An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

Abstract

We aimed to identify diagnosis-specific/transdiagnostic/transoutcome multivariable candidate predictors (MCPs) of key outcomes in mental disorders. We conducted an umbrella review (protocol link), searching MEDLINE/Embase (19/07/2022), including systematic reviews of studies reporting on MCPs of response, remission, recovery, or relapse, in DSM/ICD-defined mental disorders. From published predictors, we filtered MCPs, validating MCP criteria. AMSTAR2/PROBAST measured quality/risk of bias of systematic reviews/individual studies. We included 117 systematic reviews, 403 studies, 299,888 individuals with mental disorders, testing 796 prediction models. Only 4.3%/1.2% of the systematic reviews/individual studies were at low risk of bias. The most frequently targeted outcome was remission (36.9%), the least frequent was recovery (2.5%). Studies mainly focused on depressive (39.4%), substance-use (17.9%), and schizophrenia-spectrum (11.9%) disorders. We identified numerous MCPs within disorders for response, remission and relapse, but none for recovery. Transdiagnostic MCPs of remission included lower disease-specific symptoms (disorders = 5), female sex/higher education (disorders = 3), and quality of life/functioning (disorders = 2). Transdiagnostic MCPs of relapse included higher disease-specific symptoms (disorders = 5), higher depressive symptoms (disorders = 3), and younger age/higher anxiety symptoms/global illness severity/ number of previous episodes/negative life events (disorders = 2). Finally, positive trans-outcome MCPs for depression included less negative life events/depressive symptoms (response, remission, less relapse), female sex (response, remission) and better functioning (response, less relapse); for schizophrenia, less positive symptoms/higher depressive symptoms (remission, less relapse); for substance use disorder, marital status/higher education (remission, less relapse). Male sex, younger age, more clinical symptoms and comorbid mental/physical symptoms/disorders were poor prognostic factors, while positive factors included social contacts and employment, absent negative life events, higher education, early access/intervention, lower disease-specific and comorbid mental and physical symptoms/conditions, across mental disorders. Current data limitations include high risk of bias of studies and extraction of single predictors from multivariable models. Identified MCPs can inform future development, validation or refinement of prediction models of key outcomes in mental disorders.

On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia – Results from an Expert Consensus Following the Delphi Method

“…Neuropsychiatric Disease and Treatment 2024:20 1140 practice-modifying impact despite extensive research over decades. 5,[39][40][41] Nevertheless, the lack of actionable biomarkers should not lead to the conclusion that individualized management of schizophrenia is not feasible.…”

“…However, while some genetic, immunological, clinical, and neuroimaging biomarkers have shown potential, particularly in the areas of predicting conversion to psychosis and treatment response, discontinuation, and relapse risk, no single biomarker has been able to achieve disease- or practice-modifying impact despite extensive research over decades. 5 , 39–41 Nevertheless, the lack of actionable biomarkers should not lead to the conclusion that individualized management of schizophrenia is not feasible.…”

“…Schizophrenia is a mental disorder characterized by a persistent tendency to recurrent psychotic symptoms associated with cognitive, emotional, behavioral, psychological, and social dysfunction, 1 generally characterized by a fluctuating clinical course with relapses and remissions. [2][3][4][5][6] Schizophrenia affects approximately 7/1000 people, with a male-tofemale ratio of approximately 1.4:1 4,7,8 and causes a significant clinical, personal, and economic burden, [9][10][11] with patients continuing to experience impairment in activities of daily living, work capacity, and social functioning. [12][13][14] While psychopharmacology remains the cornerstone of schizophrenia treatment, [15][16][17][18][19][20] the addition of psychosocial interventions or psychotherapy is essential to improve the overall personal and family well-being of individuals affected by this complex mental disorder.…”

How to optimize the systematic review process using AI tools

“…This allows for informed decisions to be made by psychiatrists and gaps in the literature to be unveiled, providing direction for future research. In psychiatry, elements such as early predictors of psychopathology, disease prognosis and effectiveness of interventions are of particular interest to clinicians as they assist in determining appropriate treatment regimes (Bellato, Admani, et al., 2023 ; Fabiano et al., 2023 ; Solmi et al., 2023 ). Oftentimes, individual primary studies may either be underpowered to detect a particular outcome of interest or have conflicting outcomes based on other available literature.…”

Anxiety Symptom Trajectories Predict Depression Symptom Trajectories up to Four Years After CBT for Youth Anxiety Disorders

“…In the current study, we considered multiple potential predictors when examining the long-term depression outcomes after CBT for youth anxiety disorders that were informed by the conceptual framework outlined above. In terms of background factors, we included youth age and gender because females and older youth tend to show more internalizing symptoms than males and younger youth (Rognstad et al, 2022;Solmi et al, 2023). We also included family social class because poor socio-economic status is a risk factor for mental health problems (Bøe et al, 2021).…”