Do early intervention services for psychosis maintain their effects after transition to usual/modular care? A systematic review and meta-analysis.

Early intervention services (EIS) for psychosis have demonstrated superiority to usual care/modular care (UC/MC) until the end of their delivery. However, the maintenance effects of EIS care after transition to UC/MC are less clear. We aimed to compare these effects vs. UC/MC at least one year after the end of EIS care. This PRISMA and MOOSE-compliant systematic review searched PubMed, EMBASE, PsycINFO and Web of Science databases and Cochrane Central Register of Reviews, without time or language restrictions. We included studies initially designed as randomized controlled trials (RCTs) comparing EIS vs. UC/MC in patients with early-phase psychosis, in which both the intervention and control groups were followed for at least 12 months after cessation of EIS care in the intervention group. Co-primary outcomes were psychiatric hospitalization, duration of hospitalization, and drop-out at the end of follow-up (preferably 5 years post-EIS initiation). Secondary outcomes were severity of total, positive and negative symptoms; quality of life, work involvement, remission, legal offences, antipsychotic use, and suicide attempts. We meta-analyzed six RCTs with data from 13 papers, including 1,416 individuals (mean age: 23.9 years, females: 36.7%). After 2-3 years of receiving UC/MC, subsequent to 2-3 years of EIS care or UC/MC, individuals who originally received EIS care spent less days hospitalized than those continuing UC/MC (n=5, standardized mean difference, SMD=0.128, 95% CI: 0.019-0.237, p=0.021). However, although we confirmed the superiority of EIS care to UC/MC at the end of the intervention period (except for work involvement and legal offences), the two groups did not differ significantly at 2-3 years post-EIS care regarding hospitalization, all-cause drop-out, quality of life; severity of total, positive and negative symptoms; work involvement, remission, legal offences, antipsychotic use, and suicide attempts. In summary, EIS care did not maintain its superiority over UC/MC 2-3 years after its cessation across meta-analyzable outcomes, except for duration of hospitalizations. These results support the need to further develop and potentially extend full or individualized EIS delivery.