TY - JOUR
T1 - The dark side of the moon
T2 - meta-analytical impact of recruitment strategies on risk enrichment in the clinical high risk state for psychosis
AU - Fusar-Poli, Paolo
AU - Schultze-Lutter, Frauke
AU - Cappucciati, Marco
AU - Rutigliano, Grazia
AU - Bonoldi, Ilaria
AU - Stahl, Daniel
AU - Borgwardt, Stephan
AU - Riecher-Rössler, Anita
AU - Addington, Jean
AU - Perkins, Diana O.
AU - Woods, Scott W.
AU - Mcglashan, Thomas
AU - Lee, Jimmy
AU - Klosterkötter, Joachim
AU - Yung, Alison R.
AU - Mcguire, Philip
N1 - Publisher Copyright:
© The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background: The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. Methods: Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR-). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. Results: 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR-: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%-24%, I 2 = 96, P <. 001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = -.166, Q = 9.441, P =. 002) outreach campaigns primarily targeting the general public (n = 11, β = -1.15, Q = 21.35, P <. 001) along with higher proportions of self-referrals (n = 10, β = -.029, Q = 4.262, P =. 039), which diluted pretest risk for psychosis in patients undergoing CHR assessment. Conclusions: There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.
AB - Background: The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. Methods: Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR-). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. Results: 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR-: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%-24%, I 2 = 96, P <. 001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = -.166, Q = 9.441, P =. 002) outreach campaigns primarily targeting the general public (n = 11, β = -1.15, Q = 21.35, P <. 001) along with higher proportions of self-referrals (n = 10, β = -.029, Q = 4.262, P =. 039), which diluted pretest risk for psychosis in patients undergoing CHR assessment. Conclusions: There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.
UR - http://www.scopus.com/inward/record.url?scp=84966454983&partnerID=8YFLogxK
U2 - 10.1093/schbul/sbv162
DO - 10.1093/schbul/sbv162
M3 - Journal articles
C2 - 26591006
AN - SCOPUS:84966454983
SN - 0586-7614
VL - 42
SP - 732
EP - 743
JO - Schizophrenia bulletin
JF - Schizophrenia bulletin
IS - 3
ER -