Clinical prediction models in psychiatry: a systematic review of two decades of progress and challenges

Alan J. Meehan, Stephanie J. Lewis, Seena Fazel, Paolo Fusar-Poli, Ewout W. Steyerberg, Daniel Stahl, Andrea Danese*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

24 Citations (Scopus)
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Recent years have seen the rapid proliferation of clinical prediction models aiming to support risk stratification and individualized care within psychiatry. Despite growing interest, attempts to synthesize current evidence in the nascent field of precision psychiatry have remained scarce. This systematic review therefore sought to summarize progress towards clinical implementation of prediction modeling for psychiatric outcomes. We searched MEDLINE, PubMed, Embase, and PsychINFO databases from inception to September 30, 2020, for English-language articles that developed and/or validated multivariable models to predict (at an individual level) onset, course, or treatment response for non-organic psychiatric disorders (PROSPERO: CRD42020216530). Individual prediction models were evaluated based on three key criteria: (i) mitigation of bias and overfitting; (ii) generalizability, and (iii) clinical utility. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to formally appraise each study’s risk of bias. 228 studies detailing 308 prediction models were ultimately eligible for inclusion. 94.5% of developed prediction models were deemed to be at high risk of bias, largely due to inadequate or inappropriate analytic decisions. Insufficient internal validation efforts (within the development sample) were also observed, while only one-fifth of models underwent external validation in an independent sample. Finally, our search identified just one published model whose potential utility in clinical practice was formally assessed. Our findings illustrated significant growth in precision psychiatry with promising progress towards real-world application. Nevertheless, these efforts have been inhibited by a preponderance of bias and overfitting, while the generalizability and clinical utility of many published models has yet to be formally established. Through improved methodological rigor during initial development, robust evaluations of reproducibility via independent validation, and evidence-based implementation frameworks, future research has the potential to generate risk prediction tools capable of enhancing clinical decision-making in psychiatric care.

Original languageEnglish
Pages (from-to)2700-2708
Number of pages9
JournalMolecular Psychiatry
Issue number6
Early online date1 Apr 2022
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
AJM acknowledges financial support from Yale Child Study Center, Yale University. SJL is supported by an MRC Clinical Research Training Fellowship. This research was funded in whole, or in part, by a Wellcome Trust grant to SF (202836/Z/16/Z). AD is funded by grant MR/P005918/1 from the UK Medical Research Council. DS and AD are part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the UK National Health Service, NIHR, MRC, Wellcome Trust, or King’s College London.

Publisher Copyright:
© 2022, The Author(s).


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