Abstract
The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings. PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model. The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8-52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0-32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3-9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type. The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.
Published Version
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