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Lee YY, Skeen S, Melendez-Torres GJ, Laurenzi CA, van Ommeren M, Fleischmann A, Servili C, Mihalopoulos C, Chisholm D. School-based socio-emotional learning programs to prevent depression, anxiety and suicide among adolescents: a global cost-effectiveness analysis. Epidemiol Psychiatr Sci 2023; 32:e46. [PMID: 37434513 PMCID: PMC10477081 DOI: 10.1017/s204579602300029x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 07/13/2023] Open
Abstract
AIMS Preventing the occurrence of depression/anxiety and suicide during adolescence can lead to substantive health gains over the course of an individual person's life. This study set out to identify the expected population-level costs and health impacts of implementing universal and indicated school-based socio-emotional learning (SEL) programs in different country contexts. METHODS A Markov model was developed to examine the effectiveness of delivering universal and indicated school-based SEL programs to prevent the onset of depression/anxiety and suicide deaths among adolescents. Intervention health impacts were measured in healthy life years gained (HLYGs) over a 100-year time horizon. Country-specific intervention costs were calculated and denominated in 2017 international dollars (2017 I$) under a health systems perspective. Cost-effectiveness findings were subsequently expressed in terms of I$ per HLYG. Analyses were conducted on a group of 20 countries from different regions and income levels, with final results aggregated and presented by country income group - that is, low and lower middle income countries (LLMICs) and upper middle and high-income countries (UMHICs). Uncertainty and sensitivity analyses were conducted to test model assumptions. RESULTS Implementation costs ranged from an annual per capita investment of I$0.10 in LLMICs to I$0.16 in UMHICs for the universal SEL program and I$0.06 in LLMICs to I$0.09 in UMHICs for the indicated SEL program. The universal SEL program generated 100 HLYGs per 1 million population compared to 5 for the indicated SEL program in LLMICs. The cost per HLYG was I$958 in LLMICS and I$2,006 in UMHICs for the universal SEL program and I$11,123 in LLMICs and I$18,473 in UMHICs for the indicated SEL program. Cost-effectiveness findings were highly sensitive to variations around input parameter values involving the intervention effect sizes and the disability weight used to estimate HLYGs. CONCLUSIONS The results of this analysis suggest that universal and indicated SEL programs require a low level of investment (in the range of I$0.05 to I$0.20 per head of population) but that universal SEL programs produce significantly greater health benefits at a population level and therefore better value for money (e.g., less than I$1,000 per HLYG in LLMICs). Despite producing fewer population-level health benefits, the implementation of indicated SEL programs may be justified as a means of reducing population inequalities that affect high-risk populations who would benefit from a more tailored intervention approach.
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Affiliation(s)
- Y. Y. Lee
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mental Health Evaluation Research Stream, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - S. Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | | | - C. A. Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - M. van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - A. Fleischmann
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - C. Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - C. Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - D. Chisholm
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Gaebel W, Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Tosevski DL, Milosavljevic M, Nakov V, Winkler P, Zielasek J. Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1017-1025. [PMID: 32270290 DOI: 10.1007/s00406-020-01124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany. .,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Lehmann
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - H Hinkov
- NCPHA-National Center of Public Health and Analyses, Sofia, Bulgaria
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - G Kapócs
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Institute for Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - T Kurimay
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - M Milosavljevic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Nakov
- Mental Health, National Center of Mental Health and Analyses, Sofia, Bulgaria
| | - P Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
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Lee YY, Chisholm D, Eddleston M, Gunnell D, Fleischmann A, Konradsen F, Bertram MY, Mihalopoulos C, Brown R, Santomauro DF, Schess J, van Ommeren M. The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study. Lancet Glob Health 2021; 9:e291-e300. [PMID: 33341152 PMCID: PMC7886657 DOI: 10.1016/s2214-109x(20)30493-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. METHODS A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. FINDINGS Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000-32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006-0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73-123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191-303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58-99) in two countries with proportions of more than 30%. INTERPRETATION National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. FUNDING WHO.
