A Systematic Review and Meta-Analysis of Psychosocial Intervention Targeting Social and Occupational Function in Early Psychosis

Background: Psychosis, including early psychosis, ranks highly among the causes of disability worldwide, even when clinical symptoms are well managed. This has resulted in an increased focus on how recovery of social and occupational functioning can be targeted using psychosocial interventions. The purpose of this review and meta-analysis was to survey psychosocial interventions in current use and provide an estimate of their effectiveness.  Methods: An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to May 2020 and is reported following PRISMA guidelines. Data were extracted on social and occupational functioning outcomes from included studies. Pooled standardised difference in means (SMD) were estimated with Comprehensive Meta-Analysis Software (CMA), Version 3.  Findings: In total, 31 studies involving 2811 participants were included in our analysis. Studies were categorised by psychosocial intervention type as follows: Cognitive Behavioural Therapy for Psychosis (CBTp), Family Based Therapy (FBT), Supported Employment, Cognitive Remediation (CR), and Multi-Component psychosocial interventions. Across the interventions considered, psychosocial interventions were associated with improvements in social and occupational function: CBTp (d= 0∙139), FBT (d=0∙299), Supported Employment (d= 0∙611), CR (d=0∙301), and Multi-Component psychosocial intervention (d=0∙452), Effect sizes varied by intervention type, stage of illness (ultra-high-risk v first episode v early psychosis), length and duration of treatment, and measure used.  Interpretation: Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services. Funding Statement: This work was funded by the Irish Health Research Board as part of the collaborative doctoral award in Youth Mental Health [YOULEAD] (HRB grant number:CDA-2018 001). Declaration of Interests: None to declare.