Prevalence of Individuals at Clinical High-Risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-Analysis.

Brain Sci

Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AB, UK.

Published: November 2021

(1) The consistency and magnitude of the prevalence of Clinical High-Risk for Psychosis (CHR-P) individuals are undetermined, limiting efficient detection of cases. We aimed to evaluate the prevalence of CHR-P individuals systematically assessed in the general population or clinical samples. (2) PRISMA/MOOSE-compliant (PROSPERO: CRD42020168672) meta-analysis of multiple databases until 21/01/21: a random-effects model meta-analysis, heterogeneity analysis, publication bias and quality assessment, sensitivity analysis-according to the gold-standard CHR-P and pre-screening instruments-leave-one-study-out analyses, and meta-regressions were conducted. (3) 35 studies were included, with 37,135 individuals tested and 1554 CHR-P individuals identified (median age = 19.3 years, Interquartile range (IQR) = 15.8-22.1; 52.2% females, IQR = 38.7-64.4). In the general population (k = 13, = 26,835 individuals evaluated), the prevalence of the CHR-P state was 1.7% (95% Confidence Interval (CI) = 1.0-2.9%). In clinical samples (k = 22, = 10,300 individuals evaluated), the prevalence of the CHR-P state was 19.2% (95% CI = 12.9-27.7%). Using a pre-screening instrument was associated with false negatives (5.6%, 95% CI = 2.2-13.3%) and a lower CHR-P prevalence (11.5%, 95% CI = 6.2-20.5%) compared to using CHR-P instruments only (28.5%, 95% CI = 23.0-34.7%, = 0.003). (4) The prevalence of the CHR-P state is low in the general population and ten times higher in clinical samples. The prevalence of CHR-P may increase with a higher proportion of females in the general population and with a younger population in clinical samples. The CHR-P state may be unrecognized in routine clinical practice. These findings can refine detection and preventive strategies.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615691PMC
http://dx.doi.org/10.3390/brainsci11111544DOI Listing

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