An appraisal of practice guidelines for early intervention services (EIS) for psychosis : Using AGREE II (Appraisal of Guidelines for Research and Evaluation) to enhance guideline quality and trustworthiness for the future

Abstract

Background

Early intervention services (EIS) for psychosis have expanded internationally. Yet, the quality of the guidelines to support and monitor them has never been evaluated. We therefore aimed to systematically appraise the quality of EIS guidelines.

Study design

We conducted a systematic review of grey literature websites, supplemented by guidelines identified in a prior scoping review. Eligible documents were guidelines focused on/with a section on early intervention or first episode psychosis. Two independent reviewers appraised each guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II).

Study results

Thirty-two guidelines were included. Guidelines varied widely on scores for the AGREE II domains. Many scored high (≥70%) on Scope and Purpose (24/32; 75%) and Clarity of Presentation (22/32; 69%). Only 22% (7/32) scored well on Rigour of Development, primarily due to the lack of methods for evidence identification and appraisal. The lowest scoring domain was Applicability; only two guidelines scored ≥70%, while more than half provided no information on barriers or facilitators to implementation. Stakeholder involvement, especially from service users, was limited in developing EIS-specific guidelines. Guidelines performing consistently well were from large guideline development groups and used established evidence-grading methods.

Conclusions

This first systematic appraisal shows that while many EIS guidelines clearly articulate aims and recommendations, substantial methodological and implementation gaps remain. Nonetheless, EIS guidelines score like others in psychiatry. Still, limited stakeholder engagement and applicability may impede consistent, evidence-based EIS delivery. Future guidelines should explicitly describe evidence-based review processes, integrate service user input, and use AGREE II-like tools to enhance their usability and impact.