Review: Efficacy of preventative interventions for children and adolescents at clinical high risk of psychosis – a systematic review and meta-analysis of intervention studies

IF 6.8 3区医学 Q1 PEDIATRICS Child and Adolescent Mental Health Pub Date : 2024-12-17 DOI:10.1111/camh.12755

Grace Frearson, Javier de Otazu Olivares, Ana Catalan, Claudia Aymerich, Gonzalo Salazar de Pablo

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Abstract

Background

Despite evidence suggesting that age moderates the response to preventative treatment for those at clinical high risk of psychosis (CHR-P), no meta-analysis has assessed the effectiveness of preventative interventions for CHR-P children and adolescents. Our aim was to synthesise evidence assessing preventative interventions on a wide range of mental health outcomes for CHR-P children and adolescents.

Method

A systematic search was conducted on Ovid MEDLINE, Pubmed, APA PsycInfo and Web of Science until June 2024 (PROSPERO: CRD42023406696). Intervention studies that had a mean participant age of under 18 years old that reported on mental health outcomes for CHR-P participants were selected. A meta-analysis was conducted for independent studies reporting the effectiveness of interventions on different outcomes (transition to psychosis, attenuated positive, negative and total prodromal psychotic symptoms, depressive symptoms and global functioning) compared to control conditions of no intervention or placebo. Evidence from other studies was also reported narratively.

Results

Twenty-four studies and 1319 CHR-P children and adolescents were included. Compared to no intervention or placebo, preventative interventions were effective for positive symptoms (SMD = 0.379, p = .022, 95% CI 0.055, 0.703), negative symptoms (SMD = 0.583, p = .004, 95% CI 0.187, 0.980), total symptoms (SMD = 0.677, p = .002, 95% CI 0.249, 1.105) and functioning (SMD = 0.944, p = .038, 95% CI 0.052, 1.836) but not reducing transition to psychosis or depressive symptoms.

Conclusions

There are disparities in the effectiveness of preventative interventions for different outcomes, with transition to psychosis not being the only relevant outcome. Differences in the efficacy of preventative interventions emerged between CHR-P children and adolescents versus adults.

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综述：预防干预对临床精神病高危儿童和青少年的疗效——干预研究的系统回顾和荟萃分析。

背景：尽管有证据表明，年龄会调节精神病临床高危人群（CHR-P）对预防性治疗的反应，但目前还没有荟萃分析评估预防性干预对CHR-P儿童和青少年的有效性。我们的目的是综合评估预防性干预措施对临床高危儿童和青少年的各种心理健康影响的证据：截至 2024 年 6 月，我们在 Ovid MEDLINE、Pubmed、APA PsycInfo 和 Web of Science 上进行了系统检索（PROSPERO：CRD42023406696）。研究选取了平均参与年龄在 18 岁以下、报告了 CHR-P 参与者心理健康结果的干预研究。我们对报告了干预措施对不同结果（向精神病转变、减轻的阳性、阴性和全部前驱精神病症状、抑郁症状和整体功能）的有效性的独立研究进行了荟萃分析，并与无干预措施或安慰剂的对照条件进行了比较。此外，还对其他研究的证据进行了叙述性报告：结果：共纳入 24 项研究和 1319 名 CHR-P 儿童和青少年。980）、总症状（SMD = 0.677，p = .002，95% CI 0.249，1.105）和功能（SMD = 0.944，p = .038，95% CI 0.052，1.836），但不能减少向精神病或抑郁症状的转变：结论：预防性干预措施对不同结果的疗效存在差异，精神病转归并非唯一的相关结果。在CHR-P儿童和青少年与成人之间，预防性干预措施的效果存在差异。

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

Child and Adolescent Mental Health PEDIATRICS-PSYCHIATRY

CiteScore

8.30

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Child and Adolescent Mental Health (CAMH) publishes high quality, peer-reviewed child and adolescent mental health services research of relevance to academics, clinicians and commissioners internationally. The journal''s principal aim is to foster evidence-based clinical practice and clinically orientated research among clinicians and health services researchers working with children and adolescents, parents and their families in relation to or with a particular interest in mental health. CAMH publishes reviews, original articles, and pilot reports of innovative approaches, interventions, clinical methods and service developments. The journal has regular sections on Measurement Issues, Innovations in Practice, Global Child Mental Health and Humanities. All published papers should be of direct relevance to mental health practitioners and clearly draw out clinical implications for the field.