LOS than White participants (RR = 1.67, p = .01). Conclusions While CSC reduces overall hospitalization risk, females, younger individuals, and those with prior admissions remain at elevated risk. These findings underscore the need for tailored strategies to mitigate disparities and optimize early psychosis care.

  PublisherOA PDFDOI

• Sample Ascertainment and Recruitment Sources in the Accelerating Medicines Partnership Schizophrenia Program

  Schizophrenia Bulletin Open · 2025-01-01

  articleOpen access

  Background: This paper presents the recruitment sources of clinical high-risk (CHR) and community controls (CC) from the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program, which aims to study various clinical variables and biomarkers in 2040 CHR and 652 CC participants. Methods: A total of 1640 CHR and 514 CC had recruitment source data. The Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the SIPS was utilized to assess CHR criteria and severity of attenuated psychotic symptoms (APSs), and the Global Functioning: Social Scale was used for social functioning. Participants were recruited through various methods, including referrals from healthcare providers, schools, and community agencies, and self-referrals via outreach efforts and advertising. Results: Participants were recruited from 13 different sources, with self-referral being the most common for both CHR and CC. Other notable sources included child and youth services and psychiatric hospitals and departments. Regional differences in recruitment patterns were observed across continents. Differences in age, APS, and social functioning for CHR participants were examined in the top 5 recruitment sources. Overall, self-referred individuals were typically older, with less severe APS and higher levels of functioning, whereas those from adult community mental health services had poorer functioning and more severe APS. The remaining recruitment groups fell between these 2 extremes. Conclusion: This paper highlights the diverse recruitment sources for the AMP SCZ program. Self-referral was a significant source, particularly in North America, reflecting changing help-seeking behaviors influenced by the internet and social media. The findings underscore the importance of understanding recruitment sources to optimize future CHR research.

  PublisherDOI

• Understanding Capacity to Treat First Episode Psychosis with a Hybrid Telemental Health Delivery Model: A Needs Assessment of Ohio Community Mental Health Centers

  Administration and Policy in Mental Health and Mental Health Services Research · 2025-03-28 · 1 citations

  articleOpen access

  Coordinated specialty care (CSC) is considered the gold-standard treatment for individuals experiencing first episode psychosis (FEP). However, CSC teams are resource-intensive, motivating the development of a hybrid delivery approach where community mental health centers (CMHCs) collaborate with an academic medical center to deliver a mix of in-person and virtual services. To inform the development of this hybrid approach, a needs assessment was conducted, evaluating the existing capacity of Ohio CMHCs to treat FEP and identifying barriers to expanded use of telemental health. CMHC administrators throughout Ohio whose agencies primarily provide mental health services were surveyed using a novel instrument. A concurrent mixed methods approach combined multivariable analysis of cross-sectional survey data with thematic coding of responses to open-ended questions. The 56 responding CMHCs on average offered 10.96 of 17 services associated with CSC for FEP. Agency size was positively associated with number of service offerings, but rurality was not. Most agencies perceived gaps in their care for patients with FEP, particularly rural CMHCs. 75% believed that telemental health service expansion would benefit patients. Thematic analysis revealed three success factors for expanded telemental health usage: adapting care to virtual assessment, ensuring patient access, and adjusting workflows for virtual delivery. Responding CMHCs generally agreed that care for individuals with FEP could be improved and saw potential in expanded use of virtual services. Hybrid models may represent a valuable opportunity to overcome conventional barriers to CSC availability, but their development must account for current CMHC resource infrastructure and workflows.

  PublisherOA PDFDOI

• Imposters, Bots, and Other Threats to Data Integrity in Online Research: A Review of the Literature and Recommendations for Best Practices (Preprint)

  2025-01-06

  reviewOpen access

  <sec> <title>BACKGROUND</title> Threats to data integrity have always existed in online human subjects research, but it appears these threats have become more common and more advanced in recent years. Researchers have proposed various techniques to address bots, fraudulent participants, repeat participants, and satisficers, yet no review of this literature has been conducted. </sec> <sec> <title>OBJECTIVE</title> To synthesize and evaluate the recent research published on methods for addressing threats to data integrity in online research. </sec> <sec> <title>METHODS</title> We conducted a comprehensive review of the literature addressing threats to data integrity in online research. Ninety articles were ultimately reviewed and coded. </sec> <sec> <title>RESULTS</title> Findings revealed that techniques to authenticate personal information (e.g., videoconferencing, mailing incentives to a physical address) were discussed by 47% of the articles and appear to be very effective at deterring or identifying fraudulent participants. Yet such techniques also come with ethical considerations, including participant burden and increased threats to privacy. Other techniques, such as reCAPTCHA scores and checking IP addresses, although very common, were also deemed by several researchers as no longer sufficient protections against advanced threats to data integrity. </sec> <sec> <title>CONCLUSIONS</title> Overall, this review demonstrates the importance of shifting online research protocols as bots and fraudulent participants become more sophisticated. </sec>

  PublisherDOI

Recent grants

• NIH Grant F31MH071054

  NIH · $19k · 2006

Frequent coauthors

• G Anil Kumar

  306 shared

• Simon I Hay

  286 shared

• Christopher J L Murray

  University of Washington

  282 shared

• Khurshid Alam

  Murdoch University

  279 shared

• Ferrán Catalá-López

  Institute for Health Metrics and Evaluation

  274 shared

• Ted R. Miller

  273 shared

• Mustafa Z Younis

  272 shared

• Jost B. Jonas

  University of Washington

  272 shared

Awards & honors

• Ohio State Early Psychosis Intervention Center (EPICENTER)