Prognostic accuracy and clinical utility of psychometric instruments for individuals at clinical high-risk of psychosis: a systematic review and meta-analysis
Open accessAbstract
Accurate prognostication of individuals at clinical high-risk for psychosis (CHR-P) is an essential initial step for effective primary indicated prevention. We aimed to summarise the prognostic accuracy and clinical utility of CHR-P assessments for primary indicated psychosis prevention. Web of Knowledge databases were searched until 1st January 2022 for longitudinal studies following-up individuals undergoing a psychometric or diagnostic CHR-P assessment, reporting transition to psychotic disorders in both those who meet CHR-P criteria (CHR-P + ) or not (CHR-P-). Prognostic accuracy meta-analysis was conducted following relevant guidelines. Primary outcome was prognostic accuracy, indexed by area-under-the-curve (AUC), sensitivity and specificity, estimated by the number of true positives, false positives, false negatives and true negatives at the longest available follow-up time. Clinical utility analyses included: likelihood ratios, Fagan's nomogram, and population-level preventive capacity (Population Attributable Fraction, PAF). A total of 22 studies (n = 4 966, 47.5% female, age range 12-40) were included. There were not enough meta-analysable studies on CHR-P diagnostic criteria (DSM-5 Attenuated Psychosis Syndrome) or non-clinical samples. Prognostic accuracy of CHR-P psychometric instruments in clinical samples (individuals referred to CHR-P services or diagnosed with 22q.11.2 deletion syndrome) was excellent: AUC = 0.85 (95% CI: 0.81-0.88) at a mean follow-up time of 34 months. This result was driven by outstanding sensitivity (0.93, 95% CI: 0.87-0.96) and poor specificity (0.58, 95% CI: 0.50-0.66). Being CHR-P + was associated with a small likelihood ratio LR + (2.17, 95% CI: 1.81-2.60) for developing psychosis. Being CHR-P- was associated with a large LR- (0.11, 95%CI: 0.06-0.21) for developing psychosis. Fagan's nomogram indicated a low positive (0.0017%) and negative (0.0001%) post-test risk in non-clinical general population samples. The PAF of the CHR-P state is 10.9% (95% CI: 4.1-25.5%). These findings consolidate the use of psychometric instruments for CHR-P in clinical samples for primary indicated prevention of psychosis. Future research should improve the ability to rule in psychosis risk.
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Recent evidence indicates that at-risk conditions have low positive predictive value, since most individuals identified as at risk never develop the disorder.
“Recent evidence, however, has shown that at-risk conditions have a low positive predictive value, as the majority of individuals identified as at risk for a mental disorder will never develop it 130,131 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [131]
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- Authors
- Oliver, D., Arribas, M., Radua, J., Salazar de Pablo, G., De Micheli, A., Spada, G., Mensi, M. M., Kotlicka-Antczak, M., Borgatti, R., Solmi, M., Shin, J. I., Woods, S. W., Addington, J., McGuire, P., & Fusar-Poli, P.
- Affiliations
- King's College London (GB)
- University of Pavia (IT)
- University of Ottawa (CA)
- Yonsei University (KR)
- Yale University (US)
- University of Calgary (CA)
- National Health Service (GB)
- Corresponding author
- Oliver, Dominic
- ORCID
- Venue
- Molecular Psychiatry
- Published
- 2022-06-03
- Volume
- 27
- Issue
- 9
- Pages
- 3670-3678
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC9708585
- OpenAlex
- W4281707390
- Cited by
- 49
- References
- 102
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 12 · 2023: 11
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Molecular Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Wellcome Trust (215793/Z/19/Z)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- clinical high risk for psychosis, prognostic accuracy, psychometric scale, psychosis prevention, transition to psychosis, likelihood ratios, population attributable fraction, sensitivity and specificity, attenuated psychosis syndrome, primary prevention, risk assessment tools, clinical utility, longitudinal follow-up study
- MeSH terms
- Adolescent, Adult, Child, Female, Humans, Male, Prognosis, Psychometrics, Psychotic Disorders, Sensitivity and Specificity, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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