Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

Abstract

BackgroundDespite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.MethodsThis systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.ResultsForty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.ConclusionsAt least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

Patterns and predictors of trajectories for subjective quality of life in patients with early psychosis: Three-year follow-up of the randomized controlled trial on extended early intervention

“…It is also posited that depressed patients have higher tendency of negative self-appraisal, which may lead to their lower satisfaction with various life domains, particularly psychological wellbeing (Renwick et al, 2012). Importantly, given that depression represents a major determinant of SQoL and is prevalent in the early phase of illness (Herniman et al, 2019), comprehensive evaluation and regular monitoring of depressive symptoms should be integrated in EI service to facilitate early detection and intervention which will in turn promote patients' SQoL. Alternatively, our analysis found that patients with younger age at onset of psychosis exhibited poor SQoL trajectory.…”

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

“…The presence of mood symptoms, including depression and mania, is common in schizophrenia, as is the presence of positive symptoms in bipolar disorder. Diagnostic fluidity is a key component in first-episode psychosis; mood symptoms such as depression are particularly common in this early phase of illness (Herniman et al, 2019; Upthegrove et al, 2017). While the majority of first-episode psychosis patients would meet diagnostic criteria for schizophrenia, for those patients without a clear schizophreniform presentation making a diagnosis is still essential for effective and prompt treatment (Marshall et al, 2014), as reviewed in the section on First-episode psychosis above, and multidisciplinary teams should be prepared to make and then if necessary change a diagnosis as the clinical presentation becomes clearer.…”

Placebo response mitigation with a participant-focused psychoeducational procedure: a randomized, single-blind, all placebo study in major depressive and psychotic disorders

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