Need for evidence-based early intervention programmes: a public health perspective

Area of Science:

• Psychiatry
• Public Health
• Clinical Psychology

Background:

• The current framework for identifying individuals at ultra-high risk (UHR) or clinical high risk (CHR) for psychosis transition is widely used.
• However, its effectiveness in generating measurable and economically feasible public health impacts is questioned.

Purpose of the Study:

• To critically evaluate the limitations of the UHR/CHR framework for psychosis transition.
• To explore alternative strategies for early intervention in psychopathology.

Main Methods:

• Review of existing literature and meta-analytical evidence on UHR/CHR predictive accuracy and intervention efficacy.
• Analysis of the determinants of psychosis transition rates.
• Discussion of the limitations of current assessment tools and sampling strategies.

Main Results:

• The 'transition' rate is primarily determined by risk-enrichment, not predictive accuracy of UHR/CHR tools.
• Prognostic accuracy of assessment tools is mediocre.
• Therapeutic interventions may prolong, not prevent, psychosis onset.
• No effective treatments are proven to prevent transition.
• The UHR/CHR target is precarious due to unpredictability and false positives.
• Only a small fraction of individuals developing psychosis benefit from UHR/CHR services.
• Limited cost-effectiveness data exists for these services.

Conclusions:

• The narrow focus of the UHR/CHR framework presents significant limitations for public health impact.
• A broader, transdiagnostic prevention strategy for early psychopathology is a more promising alternative.
• Further economic evaluations of extended, transdiagnostic early intervention programs are needed.