Discriminative validity of Clinical High-Risk Status for Psychosis among help-seekers: a systematic review and meta-analysis
4 affiliations
- 1Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- 2Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
- 3Department of Neuroscience, University of Turin, Turin, Italy
- 4Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Abstract
The Clinical High-Risk for Psychosis (CHR-P) paradigm underpins early detection strategies and informs the DSM-5 construct of Attenuated Psychosis Syndrome (APS), yet its discriminative predictive validity relative to CHR-P–negative help-seekers has not been systematically quantified. We conducted a systematic review and meta-analysis of longitudinal studies comparing transition to psychosis among help-seeking individuals according to CHR-P status. PubMed/MEDLINE and the Cochrane Library were searched from inception to June 22, 2026. Eligible studies included help-seeking samples assessed with validated CHR-P instruments and reporting psychosis transition outcomes separately for CHR-P-positive and CHR-P-negative participants. Random-effects meta-analyses estimated transition prevalence and relative risks (RRs), while heterogeneity, publication bias, and moderators were examined. 14 studies including 4477 participants (2220 CHR-P–positive and 2257 CHR-P–negative) met inclusion criteria. Estimated transition rates were 14.7% [95% CI, 9.7–21.7%) among CHR-P-positive individuals and 1.6% (95% CI, 0.8–3.2%) among CHR-P-negative individuals. CHR-P status was associated with an almost ten-fold increased risk of transition to psychosis (RR, 9.8; 95% CI, 4.5–21.82), with no significant moderation by follow-up duration or sample characteristics. These findings demonstrate strong discriminative and predictive validity of CHR-P criteria among help-seekers, supporting attenuated psychotic symptoms as a clinically meaningful pre-psychotic phenotype. Results support consideration of APS in DSM-6 within a prognostically grounded, stepped-care framework rather than as a categorical disorder.
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BibTeX
@article{raballo2026discriminative,
title = {{Discriminative validity of Clinical High-Risk Status for Psychosis among help-seekers: a systematic review and meta-analysis}},
author = {Andrea Raballo and Antonio Preti and Michele Poletti},
journal = {Schizophrenia},
year = {2026},
month = jul,
doi = {10.1038/s41537-026-00785-4},
url = {https://doi.org/10.1038/s41537-026-00785-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Discriminative validity of Clinical High-Risk Status for Psychosis among help-seekers: a systematic review and meta-analysis
AU - Andrea Raballo
AU - Antonio Preti
AU - Michele Poletti
PY - 2026
DA - 2026/07/16
JO - Schizophrenia
DO - 10.1038/s41537-026-00785-4
UR - https://doi.org/10.1038/s41537-026-00785-4
AB - The Clinical High-Risk for Psychosis (CHR-P) paradigm underpins early detection strategies and informs the DSM-5 construct of Attenuated Psychosis Syndrome (APS), yet its discriminative predictive validity relative to CHR-P–negative help-seekers has not been systematically quantified. We conducted a systematic review and meta-analysis of longitudinal studies comparing transition to psychosis among help-seeking individuals according to CHR-P status. PubMed/MEDLINE and the Cochrane Library were searched from inception to June 22, 2026. Eligible studies included help-seeking samples assessed with validated CHR-P instruments and reporting psychosis transition outcomes separately for CHR-P-positive and CHR-P-negative participants. Random-effects meta-analyses estimated transition prevalence and relative risks (RRs), while heterogeneity, publication bias, and moderators were examined. 14 studies including 4477 participants (2220 CHR-P–positive and 2257 CHR-P–negative) met inclusion criteria. Estimated transition rates were 14.7% [95% CI, 9.7–21.7%) among CHR-P-positive individuals and 1.6% (95% CI, 0.8–3.2%) among CHR-P-negative individuals. CHR-P status was associated with an almost ten-fold increased risk of transition to psychosis (RR, 9.8; 95% CI, 4.5–21.82), with no significant moderation by follow-up duration or sample characteristics. These findings demonstrate strong discriminative and predictive validity of CHR-P criteria among help-seekers, supporting attenuated psychotic symptoms as a clinically meaningful pre-psychotic phenotype. Results support consideration of APS in DSM-6 within a prognostically grounded, stepped-care framework rather than as a categorical disorder.
SN - 2754-6993
ER -