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A set of clinical criteria, the Clinical High At-Risk Mental State (CHARMS) criteria, have been developed to identify symptomatic young people who are at-risk of disorder progression. The current study aimed to validate the CHARMS criteria by testing whether they prospectively identify individuals at-risk of progressing from attenuated symptomatology to a first episode of serious mental disorder, namely first episode psychosis, first episode mania, severe major depression, and borderline personality disorder. 121 young people completed clinical evaluations at baseline, 6- and 12-month follow-up. The Kaplan-Meier method was used to assess transition rates. Cox regression and LASSO were used to examine baseline clinical predictors of transition. Linear mixed effects modelling was used to examine symptom severity. 28% of CHARMS+ individuals transitioned to a Stage 2 disorder by 12-month follow-up. The CHARMS+ group had more severe symptoms at follow-up than the CHARMS- group. 96% of Stage 2 transitions were initially to severe depression. Meeting criteria for multiple CHARMS subgroups was associated with higher transition risk: meeting one at-risk group = 24%; meeting two at-risk groups = 17%, meeting three at-risk groups = 55%, meeting four at-risk groups = 50%. The strongest baseline predictor of transition was severity of depressive symptoms. The CHARMS criteria identified a group of individuals at risk of imminent onset of severe mental disorder, particularly severe depression. Larger scale studies and longer follow-up periods are required to validate and extend these findings.

Highlights:
• 28% of Stage 1b (CHARMS+) individuals transitioned to a Stage 2 disorder by 12- month follow-up.
• The Stage 1b (CHARMS+) group had more severe symptoms at follow-up than the CHARMS- group.
• 96% of Stage 2 transitions were initially to severe depression.
• Meeting criteria for multiple CHARMS subgroups was associated with higher transition risk.
• The strongest baseline predictor of transition was severity of depressive symptoms.
• The CHARMS criteria identified a group of individuals at-risk of imminent onset of severe mental disorder, particularly severe depression.