Meta-analysis of Quality of Life Data in Subjects at High Risk for Psychosis.

Abstract

The nosology of the psychosis high-risk (HR) state is highly controversial. Traditionally conceived as an ‘at-risk” state for the development of psychotic disorders, it is also conceptualized as a clinical syndrome associated with functional impairment and disability. In this meta-analysis quality of life (QoL) in HR were compared to healthy controls (HC) and psychotic patients (PS).

We performed a systematic search of studies published until 2013 selecting cross-sectional studies addressing QoL in HR. Raw scores, demographic data were extracted by two independent authors. We performed the meta-analyses comparing QoL data between HR, HC and PS 945 subjects : mean age 23, 40% female).

The analysis found HR subjects experience a significantly worse QoL than healthy controls (Hedges’ g=-1.824, 95% CI from −2.853 to −0.795, p=0.001, 4 studies included), while no difference with psychotic subjects was found (Hedges’ g=0.017, 95% CI from −0.636 to 0.671, p=0.958, 3 studies included). Despite the high heterogeneity (l²=95,18%) the effect size of each study comparing HR and healthy controls was significant and coherent in the direction of the effect.

Our results indicate that the HR state is characterised by consistent and large reduction in QoL, a clinical indicator for functional disruption: these impairments would call not only for prevention of a future transition to psychosis, but also for treatment of the current disorder.

Acknowledging the limitation of our study, due to the reduced number of studies included and the high heterogeneity, these preliminary results urge for further research on this domain.