Abstract
BACKGROUND: Quality of life (QoL) is an important clinical outcome in mental health. However, evidence on its progression and predictors in individuals at clinical high risk for psychosis (CHR-P) remains limited. This meta-analysis examined correlates, impact, and longitudinal changes in QoL among CHR-P individuals. METHODS: Following PRISMA guidelines (PROSPERO: CRD42024560092), we systematically searched multiple databases from inception to 27 May 2025. Eligible studies included CHR-P participants assessed with validated QoL instruments. Data extraction was performed independently, and meta-analyses, meta-regressions, heterogeneity, and publication bias analyses were conducted. Risk of bias was evaluated using a modified Newcastle–Ottawa Scale (NOS). RESULTS: Thirty-one studies were included (2,288 CHR-P individuals; mean age = 21.47 years; 48.9% female). Compared with healthy controls (HC), CHR-P participants showed significantly poorer QoL (Hedges’ g = 1.39, 95% CI = 0.97–1.83). Longitudinal analyses indicated QoL improvements after 1 year (Hedges’ g = 1.40, 95% CI = 0.74–2.07) and at 2–3 years follow-up (Hedges’ g = 3.24, 95% CI = 0.73–5.75). Substantial heterogeneity was observed across analyses. Meta-regressions showed no significant influence of age, sex, functioning, symptom severity, or study quality. Study quality scores ranged from 1 to 8 (median = 6, mean = 5.8, SD = 1.13). CONCLUSIONS: Individuals at CHR-P present markedly poorer QoL compared with healthy controls. Longitudinal data suggest possible improvements over time; however, heterogeneity and limited long-term evidence warrant cautious interpretation. Further longitudinal studies are needed to better characterize QoL trajectories and identify subgroups requiring sustained intervention.