A systematic review and meta-analysis of recovery from schizophrenic psychoses Erika Jääskeläinen (1), Pauliina Juola (1), John McGrath (2), Sukanta Saha (2), Juha Veijola (1), Noora Hirvonen (1), Matti Isohanni (1), Jouko Miettunen (1)
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A systematic review and meta-analysis of
recovery from schizophrenic psychoses
Erika Jääskeläinen(1), Pauliina Juola (1), John McGrath (2), Sukanta Saha (2),
Juha Veijola(1), Noora Hirvonen (1), Matti Isohanni(1), Jouko Miettunen(1)
1 Department of Psychiatry, University of Oulu and Oulu University Hospital, Finland
2 Queensland Centre for Mental Health Research, Australia.
On average 17% of individuals having schizophrenic psychosis experience recovery.
Recovery in schizophrenia is still a limitedly understood issue having extreme high scientific and human importance. No systematic review on this topic exist.
To systematically collate studies presenting amount of recovered individuals with schizophrenic psychoses and to synthesize these data with meta-analytic techniques.
● Seven electronic databases, manual literature searching, contacting authors via email
● Keywords in electronic database search: “schizo* or psychotic or psychos*s” and “recovery or remission or outcome* or course or prognosis or follow-up or longitudinal” were used as a title search. The second search in abstracts included keywords “schizophrenia” and “recovery or remission”.
● Inclusion criteria: English language, presentation of primary data, not therapy/drug trials/interventions, had at least 15 subjects, and had follow up data for at least two years
● Recovery needed to be measured as combination of clinical and social dimensions, with at least two-year measurement window for either of the outcome dimensions.
● All abstracts and articles were critically analysed by two of the authors (EJ and JMi).
● The search identified 5950 potentially relevant articles. After further screening,
59 studies met our inclusion criteria (Figure).
● Between 0% to 60% of the subjects recovered (mean 17.3%, 10–90% quantiles 3.4%-32.4%).
● Meanannual recovery rate was 1.5% (95% CI 1.1-1.9%)
● Compared to North-American and European studies (n=49), recovery was more common in studies from other locations (n=10; mean 24.4% vs. 15.8%; meta-regression, z test –2.00, p=0.050).
● The time of starting the study (before vs. after 1965), length of follow-up (less vs. more than 10 years), diagnostic system (DSM vs. ICD vs. other) and gender did not affect the percentage of recovered individuals.
Figure. Included studies (n=59) and the percentage of recovered individuals.
Based on this systematic review, at least periods of recovery from schizophrenic psychoses do occur. The proportion of patients meeting recovery criteria do not seem to increased during last decades. Relatively little primary data on recovery in schizophrenia exist, and various conceptual and methodological pitfalls cause challenges when studying the topic. More accurate reporting of multidimensional recovery results and structured consensus criteria for recovery in schizophrenia are needed. Additionally, identifying predictors of recovery would be useful for clinical work.
Correspondence: MD, PhD Erika Jääskeläinen
Department of Psychiatry, P.O.Box 5000
90014 University of Oulu, Finland
tel. +358 40 7191146
Acknowledgements: NARSAD, the Sigrid Juselius Foundation, the Finnish Medical Foundation , Medical Society Duodecim Oulu