The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual participant data meta-analyses are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. In this study, we first conducted a systematic review and extracted 43 studies. Fifteen of the 43 studies identified agreed to share individual participant data, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell’s C-statistic 0.655, 95% confidence interval (CIs), 0.627–0.682]. To deliver robust prognostic models, studies with less heterogeneity will be needed.
Individualized Prediction of Transition to Psychosis in 1,676 Individuals at Clinical High Risk: Development and Validation of a Multivariable Prediction Model Based on Individual Patient Data Meta-Analysis
DOI : 10.3389/fpsyt.2019.00345/full
Aaltsje Malda, Nynke Boonstra, Hans Barf, Steven de Jong, Andre Aleman, Jean Addington, Marita Pruessner, Dorien Nieman, Lieuwe de Haan, Anthony Morrison, Anita Riecher-Rössler, Erich Studerus, Stephan Ruhrmann, Frauke Schultze-Lutter, Suk Kyoon An, Shinsuke Koike, Kiyoto Kasai, Barnaby Nelson, Patrick McGorry, Stephen Wood, Ashleigh Lin, Alison Y. Yung, Magdalena Kotlicka-Antczak, Marco Armando, Stefano Vicari, Masahiro Katsura, Kazunori Matsumoto, Sarah Durston, Tim Ziermans, Lex Wunderink, Helga Ising, Mark van der Gaag, Paolo Fusar-Poli and Gerdina Hendrika Maria Pijnenborg
Frontiers in Psychiatry