Corrigendum: Expert arguments for trends of psychiatric bed numbers: A systematic review of qualitative data.

[This corrects the article DOI: 10.3389/fpsyt.2021.745247.].

Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process.

The required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, the expert panel provided responses exploring estimate ranges for a minimum to optimal numbers of psychiatric beds and three levels of shortage. In a second round, the panel reconsidered their responses using the input from the total group to achieve consensus. The Delphi panel comprised 65 experts (42% women, 54% based in low- and middle-income countries) from 40 countries in the six regions of the World Health Organization. Sixty psychiatric beds per 100 000 population were considered optimal and 30 the minimum, whilst 25-30 was regarded as mild, 15-25 as moderate, and less than 15 as severe shortage. This is the first expert consensus on minimum and optimal bed numbers involving experts from HICs and LMICs. Many high-income countries have psychiatric bed numbers that fall within the recommended range. In contrast, the number of beds in many LMIC is below the minimum recommended rate.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis.

BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data.

Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers. Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers. Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease. Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.

Effectiveness of Sleep Deprivation in Treating Acute Bipolar Depression as Augmentation Strategy: A Systematic Review and Meta-Analysis.

BACKGROUND: Bipolar disorder is a disabling disease characterized by the recurrence of mood episodes. Successful strategies for the acute treatment of bipolar depression are still a matter of controversy. Total sleep deprivation (TSD) has shown acute antidepressant effect; however, the prompt relapse of depressive symptoms after sleep recovery has been reported. Taking this into consideration, we aimed to address a twofold research question: what are the acute effects of adding TSD to pharmacological treatment and what are the acute and chronic effects of adding medications to TSD. METHODS: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for clinical trials assessing bipolar depression and TSD. Two independent reviewers selected and classified 90 abstracts. The outcomes we assessed were change in Hamilton Depression Rating Scale (HDRS) or Montgomery-Asberg Depression Rating Scale (MADRS), sustained long-term response rate, treatment-emergent mania or hypomania, and tolerability (using dropout rates as a proxy). The compared groups were: TSD alone versus TSD plus medications and medications alone versus medications plus TSD. Data was analyzed using Stata 16.0. RESULTS: Patients treated with TSD plus medications compared with medications alone showed a significant decrease in depressive symptomatology after one week (SMD -0.584 [95% CI -1.126 to -0.042], p = 0.03. Also, a significant decrease in depressive symptomatology (SMD -0.894 [95% CI -1.388 to -0.399], p < 0.001) was found in the group with TSD plus medications compared with TSD alone, at the 10th day of treatment. We meta-analyzed the long-term effect of the TSD. It showed a sustained antidepressant effect (log OR = 2.365 (95% CI 0.95 to 3.779, p < 0.001) in the group where TSD was combined with medication when compared with patients treated only with TSD. Finally, no differences in tolerability (log OR = 0.234 (95% CI -1.164 to 1.632, p = 0.74) or affective switch were found. CONCLUSION: Adding TSD to medications to bipolar depression treatment resulted in an augmentation in acute response. We also found that medications have a positive impact in acute response when added to TSD. Furthermore, this higher response rate was maintained after 3 months while keeping Lithium therapy.