NIHR Patient Safety Translational Research Centre, Imperial College London, London, UK.
School of Public Health, Imperial College London, London, UK.
Syst Rev. 2021 Sep 17;10(1):250. doi: 10.1186/s13643-021-01798-z.
Serious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14 and 25. Once diagnosed, young peoples' health can deteriorate, and it is therefore vital to detect this early to prevent severe outcomes including hospitalisations and deaths by suicide. The main study aim is to describe and discuss observational studies that examine signs of deterioration in young patients with SMI.
A systematic review guided by the published protocol was conducted. Cumulative Index to Nursing and allied Health Literature (CINAHL), MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC) and Web of Science were searched against pre-defined criteria until 1 March 2021. Observational studies were extracted according to design, country, participant, indicator, outcome and main finding categories. Quality was assessed independently using the Newcastle Ottawa Scale (NOS).
Of the 15,788 publications identified, 5 studies were included and subjected to narrative synthesis. Two indicators of mental health deterioration were identified: cognitive functioning (decline, worsening and poor school/academic performance) and expressed emotion status. Indicators revealed mixed views on predicting deterioration. Worsening cognitive functioning and expressed emotion status significantly predicted medication non-adherence and relapse respectively. However, a decline in cognitive functioning (poor academic performance) was not found to significantly correlate to deaths by suicide. Study quality was mostly poor and associations between indicators and varied outcomes were weak. The heterogeneous nature of the data made comparisons difficult and did not allow for further statistical analysis.
To our knowledge, this is the first review of observational studies to identify indicators of deterioration in young patients with SMI. Worsening cognitive functioning and expressed emotion status could indicate non-adherence and relapse in young patients with SMI but larger sample sizes in good quality studies are needed. The dearth of observational studies means further research is required to ascertain other indicators of deterioration before serious outcomes occur.
This work was supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre via an NIHR programme grant. The authors are also grateful for support from the NIHR under the Applied Health Research programme for North West London and the NIHR Imperial Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
This systematic review has been registered on PROSPERO (registration number: CRD42017075755 ).
严重精神疾病（SMI），如精神分裂症和双相情感障碍，首次发病于 14 至 25 岁之间。一旦确诊，年轻人的健康状况可能会恶化，因此及早发现这一点至关重要，以预防严重后果，包括住院和自杀死亡。主要研究目的是描述和讨论观察性研究，这些研究检查了患有 SMI 的年轻患者的恶化迹象。
本研究采用发表的方案指导下进行系统评价。从预先设定的标准对 Cumulative Index to Nursing and allied Health Literature（CINAHL）、MEDLINE、Embase、PsycINFO、Health Management Information Consortium（HMIC）和 Web of Science 进行了检索，检索时间截至 2021 年 3 月 1 日。根据设计、国家、参与者、指标、结果和主要发现类别提取观察性研究。使用 Newcastle Ottawa Scale（NOS）独立评估质量。
在确定的 15788 篇文献中，有 5 项研究被纳入并进行了叙述性综合。确定了两个精神健康恶化的指标：认知功能（下降、恶化和学业表现不佳）和表达情感状况。这些指标对预测恶化的观点不一。认知功能恶化（学业表现不佳）与自杀死亡无显著相关性，而认知功能恶化（较差的学业成绩）与自杀死亡无显著相关性。表达情感状态显著预测了药物不依从和复发。表达情感状态显著预测了药物不依从和复发。然而，认知功能恶化与自杀死亡无显著相关性。研究质量大多较差，指标与不同结果之间的相关性较弱。数据的异质性使得比较困难，并且不允许进行进一步的统计分析。
据我们所知，这是第一项旨在确定患有 SMI 的年轻患者恶化指标的观察性研究综述。认知功能恶化和表达情感状态可能表明患有 SMI 的年轻患者不依从和复发，但需要更大样本量的高质量研究。观察性研究的缺乏意味着需要进一步研究，以确定在发生严重后果之前的其他恶化指标。
这项工作得到了国家卫生研究院（NIHR）帝国患者安全转化研究中心通过国家卫生研究院计划拨款的支持。作者还要感谢国家卫生研究院在北伦敦应用健康研究计划和国家卫生研究院帝国生物医学研究中心的支持。本文表达的观点是作者的观点，不一定代表国民保健制度（NHS）、国家卫生研究院或卫生部的观点。资助者在研究设计、数据收集和分析、出版决定或手稿准备方面没有任何作用。
本系统评价已在 PROSPERO（注册号：CRD42017075755）上注册。
