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

Gonzalo Salazar De Pablo; Claudia Aymerich; Daniel Guinart; Ana Catalan; Luis Alameda; Giulia Trotta; Alvaro Armendariz; Estrella Martinez Baringo; Joan Soler-Vidal; Jose M. Rubio; Nathalia Garrido-Torres; Sandra Gómez-Vallejo; John M. Kane; Oliver Howes; Paolo Fusar-Poli; Christoph U. Correll

doi:10.1017/S0033291723003458

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

Gonzalo Salazar De Pablo^*, Claudia Aymerich, Daniel Guinart, Ana Catalan, Luis Alameda, Giulia Trotta, Alvaro Armendariz, Estrella Martinez Baringo, Joan Soler-Vidal, Jose M. Rubio, Nathalia Garrido-Torres, Sandra Gómez-Vallejo, John M. Kane, Oliver Howes, Paolo Fusar-Poli, Christoph U. Correll

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

11 Citations (Scopus)

Abstract

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 (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 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.

Original language	English
Pages (from-to)	652-662
Number of pages	11
Journal	Psychological Medicine
Volume	54
Issue number	4
DOIs	https://doi.org/10.1017/S0033291723003458
Publication status	Published - 13 Mar 2024

Keywords

duration of untreated psychosis
early intervention
first episode psychosis
meta-analysis

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10.1017/S0033291723003458

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Salazar De Pablo, G., Aymerich, C., Guinart, D., Catalan, A., Alameda, L., Trotta, G., Armendariz, A., Martinez Baringo, E., Soler-Vidal, J., Rubio, J. M., Garrido-Torres, N., Gómez-Vallejo, S., Kane, J. M., Howes, O., Fusar-Poli, P., & Correll, C. U. (2024). 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. Psychological Medicine, 54(4), 652-662. https://doi.org/10.1017/S0033291723003458

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title = "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",

abstract = "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 (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 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.",

keywords = "duration of untreated psychosis, early intervention, first episode psychosis, meta-analysis",

author = "{Salazar De Pablo}, Gonzalo and Claudia Aymerich and Daniel Guinart and Ana Catalan and Luis Alameda and Giulia Trotta and Alvaro Armendariz and {Martinez Baringo}, Estrella and Joan Soler-Vidal and Rubio, {Jose M.} and Nathalia Garrido-Torres and Sandra G{\'o}mez-Vallejo and Kane, {John M.} and Oliver Howes and Paolo Fusar-Poli and Correll, {Christoph U.}",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2023. Published by Cambridge University Press.",

year = "2024",

month = mar,

day = "13",

doi = "10.1017/S0033291723003458",

language = "English",

volume = "54",

pages = "652--662",

journal = "Psychological Medicine",

issn = "0033-2917",

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number = "4",

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Salazar De Pablo, G, Aymerich, C, Guinart, D, Catalan, A, Alameda, L , Trotta, G, Armendariz, A, Martinez Baringo, E, Soler-Vidal, J, Rubio, JM, Garrido-Torres, N, Gómez-Vallejo, S, Kane, JM, Howes, O , Fusar-Poli, P & Correll, CU 2024, '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', Psychological Medicine, vol. 54, no. 4, pp. 652-662. https://doi.org/10.1017/S0033291723003458

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. / Salazar De Pablo, Gonzalo; Aymerich, Claudia; Guinart, Daniel et al.
In: Psychological Medicine, Vol. 54, No. 4, 13.03.2024, p. 652-662.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - 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

AU - Salazar De Pablo, Gonzalo

AU - Aymerich, Claudia

AU - Guinart, Daniel

AU - Catalan, Ana

AU - Alameda, Luis

AU - Trotta, Giulia

AU - Armendariz, Alvaro

AU - Martinez Baringo, Estrella

AU - Soler-Vidal, Joan

AU - Rubio, Jose M.

AU - Garrido-Torres, Nathalia

AU - Gómez-Vallejo, Sandra

AU - Kane, John M.

AU - Howes, Oliver

AU - Fusar-Poli, Paolo

AU - Correll, Christoph U.

PY - 2024/3/13

Y1 - 2024/3/13

N2 - 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 (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 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.

AB - 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 (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 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.

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KW - early intervention

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U2 - 10.1017/S0033291723003458

DO - 10.1017/S0033291723003458

M3 - Review article

C2 - 38087871

AN - SCOPUS:85179976156

SN - 0033-2917

VL - 54

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JO - Psychological Medicine

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IS - 4

ER -

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

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Keywords

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