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Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

Published online by Cambridge University Press:  16 September 2019

Sarah E. Herniman Open the ORCID record for Sarah E. Herniman [Opens in a new window] ,
Kelly Allott ,
Lisa J. Phillips ,
Stephen J. Wood ,
Jacqueline Uren ,
Sumudu R. Mallawaarachchi  and
Sue M. Cotton
Sarah E. Herniman*
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Kelly Allott
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Lisa J. Phillips
Affiliation:
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Stephen J. Wood
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia School of Psychology, University of Birmingham, Birmingham, UK
Jacqueline Uren
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Sumudu R. Mallawaarachchi
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
Sue M. Cotton
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
*
Author for correspondence: Sarah E. Herniman, E-mail: [email protected]
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Abstract

Background

Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.

Methods

This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.

Results

Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.

Conclusions

At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

Keywords

Casenesscomorbiditydepressiondisorderpsychosissymptoms
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 15 , November 2019 , pp. 2463 - 2474
Copyright
Copyright © Cambridge University Press 2019 

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