Table 3.
Evidence for associations between duration of untreated psychosis (DUP) and outcomes at follow‐up
| Outcome | Studies | Mean/median follow‐up (years) | N | Random‐effects p value | Random‐effects measure (95% CI) | I2 (p value) | 95% prediction interval | Small study effects/excess significance bias | Largest study significant | Class of evidence | Predicted difference in continuous outcome for every doubling in DUP |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Negative symptoms |
27 |
5.9/2 | 3,633 |
3.46x10–10 |
beta=–0.11 (–0.15 to –0.08) |
86.7% (<0.0001) |
–0.27; 0.05 |
No/No (fail‐safe N: 1,667) |
Yes | II | 8% worse |
| Remission | 22 | 6.1/2.1 | 3,570 |
2.98x10‐10 |
OR=2.16 (1.7‐2.75) |
63.7% (<0.0001) |
1.003; 4.67 |
Yes/Yes (fail‐safe N: 46) |
Yes | II | NA |
| Positive symptoms | 21 | 6.8/3 | 2,934 |
4.52x10–8 |
beta=–0.16 (–0.22 to –0.11) |
94.4% (<0.0001) |
–0.42; 0.10 |
Yes/No (fail‐safe N: 47) |
Yes | II | 12% worse |
|
Global psychopathology |
14 | 9.1/10.6 |
1,412 |
4.72x10–6 |
beta=–0.16 (–0.22 to –0.09) |
96.0% (<0.0001) |
–0.41; 0.09 |
No/No (fail‐safe N: 3) |
Yes | III | 12% worse |
| Overall functional outcome | 27 | 6.9/3 |
3,104 |
2.16x10–6 |
beta=–0.11 (–0.16 to –0.07) |
96.3% (<0.0001) |
–0.35; 0.12 |
No/No (fail‐safe N: 13) |
Yes | III | 8% worse |
| Social functioning | 4 | 5.5/4.5 | 286 |
1.38x10–11 |
beta=–0.06 (–0.08 to –0.04) |
0% (0.64) |
–0.08; –0.04 |
No/No (fail‐safe N: 41) |
Yes | IV | 4% worse |
| Vocational functioning | 3 | 9/10 | 371 |
0.0005 |
beta=–0.04 (–0.06 to –0.02) |
0% (0.61) |
–0.06; –0.02 |
No/Yes (fail‐safe N: 1) |
Yes | IV | 3% worse |
| Reduction in total symptoms | 4 | 0.6/0.16 |
350 |
0.031 |
beta=–0.14 (–0.26 to –0.01) |
94.5% (<0.0001) |
–0.41; 0.14 |
No/No (fail‐safe N: 1) |
Yes | IV | 10% worse |
|
Quality of life |
8 | 3.7/1.5 | 1,162 |
0.042 |
beta=–0.09 (–0.17 to –0.003) |
96.9% (<0.0001) |
–0.33; 0.16 |
No/No (fail‐safe N: 1) |
Yes | IV | 6% worse |
| Relapse | 9 | 4/2 | 1,264 |
0.09 |
OR=1.67 (0.93‐3.02) |
100% (<0.0001) |
0.29; 9.71 | No/No | Yes | NS | NA |
| Global cognition | 5 | 1.9/2 | 590 | 0.11 |
beta=–0.04 (–0.09 to 0.01) |
44.9% (0.01) |
–0.13; 0.05 | No/No | No | NS | NA |
| Time hospitalized | 3 | 6.7/6 | 233 | 0.42 |
beta=–0.09 (–0.31 to 0.13) |
60.3% (0.08) |
–0.45; 0.27 |
No/No | No | NS | NA |
|
Number of hospitalizations |
3 | 13.1/11.1 |
355 |
0.56 |
beta=–0.24 (–1 to 0.57) |
98.7% (<0.0001) |
–1; 1 | Yes/No | Yes | NS | NA |
| Deliberate self‐harm |
4 |
2.4/2.1 | 1,611 | 0.91 |
OR=1.02 (0.74‐1.40) |
0% (0.79) |
0.74; 1.40 | No/No | No | NS | NA |
OR – odds ratio, NS – not significant, NA – not applicable