Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis

Sebastien Brodeur; Dominic Oliver; Muhammad S Ahmed; Joaquim Radua; Jemma Venables; Yueming Gao; Vincenzo Gigante; Giulia Veneziano; Giulia Vinci; Edward Chesney; Sunil Nandha; Andrea De Micheli; Ilaria Basadonne; Valentina Floris; Gonzalo Salazar de Pablo; Paolo Fusar-Poli

doi:10.1016/j.neubiorev.2024.105669

Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis

Neurosci Biobehav Rev. 2024 Apr 9:161:105669. doi: 10.1016/j.neubiorev.2024.105669. Online ahead of print.

Authors

Sebastien Brodeur¹, Dominic Oliver², Muhammad S Ahmed³, Joaquim Radua⁴, Jemma Venables⁵, Yueming Gao⁶, Vincenzo Gigante⁷, Giulia Veneziano⁷, Giulia Vinci⁷, Edward Chesney⁸, Sunil Nandha⁹, Andrea De Micheli¹⁰, Ilaria Basadonne⁷, Valentina Floris⁷, Gonzalo Salazar de Pablo¹¹, Paolo Fusar-Poli¹²

Affiliations

¹ Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Département de Psychiatrie et Neurosciences, Université Laval, Canada.
² Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; NIHR Oxford Health Biomedical Research Centre, Oxford OX3 7JX, UK; OPEN early detection service, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK. Electronic address: dominic.a.oliver@kcl.ac.uk.
³ South London and Maudsley NHS Foundation Trust, London, UK.
⁴ Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
⁵ Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK.
⁶ Department of Psychiatry, University of Cambridge, Cambridge, UK.
⁷ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
⁸ South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
⁹ OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK.
¹⁰ Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK.
¹¹ Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK.
¹² Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Germany.

PMID: 38599355
DOI: 10.1016/j.neubiorev.2024.105669

Abstract

The effectiveness of universal preventive approaches in reducing the incidence of affective/psychotic disorders is unclear. We therefore aimed to synthesise the available evidence from randomised controlled trials. For studies reporting change in prevalence, we simulated all possible scenarios for the proportion of individuals with the disorder at baseline and at follow-up to exclude them. We then combined these data with studies directly measuring incidence and conducted random effects meta-analysis with relative risk (RR) to estimate the incidence in the intervention group compared to the control group. Eighteen studies (k=21 samples) were included investigating the universal prevention of depression in 66,625 individuals. No studies were available investigating universal prevention on the incidence of bipolar/psychotic disorders. 63 % of simulated scenarios showed a significant preventive effect on reducing the incidence of depression (k=9 - 19, RR=0.75-0.94, 95 %CIs=0.55-0.87,0.93-1.15, p=0.007-0.246) but did not survive sensitivity analyses. There is some limited evidence for the effectiveness of universal interventions for reducing the incidence of depression but not for bipolar/psychotic disorders.

Keywords: Bipolar; Depression; Intervention; Meta-analysis; Prevention; Psychosis; Universal.

Publication types

Review