Neiders Ivars, Mežinska Signe, van Haren Neeltje E M
University of Latvia, Institute of Clinical and Preventive Medicine, Riga, Latvia.
Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, Netherlands.
BMC Psychiatry. 2025 May 19;25(1):501. doi: 10.1186/s12888-025-06949-3.
Over the last decade, there has been considerable development in precision psychiatry, especially in the development of novel prediction tools that can be used for early prediction of the risk of developing a severe mental disorder such as schizophrenia, depression, bipolar disorder. Although the clinical efficiency of those tools is still unclear it is crucial to consider the future ethical and social consequences of their clinical use before they are used in clinical practice. The literature on this issue is rapidly growing and represents input from scholars from different fields-psychiatrists, bioethicists etc. However, to our knowledge, nobody has produced a review addressing these issues. Therefore, the present study aims to bridge the gap.
We conducted a scoping review, allowing integration of both empirical and non-empirical studies. The research question addressed is: what are the ethical and social issues raised by the potential use of predictive tools for the risk of developing of severe mental disorder identified in the existing empirical and theoretical literature? After developing the search terms, we conducted a search in three electronic databases: Scopus, Web of Science and PubMed. For the included articles bibliometric analysis and inductive thematic coding was performed. To ensure the transparency and rigour of this scoping review we followed he Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A qualitative inductive thematic analysis of the included articles was performed using Atlas.ti.
After screening, evaluation for eligibility and citation tracing 129 publications were included in the scoping review. The articles represent a wide range of fields of research-clinical psychology, general medicine, neuroscience, genetics, clinical genetics, psychiatry and mental health, philosophy, ethics, etc. The majority of the articles (83) are theoretical studies, 35 papers report results of empirical research and 11 are review papers. Qualitative thematic analysis of the included articles revealed four main themes: 1) Potential benefits and harms; 2) Rights and responsibilities; 3) Counselling, education and communication; 4) Ethical issues in different applications.
The articles included in the review cover a wide variety of concerns that might be raised when implementing predictive tools for the risk of developing of severe mental disorder. However, some important gaps in the literature are indicated. First, there are issues that should deserve more attention than they have received thus far (clinical utility, extensive or mandatory use). In several cases there is no empirical knowledge that determines whether particular concerns are justified (stigmatisation, use of machine learning algorithms).
在过去十年中，精准精神病学取得了长足发展，尤其是在新型预测工具的开发方面，这些工具可用于早期预测诸如精神分裂症、抑郁症、双相情感障碍等严重精神障碍的发病风险。尽管这些工具的临床效率仍不明确，但在将其应用于临床实践之前，考虑其临床使用的未来伦理和社会后果至关重要。关于这一问题的文献正在迅速增加，代表了来自不同领域的学者——精神科医生、生物伦理学家等的观点。然而，据我们所知，尚未有人对这些问题进行综述。因此，本研究旨在填补这一空白。
我们进行了一项范围综述，允许纳入实证研究和非实证研究。所探讨的研究问题是：在现有实证和理论文献中确定的用于预测严重精神障碍发病风险的预测工具的潜在使用会引发哪些伦理和社会问题？在制定检索词后，我们在三个电子数据库中进行了检索：Scopus、科学网和PubMed。对纳入的文章进行了文献计量分析和归纳主题编码。为确保本范围综述的透明度和严谨性，我们遵循了系统评价和Meta分析扩展的范围综述的首选报告项目（PRISMA-ScR）。使用Atlas.ti对纳入的文章进行了定性归纳主题分析。
经过筛选、资格评估和引文追踪，129篇出版物被纳入范围综述。这些文章代表了广泛的研究领域——临床心理学、普通医学、神经科学、遗传学、临床遗传学、精神病学和心理健康、哲学、伦理学等。大多数文章（83篇）是理论研究，35篇论文报告了实证研究结果，11篇是综述论文。对纳入文章的定性主题分析揭示了四个主要主题：1）潜在的益处和危害；2）权利和责任；3）咨询、教育和沟通；4）不同应用中的伦理问题。
综述中纳入的文章涵盖了在实施用于预测严重精神障碍发病风险的预测工具时可能引发的各种问题。然而，文献中也指出了一些重要的空白。首先，有些问题应得到比目前更多的关注（临床效用、广泛或强制使用）。在一些情况下，没有实证知识来确定特定问题是否合理（污名化、机器学习算法的使用）。
