de Winter Lars, Jelsma Auke, Vermeulen Jentien M, Vellinga Astrid, van Weeghel Jaap, Hasson-Ohayon Ilanit, Mulder Cornelis L, Boonstra Nynke, Veling Wim, de Haan Lieuwe
Phrenos Center of Expertise, Utrecht, the Netherlands.
Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, the Netherlands.
Acta Psychiatr Scand. 2025 Mar 30;152(1):6-26. doi: 10.1111/acps.13808.
Patients with schizophrenia spectrum disorders (SSD) improve in several outcome domains over the course of illness, but to different degrees. In this meta-analysis, we investigated whether longitudinal changes in different outcome domains are associated with each other and which factors moderate these changes over time.
Our protocol was preregistered in PROSPERO (CRD42024504253). We included 109 studies, identified through searches in PsycInfo, PubMed, CINAHL, and Cochrane up until November 2023, investigating longitudinal changes in at least two outcome domains (symptoms, social functioning, cognition or personal recovery) for patients with SSD with at least 1 year follow-up. We calculated Pearson correlation coefficients for associations of changes between outcome domains. Potential moderating effects of demographic, clinical, social, or study characteristics were explored. Quality assessment was executed using the QUIPS tool.
We found substantial positive associations between changes in symptoms, social functioning, and cognition. Especially, changes in negative symptoms and overall social functioning were associated with changes in several outcome domains. Changes in personal recovery were only associated with changes in symptoms. We found more substantial improvements in combinations of outcomes for patients with a shorter illness duration, females, a lower percentage of patients diagnosed with schizophrenia, and patients receiving treatment focused on targeted outcomes.
Symptoms, social functioning, and cognition often concurrently improve and may boost each other. This suggests that an integrated approach targeting several outcome domains jointly boosts long-term improvement. However, changes in personal recovery seem to occur separately from other outcome domains. Therefore, targeted attention for personal recovery is needed.
PROSPERO: CRD42024504253.
精神分裂症谱系障碍（SSD）患者在病程中多个结局领域会有所改善，但程度不同。在这项荟萃分析中，我们研究了不同结局领域的纵向变化是否相互关联，以及哪些因素会随时间调节这些变化。
我们的方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42024504253）中预先注册。我们纳入了109项研究，这些研究通过检索截至2023年11月的PsycInfo、PubMed、CINAHL和Cochrane数据库确定，研究了SSD患者至少两个结局领域（症状、社会功能、认知或个人康复）的纵向变化，且随访时间至少为1年。我们计算了结局领域之间变化关联的皮尔逊相关系数。探讨了人口统计学、临床、社会或研究特征的潜在调节作用。使用QUIPS工具进行质量评估。
我们发现症状、社会功能和认知变化之间存在显著的正相关。特别是，阴性症状的变化和整体社会功能与多个结局领域的变化相关。个人康复的变化仅与症状变化相关。我们发现，病程较短的患者、女性、被诊断为精神分裂症的患者比例较低的患者以及接受针对特定结局的治疗的患者，其结局组合的改善更为显著。
症状、社会功能和认知通常同时改善，且可能相互促进。这表明针对多个结局领域的综合方法可共同促进长期改善。然而，个人康复的变化似乎与其他结局领域分开发生。因此，需要针对性地关注个人康复。
国际前瞻性系统评价注册库（PROSPERO）：CRD42024504253
