Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of 9 psychosis: the case for transdiagnostic assessment

TY - JOUR

T1 - Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of 9 psychosis: the case for transdiagnostic assessment

AU - Solmi, Marco

AU - Soardo, Livia

AU - Kaur, Simi

AU - Azis, Matilda

AU - Cabras, Anna

AU - Censori, Marco

AU - Fausti, Luigi

AU - Besana, Filippo

AU - Salazar de Pablo, Gonzalo

AU - Fusar-Poli, Paolo

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. We conducted a PRISMA/MOOSE-compliant systematic meta-analysis, searching PubMed/PsycInfo up to June 21st, 2021 for observational studies/randomized controlled trials reporting on comorbid DSM/ICD-mental disorders in CHR-P subjects (protocol). The primary and secondary outcomes were baseline and follow-up prevalence of comorbid mental disorders. We also explored the association of comorbid mental disorders compared with CHR-P versus psychotic/non-psychotic control groups, their impact on baseline functioning and transition to psychosis. We conducted random-effects meta-analyses, meta-regression, and assessed heterogeneity/publication bias/quality (Newcastle Ottawa Scale, NOS). We included 312 studies (largest meta-analysed sample=7,834, any non-psychotic mental disorders, mean age=19.98 (3.40), females=43.9%, overall NOS>7 in 77.6% of studies). The prevalence was 0.78 (95%CI=0.73-0.82, k=29) for any comorbid mental disorder, 0.60 (95%CI=0.36-0.84, k=3) for anxiety/mood disorders, 0.44 (95%CI=0.39-0.49, k=48) for any mood disorders, 0.38 (95%CI=0.33-0.42, k=50) for any depressive disorder/episode, 0.34 (95%CI=0.30-0.38, k=69) for any anxiety disorder, 0.30 (95%CI 0.25-0.35, k=35) for major depressive disorders, 0.29 (95%CI, 0.08-0.51, k=3) for any trauma-related disorder, 0.23 (95%CI=0.17-0.28, k=24) for any personality disorder, and 50% in 71.01% estimates). The prevalence of any comorbid mental disorder decreased over time (0.51, 95%CI=0.25-0.77 over 96 months), except any substance use which increased (0.19, 95%CI= 0.00-0.39, k=2, >96 months). Compared with controls, the CHR-P status was associated with a higher prevalence of anxiety, schizotypal personality, panic, and alcohol use disorders (OR 54 from 2.90 to 1.54 versus without psychosis), but a higher prevalence of anxiety/mood disorders (OR=9.30 to 2.02) and lower prevalence of any substance use disorder (OR=0.41, versus psychosis). Higher baseline prevalence of alcohol use disorder/schizotypal personality disorder was negatively associated with baseline functioning (beta from -0.40 to -0.15), while dysthymic disorder/generalized anxiety disorder with higher functioning (beta 0.59 to 1.49). Higher baseline prevalence of any mood disorder/generalized anxiety disorder/agoraphobia (beta from -2.39 to -0.27) was negatively associated with transition to psychosis. In conclusion, over three-quarters of CHR-P subjects have comorbid mental disorders, which modulate baseline functionig and transition to psychosis. Transdiagnostic mental health assessment should be warranted in subjects at CHR-P.

AB - Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. We conducted a PRISMA/MOOSE-compliant systematic meta-analysis, searching PubMed/PsycInfo up to June 21st, 2021 for observational studies/randomized controlled trials reporting on comorbid DSM/ICD-mental disorders in CHR-P subjects (protocol). The primary and secondary outcomes were baseline and follow-up prevalence of comorbid mental disorders. We also explored the association of comorbid mental disorders compared with CHR-P versus psychotic/non-psychotic control groups, their impact on baseline functioning and transition to psychosis. We conducted random-effects meta-analyses, meta-regression, and assessed heterogeneity/publication bias/quality (Newcastle Ottawa Scale, NOS). We included 312 studies (largest meta-analysed sample=7,834, any non-psychotic mental disorders, mean age=19.98 (3.40), females=43.9%, overall NOS>7 in 77.6% of studies). The prevalence was 0.78 (95%CI=0.73-0.82, k=29) for any comorbid mental disorder, 0.60 (95%CI=0.36-0.84, k=3) for anxiety/mood disorders, 0.44 (95%CI=0.39-0.49, k=48) for any mood disorders, 0.38 (95%CI=0.33-0.42, k=50) for any depressive disorder/episode, 0.34 (95%CI=0.30-0.38, k=69) for any anxiety disorder, 0.30 (95%CI 0.25-0.35, k=35) for major depressive disorders, 0.29 (95%CI, 0.08-0.51, k=3) for any trauma-related disorder, 0.23 (95%CI=0.17-0.28, k=24) for any personality disorder, and 50% in 71.01% estimates). The prevalence of any comorbid mental disorder decreased over time (0.51, 95%CI=0.25-0.77 over 96 months), except any substance use which increased (0.19, 95%CI= 0.00-0.39, k=2, >96 months). Compared with controls, the CHR-P status was associated with a higher prevalence of anxiety, schizotypal personality, panic, and alcohol use disorders (OR 54 from 2.90 to 1.54 versus without psychosis), but a higher prevalence of anxiety/mood disorders (OR=9.30 to 2.02) and lower prevalence of any substance use disorder (OR=0.41, versus psychosis). Higher baseline prevalence of alcohol use disorder/schizotypal personality disorder was negatively associated with baseline functioning (beta from -0.40 to -0.15), while dysthymic disorder/generalized anxiety disorder with higher functioning (beta 0.59 to 1.49). Higher baseline prevalence of any mood disorder/generalized anxiety disorder/agoraphobia (beta from -2.39 to -0.27) was negatively associated with transition to psychosis. In conclusion, over three-quarters of CHR-P subjects have comorbid mental disorders, which modulate baseline functionig and transition to psychosis. Transdiagnostic mental health assessment should be warranted in subjects at CHR-P.

M3 - Article

SN - 1359-4184

JO - Molecular Psychiatry

JF - Molecular Psychiatry

ER -