What is the duration of untreated psychosis worldwide? - A meta-analysis of pooled mean and median time and regional trends and other correlates across 369 studies.
Por:
Salazar de Pablo G, Aymerich C, Guinart D, Catalan A, Alameda L, Trotta G, Armendáriz Lacasa A, Martinez Baringo E, Soler-Vidal J, Rubio JM, Garrido-Torres N, Gómez-Vallejo S, Kane JM, Howes O, Fusar-Poli P and Correll CU
Publicada:
13 dic 2023
Ahead of Print:
13 dic 2023
Resumen:
Duration of untreated psychosis (DUP) has been associated with poor mental health outcomes. We aimed to meta-analytically estimate the mean and median DUP worldwide, evaluating also the influence of several moderating factors. This PRISMA/MOOSE-compliant meta-analysis searched for non-overlapping individual studies from inception until 9/12/2022, reporting mean ± s.d. or median DUP in patients with first episode psychosis (FEP), without language restrictions. We conducted random-effect meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO:CRD42020163640). From 12 461 citations, 369 studies were included. The mean DUP was 42.6 weeks (95% confidence interval (CI) 40.6-44.6, k = 283, n = 41 320), varying significantly across continents (p < 0.001). DUP was (in descending order) 70.0 weeks (95% CI 51.6-88.4, k = 11, n = 1508) in Africa; 48.8 weeks (95% CI 43.8-53.9, k = 73, n = 12 223) in Asia; 48.7 weeks (95% CI 43.0-54.4, k = 36, n = 5838) in North America; 38.6 weeks (95% CI 36.0-41.3, k = 145, n = 19 389) in Europe; 34.9 weeks (95% CI 23.0-46.9, k = 11, n = 1159) in South America and 28.0 weeks (95% CI 20.9-35.0, k = 6, n = 1203) in Australasia. There were differences depending on the income of countries: DUP was 48.4 weeks (95% CI 43.0-48.4, k = 58, n = 5635) in middle-low income countries and 41.2 weeks (95% CI 39.0-43.4, k = 222, n = 35 685) in high income countries. Longer DUP was significantly associated with older age (ß = 0.836, p < 0.001), older publication year (ß = 0.404, p = 0.038) and higher proportion of non-White FEP patients (ß = 0.232, p < 0.001). Median DUP was 14 weeks (Interquartile range = 8.8-28.0, k = 206, n = 37 215). In conclusion, DUP is high throughout the world, with marked variation. Efforts to identify and intervene sooner in patients with FEP, and to promote global mental health and access to early intervention services (EIS) are critical, especially in developing countries.
Filiaciones:
Salazar de Pablo G:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
Aymerich C:
Psychiatry Department, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Barakaldo, Bizkaia, Spain
Guinart D:
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
Institute of Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
Institut de Salut Mental, Hospital del Mar Research Institute (CIBERSAM), Barcelona, Spain
Catalan A:
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Psychiatry Department, Basurto University Hospital, Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Barakaldo, Bizkaia, Spain
Alameda L:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
TiPP Program Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
University Hospital Virgen del Rocio-IBIS Sevilla, CIBERSAM, ISCIII Spanish Network for Research in Mental Health, Sevilla, Spain
Trotta G:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Armendáriz Lacasa A:
Unidad Terapéutica Centre Educatiu Els Til·lers, Parc Sanitari Sant Joan de Déu, Barcelona
Grup MERITT: Etiopatogènia i tractament dels trastorns mentals greus
Martinez Baringo E:
Department of Psychiatry and Psychology, Hospital Sant Joan de Déu de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
Soler-Vidal J:
FIDMAG Germanas Hospitalàries Research Foundation, Barcelona, Spain
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
Hospital Benito Menni CASM, Hermanas Hospitalarias, Sant Boi de Llobregat, Spain
Rubio JM:
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
Institute of Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
Garrido-Torres N:
University Hospital Virgen del Rocio-IBIS Sevilla, CIBERSAM, ISCIII Spanish Network for Research in Mental Health, Sevilla, Spain
Gómez-Vallejo S:
Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
Kane JM:
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
Institute of Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
Howes O:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Faculty of Medicine, Institute of Clinical Sciences, Imperial College London, London, UK
Fusar-Poli P:
Department of Psychosis Studies, King's College London, UK
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Berlin, Germany
Correll CU:
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA
Institute of Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Berlin, Germany
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