Summary of findings 1. Extended specialised early intervention (SEI) teams compared to standard SEI teams plus treatment as usual (TAU) for recent‐onset psychosis.
| Extended specialised early intervention (SEI) teams compared to standard SEI teams plus treatment as usual (TAU) for recent‐onset psychosis | ||||||
| Patient or population: recent‐onset psychosis Setting: community mental health Intervention: extended SEI teams Comparison: standard SEI teams plus TAU | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with extended specialised early intervention teams | Risk with specialised early intervention teams plus TAU | |||||
| Global state: recovery (assessed by symptom remission over a specified time period, as defined by study) | Study population | RR 1.13 (0.97 to 1.31) | 780 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,b | ||
| 355 per 1000 | 402 per 1000 (345 to 466) | |||||
| Service use: disengagement from services (assessment varied) | Study population | RR 0.45 (0.27 to 0.75) | 380 (2 RCTs) | ⊕⊕⊝⊝ Lowc | ||
| 335 per 1000 | 151 per 1000 (90 to 251) | |||||
| Service use: admission to psychiatric hospital at end of treatment (assessed by patient records) | Study population | RR 1.55 (0.68 to 3.52) | 160 (1 RCT) | ⊕⊕⊝⊝ Lowd | ||
| 103 per 1000 | 159 per 1000 (70 to 361) | |||||
| Service use: number of days in psychiatric hospital at end of treatment (assessed by patient records) | The mean service use: number of days in psychiatric hospital at end of treatment was 34.1 days per year | MD 2.7 days per year lower (8.3 lower to 2.9 higher) | ‐ | 400 (1 RCT) | ⊕⊕⊝⊝ Lowe | |
| Mental state: global psychotic symptoms, average endpoint score on specific symptoms mental state scale (assessed by structured interview) | The mean mental state: global psychotic symptoms, average endpoint score on specific symptoms mental state scale was 5 points | MD 1.9 points lower (3.28 lower to 0.52 lower) | ‐ | 156 (1 RCT) | ⊕⊝⊝⊝ Very lowd,f | |
| Adverse effects/events: death ‐ all‐cause mortality (assessed by patient records) | Study population | RR 0.38 (0.09 to 1.64) | 780 (3 RCTs) | ⊕⊕⊝⊝ Lowi | ||
| 15 per 1000 | 6 per 1000 (1 to 25) | |||||
| Functioning: average endpoint score on specific functioning scale (assessed by structured interview) | ‐ | SMD 0.23 SD higher (0.29 lower to 0.76 higher) | ‐ | 560 (2 RCTs) | ⊕⊝⊝⊝ Very lowg,h | SMD of 0.20 represents a small effect size (Cohen 1988) |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio; SD: standard deviation; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded two levels due to indirectness: use of surrogate outcome, one trial outcome duration does not match other trial outcome durations. bDowngraded one level due to imprecision: does not meet optimal information size (OIS) criteria and few events in two of the larger trials. cDowngraded two levels due to indirectness: one trial uses surrogate outcome, outcome definitions from trials do not match. dDowngraded two levels due to imprecision: does not meet OIS criteria, few events, and small sample size. eDowngraded two levels due to imprecision: does not meet OIS criteria, 95% confidence interval includes appreciable benefits and considerable harms. fDowngraded one level due to indirectness: average scale scores used to measure outcome, not clinically important change. gDowngraded two levels due to inconsistency: high heterogeneity and conflicting direction of effect. hDowngraded one level due to imprecision: does not meet OIS. iDowngraded two levels due to imprecision: does not meet OIS criteria, small sample size with very few events, leading to wide confidence intervals.