Background and Hypothesis Duration of untreated psychosis (DUP) has been linked to worse mental health outcomes in psychotic disorders. We meta-analytically studied the relationship between “long” vs. “short” DUP and mental health outcomes. Study Design This PRISMA/MOOSE-compliant meta-analysis searched for nonoverlapping individual studies from database inception until November 01, 2023, reporting data from author-defined “short”/”long” DUP (according to author’s definition) in patients with first-episode psychosis (FEP). We compared differences between “short”/”long” DUP groups at baseline and/or follow-up in continuous and binary outcomes. We conducted random-effects meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO: CRD42023479321). Study Results From 16,055 citations, 34 studies were included (n = 6,425, age = 27.5 ± 7.1 years, males = 60.4%, white = 70.2%, DUP: mean = 60.8 ± 43.8 weeks, median = 52.5, interquartile range = 31.3, 68.0 weeks, follow-up = 19.2 ± 35.0 months). The definition of “short”/”long” varies significantly between the studies. Compared to “short” DUP (mean = 10.2 ± 11.2 weeks), “long” DUP (mean = 58.8 ± 76.4 weeks) was associated with higher baseline Positive and Negative Syndrome Scale (PANSS) negative (k = 14, ES = 0.45, 95%CI = 0.16, 0.74) and Scale for the Assessment of Negative Symptoms (k = 7, ES = 0.29, 95%CI = 0.11, 0.47) scores, lower remission (k = 7, OR = 0.40, 95%CI = 0.24, 0.67) and more suicide attempts (k = 4, OR = 2.01, 95%CI = 1.36, 2.96). At follow-up, compared to “short” DUP, “long” DUP was associated with lower Global Assessment of Functioning (k = 4, ES = −0.63, 95%CI = −0.83, −0.43) and higher PANSS negative subscale scores (k = 5, ES = 0.66, 95%CI = 0.05, 1.27). Conclusions In FEP, longer DUP is related to greater baseline negative symptoms, less remission, and more suicide attempts, as well as greater postbaseline negative symptom severity and functional disability. To what degree longer DUP contributes to poorer outcomes or whether DUP only correlates with these outcomes requires further study. A greater consensus on the definition of long DUP is needed to make comparisons between studies more feasible.

中文翻译：

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首发精神病患者未治疗精神病的“短期”与“长期”持续时间：基线状态和随访结果的系统评价和荟萃分析


背景和假设 未经治疗的精神病 （DUP） 的持续时间与精神病患者心理健康结果恶化有关。我们进行了荟萃分析研究 “long” 与 “short” DUP 与心理健康结局之间的关系。研究设计 这项符合 PRISMA/MOOSE 标准的荟萃分析检索了从数据库开始到 2023 年 11 月 1 日不重叠的个体研究，报告了作者定义的“短”/“长”DUP（根据作者的定义）在首发精神病 （FEP） 患者中的数据。我们比较了基线和/或随访时 “短” /“长” DUP 组在连续和二元结局中的差异。我们进行了随机效应荟萃分析、分层分析、异质性分析、荟萃回归分析和质量评估 （PROSPERO： CRD42023479321）。研究结果 从 16,055 次引用中，共纳入 34 项研究（n = 6,425，年龄 = 27.5 ± 7.1 岁，男性 = 60.4%，白人 = 70.2%，DUP：平均值 = 60.8 ± 43.8 周，中位数 = 52.5，四分位距 = 31.3,68.0 周，随访 = 19.2 ± 35.0 个月）。“short”/“long”的定义在研究之间差异很大。与“短”DUP（平均值 = 10.2 ± 11.2 周）相比，“长”DUP（平均值 = 58.8 ± 76.4 周）与较高的基线阳性和阴性症状量表 （PANSS） 阴性（k = 14，ES = 0.45,95%CI = 0.16,0.74）和阴性症状评估量表（k = 7，ES = 0.29,95%CI = 0.11,0.47）评分相关，缓解率较低（k = 7，OR = 0.40， 95% CI = 0.24， 0.67） 和更多的自杀未遂 （k = 4， OR = 2.01， 95%CI = 1.36， 2.96）。在随访中，与“短”DUP 相比，“长”DUP 与较低的总体功能评估 （k = 4， ES = -0.63， 95%CI = -0.83， -0.43） 和较高的 PANSS 阴性子量表分数 （k = 5， ES = 0.66， 95%CI = 0.05, 1.27).结论 在 FEP 中，较长的 DUP 与更高的基线阴性症状、更少的缓解和更多的自杀企图以及更高的基线后阴性症状严重程度和功能障碍有关。DUP 在多大程度上导致较差的结局，或者 DUP 是否仅与这些结局相关，需要进一步研究。需要对长 DUP 的定义达成更大的共识，以使研究之间的比较更加可行。