Impact of Early Intervention for Early Psychosis on Suicidal Behavior-A Meta-Analysis.

IF 5.3 2区医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-11-27 DOI:10.1111/acps.13773

Elkhan Tahmazov, Jordan Bosse, Benjamin Glemain, Patrice Nabbe, Morgane Guillou, Athéna Blachier, Michel Walter, Christophe Lemey

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Abstract

Introduction: Early-onset psychotic disorders include the prodromal phase and the first-episode psychosis (FEP). They constitute a high-risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data.

Aims of the study: The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior.

Methodology: By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta-analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt.

Results: The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case-management, or related services, and psycho-social therapies. Our meta-analysis shows that early intervention for early-onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49-0.88), p = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50-0.86), p = 0.002), with non-significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non-significant heterogeneity.

Conclusion: The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta-analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as possible and prevent the risk of suicide.

Trial registration: PROSPERO CRD42022366976.

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早期精神病早期干预对自杀行为的影响--Meta 分析。

简介早发精神病包括前驱期和首发精神病（FEP）。它们是自杀行为的高危期。精神病早期干预（EIP）包括尽早干预。许多研究都报道了早期干预对总体预后的有效性，而且 EIP 服务正在全球范围内兴起。一些作者报告称，自杀行为有所改善，但还没有研究对所有数据进行调查：工作目的：研究精神病早期干预是否会对自杀死亡和自杀未遂产生影响，并研究哪些干预方法会对自杀行为产生影响：通过遵守 PRISMA 标准（之前已在 PROSPERO 上声明），探索 5 个医学数据库（PubMed、Cochrane、PsycINFO、Scopus、Embase）中自创建之日起至 2023 年 2 月 20 日发表的英文文献，我们进行了一项荟萃分析。所选文章必须涉及 EIP 和自杀或自杀未遂死亡。我们的主要结果是自杀死亡，次要结果是自杀未遂：通过详尽搜索，共找到 2310 篇参考文献。九篇文章被纳入其中。其干预方式包括药物疗法、心理疗法、个案管理或相关服务以及社会心理疗法。我们的荟萃分析表明，对早发性精神病的早期干预可使自杀死亡人数减少三分之一（ORa = 0.66 (0.49-0.88)，p = 0.005），自杀未遂人数减少三分之一（ORa = 0.66 (0.50-0.86)，p = 0.002），异质性不显著。敏感性分析排除了因未发生事件而导致统计困难的研究和偏倚风险较高的研究，结果指向相同的方向，即在统计上显著降低，异质性不显著：文献显示，早期干预计划对自杀死亡和自杀未遂有积极影响。这是首次对早期精神障碍的早期干预及其对自杀风险的影响进行荟萃分析。为了尽早干预并预防自杀风险，EIP的部署应在全球范围内得到支持：试验注册：PREMCOCRD42022366976。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.