What is the duration of untreated psychosis worldwide? – A meta-analysis of pooled mean and median time and regional trends and othercorrelates across 369 studies

Key Findings:

• Mean and Median DUP: The study found a mean DUP of 42.6 weeks (95% confidence interval [CI] 40.6–44.6, based on 283 studies and 41,320 patients). The median DUP was 14 weeks (Interquartile range = 8.8–28.0, from 206 studies and 37,215 patients). The difference between the mean and median indicates a right-skewed distribution, meaning some individuals experience very long periods of untreated psychosis, pulling the mean higher.

• Regional Differences: DUP varied significantly across continents:

  • Africa: 70.0 weeks

  • Asia: 48.8 weeks

  • North America: 48.7 weeks

  • Europe: 38.6 weeks

  • Oceania: 34.9 weeks

  • South America: 34.9 weeks

• Income Level: DUP was longer in middle-low income countries (48.4 weeks) compared to high-income countries (41.2 weeks).

• Correlates of Longer DUP: Longer DUP was significantly associated with:

  • Older patient age

  • Older publication year (suggesting DUP may have been decreasing over time, though this could also reflect changes in reporting or methodology)

  • A higher proportion of non-White first-episode psychosis (FEP) patients.

• Heterogeneity: The study noted significant heterogeneity in the data, which is common in large meta-analyses across diverse studies and regions. However, no publication bias was identified.

Implications:

• Gap in Recommended DUP: The World Health Organization and the International Early Psychosis Association have long recommended reducing the mean DUP to less than 3 months (12 weeks) for individuals with a first episode of psychosis. This meta-analysis clearly shows that the worldwide mean DUP (42.6 weeks) is still significantly above this target. Even the median DUP (14 weeks) is slightly above the 3-month goal.

• Prognostic Significance: The study reinforces the widely accepted understanding that a longer DUP is associated with poorer mental health outcomes in psychotic disorders, including more severe positive and negative symptoms, lower chances of remission, and poorer overall functioning.

• Addressing Disparities: The regional and income-level differences in DUP highlight global disparities in access to and awareness of mental health services. The association with a higher proportion of non-White FEP patients suggests potential inequities in care pathways for certain demographic groups.

• Need for Early Intervention: The findings underscore the critical need for continued and intensified efforts in early intervention programs aimed at reducing DUP. This includes public awareness campaigns, training for healthcare professionals to recognize early signs of psychosis, and improving accessibility to mental health services, particularly in underserved regions and communities.

• Research Gaps: The meta-analysis also points to the limited efficacy of current interventions specifically designed to reduce DUP, suggesting a need for more effective strategies in this area.

https://pubmed.ncbi.nlm.nih.gov/38087871/