Individualized prediction of transition to psychosis in 1,676 individuals at clinical high risk: Development and validation of a multivariable prediction model based on individual patient data meta-analysis

Aaltsje Malda, Nynke Boonstra, Hans Barf, Steven De Jong, Andre Aleman, Jean Addington, Marita Pruessner, Dorien Nieman, Lieuwe De Haan, Anthony Morrison, Anita Riecher-Rössler, Erich Studerus, Stephan Ruhrmann, Frauke Schultze-Lutter, Suk Kyoon An, Shinsuke Koike, Kiyoto Kasai, Barnaby Nelson, Patrick McGorry, Stephen WoodAshleigh Lin, Alison Y. Yung, Magdalena Kotlicka-Antczak, Marco Armando, Stefano Vicari, Masahiro Katsura, Kazunori Matsumoto, Sarah Durston, Tim Ziermans, Lex Wunderink, Helga Ising, Mark Van Der Gaag, Paolo Fusar-Poli, Gerdina Hendrika Maria Pijnenborg

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10 Citations (Scopus)


Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. The aim of the study was to develop and validate an individualized, clinically based prognostic model for forecasting transition to psychosis from a CHR-P stage. Methods: A literature search was performed between January 30, 2016, and February 6, 2016, consulting PubMed, Psychinfo, Picarta, Embase, and ISI Web of Science, using search terms (“ultra high risk” OR “clinical high risk” OR “at risk mental state”) AND [(conver* OR transition* OR onset OR emerg* OR develop*) AND psychosis] for both longitudinal and intervention CHR-P studies. Clinical knowledge was used to a priori select predictors: age, gender, CHR-P subgroup, the severity of attenuated positive psychotic symptoms, the severity of attenuated negative psychotic symptoms, and level of functioning at baseline. The model, thus, developed was validated with an extended form of internal validation. Results: Fifteen of the 43 studies identified agreed to share IPD, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell’s C-statistic 0.655, 95% confidence interval (CIs), 0.627–0.682]. Conclusion: This is the first IPD-MA conducted in the largest samples of CHR-P ever collected to date. An individualized prognostic model based on clinical predictors available in clinical routine was developed and internally validated, reaching only moderate prognostic performance. Although personalized risk prediction is of great value in the clinical practice, future developments are essential, including the refinement of the prognostic model and its external validation. However, because of the current high diagnostic, prognostic, and therapeutic heterogeneity of CHR-P studies, IPD-MAs in this population may have an limited intrinsic power to deliver robust prognostic models.

Original languageEnglish
Article number345
JournalFrontiers in Psychiatry
Issue numberMAY
Publication statusPublished - 2019


  • Clinical high risk
  • Individual patient data meta-analysis
  • Prognosis
  • Psychosis
  • Risk prediction
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health


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