The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis

作者：Paolo Fusar‐Poli, Frauke Schultze‐Lutter, Marco Cappucciati, Grazia Rutigliano, Ilaria Bonoldi, Daniel Ståhl, Stefan Borgwardt, Anita Riecher‐Rössler, Jean Addington, Diana O. Perkins, Scott W. Woods, Thomas H. McGlashan, Jimmy Lee, Joachim Klosterkötter, Alison R. Yung, Philip McGuire · 发表于：Schizophrenia Bulletin · 年份：2015 · DOI：10.1093/schbul/sbv162 · 被引用次数：219 · 研究领域：Schizophrenia research and treatment、Mental Health and Psychiatry、Healthcare Decision-Making and Restraints

BACKGROUND: The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. METHODS: Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR-). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. RESULTS: 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR-: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%-24%, I (2) = 96, P < .001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = -.166, Q = 9.441, P = .002) outreach campaigns primarily targeting the general public (n = 11, β = -1.15, Q = 21.35, P < .001) along with higher proportions of self-referrals (n = 10, β = -.029, Q = 4.262, P = .0...