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Sun Y, Yu H, Wang Z, Zhang J, Zhou Y, Cui W, Jiang W. Relationship between medication burden and medication experience in stable patients with schizophrenia: the mediating effect of medication belief. BMC Nurs 2024; 23:197. [PMID: 38519927 PMCID: PMC10958954 DOI: 10.1186/s12912-024-01882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Individuals with schizophrenia require prolonged antipsychotic medication treatment. But more than 50% of individuals with schizophrenia experience adverse medication experiences during their antipsychotic treatments. Such individuals often adjust or discontinue medication, leading to disease relapse and impaired social functioning. Psychiatric nurses should pay close attention to the medication experiences of individuals with schizophrenia. This research explore the relationship between medication burden and medication experience, as well as the mediating effect of medication belief in stable patients with schizophrenia. METHODS A convenience sample of hospitalized stable patients with schizophrenia were selected from Daqing Third Hospital and Baiyupao Hospital from September 2023 to December 2023. A survey was conducted with them using a questionnaire consisting of general information questionnaire, The Subjective Well-being Under Neuroleptic Treatment Scale(SWN), The Living with Medicines Questionnaire(LMQ), Beliefs about Medicines Questionnaire-Specific (BMQ-Specific). Pearson correlation analysis was used to explore the correlation between LMQ, BMQ-Specific and SWN scores, and multiple linear regression analysis was used to explore the influencing factors of medication experience in patients with schizophrenia. AMOS 24.0 was used to construct the structural equation modeling(SEM), and the mediation effect of the SEM was tested using Bootstrap method. RESULTS According to the sample size calculation requirements of structural equation model, a total of 300 samples were required in this study, and 400 effective questionnaires were actually collected in this study, which met the sample size requirements for constructing structural equation models. Bootstrap test showed that the mediation effect was significant. The total effect of medication burden on medication experience was significant (Z=-12.146, 95%CI (-0.577, -0.417), P < 0.001). The indirect effect of medication burden on medication experience, that is, the mediating effect of medication belief was significant (Z=-4.839, 95%CI (-0.217, -0.096), P < 0.001). The direct effect of medication burden on medication experience was significant (Z=-7.565, 95%CI (-0.437, -0.257), P < 0.001). This model belongs to partial mediation model. CONCLUSIONS Psychiatric nurses can enhance the patients' medication experience by reducing medication burden and strengthening medication beliefs. Therefore, the results also provide theoretical references and decision-making foundations for psychiatric nursing professionals to develop appropriate management strategies for individuals with schizophrenia.
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Affiliation(s)
- Yujing Sun
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Yu
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Zhengjun Wang
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Jing Zhang
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yuqiu Zhou
- Department of Nursing, Harbin Medical University Daqing Campus, Daqing, China
| | - Wenming Cui
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Luo R, Lu H, Li H. Cost-utility analysis of using paliperidone palmitate in schizophrenia in China. Front Pharmacol 2023; 14:1238028. [PMID: 37601057 PMCID: PMC10435863 DOI: 10.3389/fphar.2023.1238028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Objective: Long-acting injections (LAIs) of paliperidone palmitate have been shown to improve medication adherence and relieve psychotic symptoms. However, the specific cost-utility analysis of these LAIs in schizophrenia in China remains unclear. Methods: A multi-state Markov model was constructed to simulate the economic outcomes of patients with schizophrenia in China who received paliperidone palmitate 1-month formulation (PP1M), paliperidone palmitate 3-month formulation (PP3M), and paliperidone extended-release (ER). A cost-utility analysis was conducted, mostly derived from published literature and clinical databases. All costs and utilities were discounted at a rate of 5% per annum. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). A series of sensitivity analyses were also applied. Results: After 20 years, compared to ER, using PP1M resulted in an increased discounted cost from $36,252.59 to $43,207.28. This increased cost was associated with a gain in quality-adjusted life years (QALYs) from 8.60 to 9.45. As a result, the ICER for PP1M was estimated to be $8,247.46/QALY, which was lower than the willingness-to-pay (WTP) threshold of $12,756.55/QALY. When using PP3M instead of ER, the incremental cost was $768.81 and the incremental utility was 0.88 QALYs, projecting an ICER of $873.13/QALY, which was also lower than the WTP threshold of $12,756.55/QALY. The univariate sensitivity analysis showed that the costs of PP1M, PP3M, and ER had the greatest impact on ICERs. The probability sensitivity analysis (PSA) revealed that when the WTP thresholds were $12,756.55/QALY, the probability of PP1M and PP3M being cost-effective was 59.2% and 66.0%, respectively. Conclusion: From the Chinese healthcare system perspective, PP3M and PP1M are both more cost-effective compared to ER, and PP3M has notable cost-utility advantages over PP1M.
