Dataset Information

Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis.

ABSTRACT:

Background

Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran.

Method

A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched until December 2022. We focused on randomized controlled trials, quasi-experimental studies, or economic studies related to individuals with SMI. Out of 127 articles, 17 were selected for a full-text review. The primary outcomes were the severity of psychopathology, rehospitalization rates, and the mental health of caregivers. We also examined community-based interventions and their impact on various outcomes. Data extraction and risk of bias assessment were performed, and critical appraisal was conducted using JBI checklists. Meta-analysis was carried out using STATA software. (PROSPERO registration. CRD42022332660).

Result

Rehospitalization rates among patients who received CBMHS were significantly lower, with an odds ratio of 2.14 (95% CI: 1.44 to 3.19), indicating a 2.14 times lower likelihood than those who received treatment as usual. A reduction in psychopathology accompanied this, SMD: -0.31, 95% CI: -0.49 to -0.13, I2 = 40.23%). Moreover, there was a notable improvement in social skills (SMD: -0.7, 95% CI: -0.98 to -0.44, I2 = 0.00%). The burden on caregivers also decreased (SMD: -0.55, 95% CI: -0.99 to -0.1, I2 = 63.2). The Incremental Cost-Effectiveness Ratio (ICER) for QUALY was acceptable, albeit with a wide range of 613 to 8400 Dollars.

Conclusion

CBMHS has demonstrated effectiveness and efficiency in Iran as a developing country. Additionally, it shows promise in mitigating the shortage of acute psychiatry beds. Using multiple data collection tools poses a limitation regarding data consolidation and conducting a meta-analysis.

SUBMITTER: Taban M

PROVIDER: S-EPMC10993444 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis.

Taban Mozhgan M Nooraeen Sara S Tanha Kiarash K Moradi-Lakeh Maziar M Malakouti Seyed Kazem SK

BMC psychiatry 20240404 1

<h4>Background</h4>Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran.<h4>Method</h4>A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched ...[more]

PMID: 38575916

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Project description:BackgroundAlthough national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users.MethodsA cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis.ResultsThe four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1-0.5), Guangzhou (B = 0.2; 95%CI: 0.1-0.3), and Shenzhen (B = 0.3; 95%CI: 0.1-0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5).ConclusionsThere have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients' utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

Project description:ObjectivesTo assess the effectiveness, cost-effectiveness and return on investment of individual placement and support (IPS) implemented through a reimbursement strategy on a nationwide scale compared with traditional vocational rehabilitation (TVR) regarding sustainable participation in competitive employment in individuals with severe mental illness receiving sickness or disability benefits.MethodsAn observational study was conducted using administrative data regarding all Dutch individuals receiving sickness or disability benefits in the period 2012-2019. Exact matching and difference-in-difference fixed-effect estimations were performed to handle the non-randomised nature of the data. The matched sample consisted of 863 IPS and 16 466 TVR participants. The primary effect measure was the proportion of individuals having worked for at least 48 hours per month in competitive employment (ie, for 12 hours or more per week); the proportion of individuals having worked in competitive employment for at least 1 hour per month was also evaluated. Cost-effectiveness and return on investment were assessed from the societal perspective (intervention, sickness/disability benefit and healthcare costs) and payer perspective (sickness/disability benefit costs).ResultsIPS led to a statistically significant higher probability of being competitively employed for at least 12 hours per week of 3.7% points (95% CI 0.8% to 6.7%) to 7.5% points (95% CI 3.8% to 11.3%) and of being competitively employed for at least 1 hour per month of 4.7% points (95% CI 1.6% to 7.7%) to 8.9% points (95% CI 5.2 to 12.6%) from 6 to 36 months after starting the intervention. From the societal and payer perspective, IPS was-on average-less costly and more effective than TVR and return-on-investment estimates showed that IPS was-on average-cost saving (eg, societal perspective: ∆C: -364 (95% CI -3977 to 3249); ∆E: 0.104 (95% CI 0.046 to 0.164); benefit-cost ratio: 2.1 (95% CI -14.8 to 19.1)), but the uncertainty surrounding these estimates was large.ConclusionsIPS implemented through a reimbursement strategy on a nationwide scale is more effective and potentially cost-effective than TVR in people with severe mental illness receiving sickness or disability benefits. Based on these results, the implementation of IPS by a wide scale reimbursement strategy could be promoted to enhance sustainable participation in competitive employment in these individuals. Future economic evaluations should strive for a more robust sample size and a long follow-up period.

Dataset Information

Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis.

Background

Method

Result

Conclusion

Publications

Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis.

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