Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis.
BMC Psychiatry
; 24(1): 256, 2024 Apr 04.
Article
in En
| MEDLINE
| ID: mdl-38575916
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Community Mental Health Services
/
Mental Disorders
Limits:
Humans
Country/Region as subject:
Asia
Language:
En
Journal:
BMC Psychiatry
Journal subject:
PSIQUIATRIA
Year:
2024
Document type:
Article
Affiliation country:
Iran