Early interventions for first onset of symptoms of mental health conditions: an umbrella review of systematic reviews
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Background
Early intervention following mental health symptom onset has great potential in reducing long-term burden on individuals, families and friends, and society. The main focus in service development and research has been on early intervention in psychosis, but advances have also been made for other mental health difficulties such as eating disorders, anxiety and depression. We aimed to take stock of the available evidence regarding effectiveness, implementation, and experiences of care for early intervention approaches through a systematic umbrella review.
Methods
We included systematic reviews of complex early intervention strategies including more than one component, for mental health conditions with typical onset in young people under 25. We searched 4 databases (January 2019-April 2024) and synthesised results from eligible reviews using a narrative approach. Quality was assessed using AMSTAR 2. We excluded reviews on At Risk Mental States for psychosis as this is an extensive literature that has been the sole focus of umbrella reviews.
Results
Sixteen reviews were included, with ten covering early intervention for psychosis, three for eating disorders, one for bipolar disorder and two for transdiagnostic early intervention approaches. Reviews of early intervention for psychosis suggest that intensive approaches can improve recovery rates following first presentation to services, although the success of initiatives aimed at reducing duration of untreated symptoms is less consistent. We found little systematically synthesised evidence of good quality regarding other diagnoses, although some early indications of success with eating disorders were described. Stigma and lack of knowledge or support act as barriers to rapid access, while insufficient service resources and staffing were barriers to effective intervention delivery.
Conclusions
Despite its high importance in reducing the global burden of mental ill-health, evidence on how to intervene early following symptom onset remains limited (as assessed via systematic reviews), especially for conditions other than psychosis. For psychosis, some approaches now warrant attention to widespread implementation. Innovative approaches for eating disorders have been developed, but there is still a pressing need for treatments supported by substantial and robust trials. Further systematic reviews would be desirable for conditions including depression and anxiety, bipolar disorder, and “personality disorder”.
