2 - (OP21)Transdiagnostic Predictors of Relapse in People with Severe Mental Illness: A Scoping Review

Background:
Relapse is highly prevalent in severe mental illness (SMI). Identifying early warning signs (EWS) that are indicative of a worsening mental health status is of great importance to prevent full-blown relapses in SMI. While mental health research traditionally classified an SMI based on pre-determined criteria and symptom scores, more recent transdiagnostic research acknowledges that different SMIs share similar underlying processes and symptoms, which explains the high comorbidity among these disorders. As such, identifying transdiagnostic relapse predictors may help build effective relapse prevention tools across the entire space of SMIs.
In a scoping review, we aim to identify time-varying factors that may serve as EWS of relapse in major depressive disorder (MDD), bipolar I or II disorder (BD), and non-affective psychotic disorders (NADP). These SMIs were chosen as they are expected to show significant overlap due to shared symptomatology and can then be marked as transdiagnostic.


Methods:
A comprehensive search was conducted in PubMed, PsycInfo, and Web of Science using a strategy that included terms related to the disorders of interest, prediction, relapse, and longitudinal study designs. Articles were included if they met the following criteria: 1) Participants were 18 years or older and experienced at least one episode of a disorder of interest; 2) The study was longitudinal; 3) Outcomes were related to relapse or symptom worsening; 4) Predictors of relapse fluctuated over time; 5) Predictors and relapse were both measured trough self-report; and 6) As EWS tend to emerge two to three weeks before an actual relapse, potential predictors and relapse were assessed at least twice, where no interval could exceed 14 days, and the total assessment period had to span at least 14 days. Intensive repeated assessments (e.g. experience sampling) had to be administered at least once a day for a minimum of 5 consecutive days to reliably capture fluctuations in relapse-related symptoms over time.

Findings:
Fifteen articles met the criteria. Findings indicate that transdiagnostic predictors of relapse across MDD, BD, and NAPD appear to be limited. Sleep problems was the only factor identified as a predictor across all three disorders. Negative affect, measured through low mood, irritability, sadness, stress, and guilt, was shared between BD and NAPD only. The limited findings may partly be explained by methodological choices in studies and our strict inclusion criteria based on prior research. That is, insufficient measurement intervals was the leading criterion for study exclusion (55 out of 93 articles).


Discussion:
Additional transdiagnostic predictors may exist but remain unidentified because they have not been measured frequently enough or over a sufficiently long period. To improve early detection of relapse, we recommend that future studies implement frequent and consistent symptom monitoring to enhance the identification of transdiagnostic EWS across psychiatric diagnoses.