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Affiliation(s)
- Rui Luo
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - He Lu
- Department of Radiology, The People’s Hospital of Jiawang District of Xuzhou, Xuzhou, Jiangsu, China
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Ren J, Duan Y, Wang J, Sun Y, Wang M, Geng Z, Meng X, Wang Z. Mortality and excess life-years lost in patients with schizophrenia under community care: a 5-year follow-up cohort study. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45:216-225. [PMID: 36753614 PMCID: PMC10288468 DOI: 10.47626/1516-4446-2022-2918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Mortality rate is a general indicator which can be used to measure care and management of schizophrenia. This cohort study evaluated the standardized mortality ratios (SMRs) of all-cause mortality and life-years lost (LYLs) in patients with schizophrenia under a community care program in China. METHODS Data were obtained from the National Community Care Program System for Severe Mental Disorders. A total of 99,214 patients diagnosed with schizophrenia were enrolled before December 2014 and followed between 2015 and 2019. A total of 9,483 patients died. Crude mortality rates (CMRs) and SMRs were then stratified by natural vs. unnatural causes, and major groups of death were standardized according to the 2010 National Population SMRs. The corresponding LYLs at birth were also calculated by gender and age. RESULTS The SMRs of patients with schizophrenia were significantly elevated during the study period, with an overall SMR of 4.98 (95%CI 2.67-7.32). Neoplasms, cardiovascular diseases, cerebrovascular diseases, external injuries, and poisonings were the most significant causes of death among patients with schizophrenia compared to the general population. The mean LYLs of patients with schizophrenia were 15.28 (95%CI 13.26-17.30). Males with schizophrenia lost 15.82 life-years (95%CI 13.48-18.16), and females lost 14.59 life-years (95%CI 13.12-16.06). CONCLUSIONS Patients with schizophrenia under community care had a high mortality rate in our study, even though mental health services have been integrated into the general healthcare system in China to narrow treatment gaps in mental health for > 10 years. In terms of mortality outcome indicators, effective and quality mental health services still have a long way to go. The current study demonstrates the potential for improved prevention and treatment of individuals with schizophrenia under community care.
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Affiliation(s)
- Jintao Ren
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Ying Duan
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Jinhuan Wang
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Ying Sun
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Mingtao Wang
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Zhi Geng
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Xianfeng Meng
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
| | - Zhe Wang
- Third People Hospital of Liaoning Province, Liaoning Center of Mental Health Prevention and Control, Tieling, China
- Department of Psychiatry, First Affiliated Hospital of China Medical University, Shenyang, China
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Kotzeva A, Mittal D, Desai S, Judge D, Samanta K. Socioeconomic burden of schizophrenia: a targeted literature review of types of costs and associated drivers across 10 countries. J Med Econ 2023; 26:70-83. [PMID: 36503357 DOI: 10.1080/13696998.2022.2157596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS Schizophrenia has the highest median societal cost per patient of all mental disorders. This review summarizes the different costs/cost drivers (cost components) associated with schizophrenia in 10 countries, including all cost types and stakeholder perspectives, and highlights aspects of disease associated with greatest costs. MATERIALS AND METHODS Targeted literature review based on a search of published research from 2006 to 2021 in the United States (US), United Kingdom (UK), France, Germany, Italy, Spain, Canada, Japan, Brazil, and China. RESULTS Sixty-four published articles (primary studies and literature reviews) were included. Comprehensive data were available on costs in schizophrenia overall, with very limited data for individual countries except the US. Most data is related to direct and not indirect costs, with extremely scarce data for several key cost components (adverse events, suicide, long-term care). Total schizophrenia-related per person per year (PPPY) costs were $2,004-94,229, with considerable variability among countries. Indirect costs were the main cost driver (50-90% of all costs), ranging from $1,852 to $62,431 PPPY. However, indirect costs are not collected systematically or incorporated in health technology assessments. Total schizophrenia-related PPPY direct costs were $4,394-31,798, with inpatient cost as the main cost driver (∼20-99% of direct costs). Intangible costs were not reported. Despite limited evidence, total schizophrenia-related costs were higher in patients with than without negative symptoms, largely due to increased costs of medication and medical visits. LIMITATIONS As this was not a systematic review, prioritization of studies may have resulted in exclusion of potentially relevant data. All costs were converted to USD but not corrected for inflation or subjected to a gross domestic product deflator. CONCLUSIONS Direct costs are most commonly reported in schizophrenia. The substantial underreporting of indirect and intangible costs undervalues the true economic burden of schizophrenia from a payer, patient, and societal perspective.
