International rates of receipt of psychological therapy for psychosis and schizophrenia: systematic review and meta-analysis

Susanna Burgess-Barr; Emily Nicholas; Bethany Venus; Niharika Singh; Abigail Nethercott; Gemma Taylor; Pamela Jacobsen

doi:10.1186/s13033-023-00576-9

International rates of receipt of psychological therapy for psychosis and schizophrenia: systematic review and meta-analysis

Int J Ment Health Syst. 2023 Mar 31;17(1):8. doi: 10.1186/s13033-023-00576-9.

Authors

Susanna Burgess-Barr¹, Emily Nicholas², Bethany Venus¹, Niharika Singh¹, Abigail Nethercott¹, Gemma Taylor¹, Pamela Jacobsen³

Affiliations

¹ Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
² Department of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB, UK.
³ Department of Psychology, University of Bath, Bath, BA2 7AY, UK. pcj25@bath.ac.uk.

Abstract

Background: International clinical practice guidelines commonly recommend the provision of psychological therapies for psychosis and schizophrenia as an adjunct to medication. However, access to recommended therapies in routine clinical practice is limited. The aim of this review was to synthesise the available data on the provision of recommended psychological therapies for psychosis and schizophrenia across international mental health systems.

Methods: Electronic databases (PsychINFO, Pubmed and EMBASE) were searched for audits, service evaluation projects, or surveys, which reported data on rates of offer or receipt of any recommended psychological therapy or therapeutic intervention as part of routine clinical care.

Results: Twenty-two eligible studies from 9 countries were identified (N participants = 79,407). The most commonly recommended therapies in national guidelines were Cognitive-Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI). The overall pooled prevalence of rate of receipt of CBTp was 24% [95% CI 0.15-0.32] based on 15 studies (N = 42,494), with a higher rate of receipt of therapy found when pooling data from Early Intervention services only (41% [95% CI 0.21-0.60], 6 studies, N = 11,068). The overall pooled prevalence of rate of receipt of FI was 30% [95% CI 0.22-0.37] based on 14 studies (N = 13,863).

Conclusions: Overall rates of receipt of recommended psychological therapies for psychosis were low across the 9 countries data were available for in this review. However, there were high rates of heterogeneity across studies, meaning that pooled estimates should be interpreted with caution. Sources of heterogeneity included different service settings (e.g. early intervention vs. non-early intervention services), and varying methods used to collect the data (e.g. audit of electronic health records vs. self-report etc.). There were no available data from the continents of South America, Asia, or Africa, meaning that a truly global picture of provision of psychological therapies for psychosis and schizophrenia is currently lacking.

Keywords: Cognitive behaviour therapy; Evidence-based medicine; Meta-analysis; Psychosocial interventions; Psychotic disorders.

Publication types

Review