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Fei X, Wang S, Li J, Wang J, Gao Y, Hu Y. The efficacy and safety of sodium nitroprusside in the treatment of schizophrenia: Protocol for an updated systematic review and meta-analysis. PLoS One 2023; 18:e0283185. [PMID: 36940201 PMCID: PMC10027216 DOI: 10.1371/journal.pone.0283185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/03/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Schizophrenia is a chronic persistent disease with high recurrence rate and high disability rate in the field of psychiatry. Sodium nitroprusside is a nitric oxide (NO) donor and considered a promising new compound for the treatment of schizophrenia. New high-quality clinical trials of sodium nitroprusside in the treatment of schizophrenia have been published in recent years. It is necessary to re-conduct the meta-analysis after the inclusion of these new clinical trials. Our study will conduct a systematic review and meta-analysis of the relevant literature in this field, so as to lay an evidence-based medicine foundation for the efficacy of sodium nitroprusside in the treatment of schizophrenia. METHODS AND ANALYSIS Randomized controlled trials (RCTs) of sodium nitroprusside in the treatment of schizophrenia were searched through English databases (PubMed, Web of Science, Embase, and Cochrane Library) and Chinese databases (China Biology Medicine disc, VIP, WanFang Data, and CNKI). The extracted data will be inputted into Review Manager 5.3 for Meta-analysis. The included literature will be assessed for bias risk according to the bias risk assessment tools in the Cochrane Handbook for Systematic Reviews of Interventions. Funnel plots will be used to assess possible publication bias. Heterogeneity is tested by I2 and χ2 tests, and the existence of heterogeneity is defined as I2 ≥50% and P ≤0.1. If heterogeneity exists, the random-effect model will be used, and sensitivity analysis or subgroup analysis will be performed to further determine the source of heterogeneity. PROSPERO REGISTRATION NUMBER CRD42022341681.
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Affiliation(s)
- Xinxing Fei
- Department of Psychiatry, Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan, People's Republic of China
| | - Shiqi Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jiyang Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Jianxiong Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Yaqian Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Yue Hu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
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Patient’s Determinants of Subjective and Objective Burden in Caregivers of People with First Episode Psychosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022. [DOI: 10.1016/j.rpsm.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vulnerabilidade social e transtornos mentais. TEXTOS & CONTEXTOS (PORTO ALEGRE) 2021. [DOI: 10.15448/1677-9509.2021.1.38616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.
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Chai X, Liu Y, Mao Z, Li S. Barriers to medication adherence for rural patients with mental disorders in eastern China: a qualitative study. BMC Psychiatry 2021; 21:141. [PMID: 33685432 PMCID: PMC7941940 DOI: 10.1186/s12888-021-03144-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mental disorders are destructive and usually require long-term medication, but non-adherence of medication is highly prevalent in patients with mental disorders. Previous studies relating to medication non-adherence were mainly quantitative. Meanwhile, there have been even fewer studies conducted in rural areas in China that focused on patients' medication non-adherence. This study aims to explore the barriers to medication adherence for rural patients with mental disorders in China from the perspectives of patients, patients' family members and healthcare providers. METHODS A qualitative study was carried out in the rural areas of four towns within Shandong Province in eastern China. The study adheres to COREQ guidelines. Semi-structured in-depth interviews were conducted with 11 patients, 21 family members and 8 primary mental health service providers. RESULTS Thematic analysis generated five major themes: (1) lack of self-insight, (2) inadequate family support, (3) long treatment duration and side effects of drugs, (4) poor economic conditions, and (5) the perceived stigma of illness. CONCLUSION These findings may be useful for policymakers and planners to improve medication adherence and decrease the recurrence rate of mental disorders in China.
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Affiliation(s)
- Xiaoyun Chai
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Rd 44, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174Center for Health Preference Research, Shandong University, Jinan, 250012 China
| | - Ying Liu
- grid.460018.b0000 0004 1769 9639Asset Management and Operation Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 China
| | - Zhuxin Mao
- School of Insurance, Southwestern University of Finance and Economics, Chengdu, 611130, China.
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Rd 44, Jinan, 250012, China. .,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China. .,Center for Health Preference Research, Shandong University, Jinan, 250012, China.
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