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Affiliation(s)
- Y Y Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Eddleston
- Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - D Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Population Health Sciences Institute, Bristol Medical School, Bristol, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - A Fleischmann
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - F Konradsen
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Y Bertram
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - C Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - R Brown
- Department of Environment, Climate Change and Health, WHO, Geneva, Switzerland
| | - D F Santomauro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - J Schess
- Generation Mental Health Association, New York, NY, USA; Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - M van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
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Ssebunnya J, Kangere S, Mugisha J, Docrat S, Chisholm D, Lund C, Kigozi F. Potential strategies for sustainably financing mental health care in Uganda. Int J Ment Health Syst 2018; 12:74. [PMID: 30534197 PMCID: PMC6280509 DOI: 10.1186/s13033-018-0252-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/24/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In spite of the pronounced adverse economic consequences of mental, neurological, and substance use disorders on households in most low- and middle-income countries, service coverage and financial protection for these families is very limited. The aim of this study was to generate potential strategies for sustainably financing mental health care in Uganda in an effort to move towards increased financial protection and service coverage for these families. METHODS The process of identifying potential strategies for sustainably financing mental health care in Uganda was guided by an analytical framework developed by the Emerging Mental health systems in low and middle income countries (EMERALD project). Data were collected through a situational analysis (public health burden assessment, health system assessment, macro fiscal assessment) and eight key informant interviews with selected stakeholders from sectors including health, finance and civil society. The situational analysis provided contextualization for the strategies, and was complimented by views from key informant interviews. RESULTS Findings indicate that the following strategies have the greatest potential for moving towards more equitable and sustainable mental health financing in the Uganda context: implementing National Health Insurance Scheme; shifting to Results Based Financing; decentralizing mental health services that can be provided at community level; and continued advocacy with decision makers with evidence through research. CONCLUSION Although several options were identified for sustainably financing mental health care in Uganda, the National Health Insurance Scheme seemed the most viable option. However, for the scheme to be effective, there is need for scale up to community health facilities and implementation in a manner that explicitly includes community level facilities.
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Affiliation(s)
- J. Ssebunnya
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - S. Kangere
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - J. Mugisha
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - S. Docrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - D. Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - C. Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, King’s College London, London, UK
| | - F. Kigozi
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
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Chisholm D, Conroy S, Glangeaud-Freudenthal N, Oates MR, Asten P, Barry S, Figueiredo B, Kammerer MH, Klier CM, Seneviratne G, Sutter-Dallay AL. Health services research into postnatal depression: results from a preliminary cross-cultural study. Br J Psychiatry 2018; 46:s45-52. [PMID: 14754818 DOI: 10.1192/bjp.184.46.s45] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundLittle is known about the availability and uptake of health and welfare services by women with postnatal depression in different countries.AimsWithin the context of a cross cultural research study, to develop and test methods for undertaking quantitative health services research in postnatal depression.MethodInterviews with service planners and the collation of key health indicators were used to obtain a profile of service avail ability and provision. A service use questionnaire was developed and administered to a pilot sample in a number of European study centres.ResultsMarked differences in service access and use were observed between the centres, including postnatal nursing care and contacts with primary care services. Rates of use of specialist services were generally low. Common barriers to access to care included perceived service quality and responsiveness. On the basis of the pilot work, a postnatal depression version of the Service Receipt Inventory was revised and finalised.ConclusionsThis preliminary study demonstrated the methodological feasibility of describing and quantifying service use, highlighted the varied and often limited use of care in this population, and indicated the need for an improved understanding of the resource needs and implications of postnatal depression.
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Affiliation(s)
- D Chisholm
- Health Services Research Department, Institute of Psychiatry, London, UK.
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Lora A, Hanna F, Chisholm D. Mental health service availability and delivery at the global level: an analysis by countries' income level from WHO's Mental Health Atlas 2014. Epidemiol Psychiatr Sci 2017; 29:1-12. [PMID: 28287062 DOI: 10.1017/s2045796017000075] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS The World Health Organization (WHO)'s Mental Health Atlas series has established itself as the single most comprehensive and most widely used source of information on the global mental health situation. The data derived from the latest Mental Health Atlas survey carried out in 2014 describes the availability and delivery of mental health services in the WHO's Member States, focussing on differences by country's income level. METHODS The data contained in this paper are mainly derived from questions relating to mental health service availability and uptake, as well as on financial and human resources for mental health. Results are presented as median values and analysed by World Bank income group. Interquartile ranges are also provided as measures of statistical dispersion. RESULTS In total, 171 out of WHO's 194 Member States were able to at least partially complete the Atlas questionnaire. The results highlight a wide gap between high and low-medium income countries in a number of areas: for example, high-income countries have 20 times more beds in community-based inpatient units and 30 times more admissions; the rate of patients cared by outpatient facilities is 40 times higher; and there are 66 times more community outpatient contacts and 15 times more mental health staff at outpatient level. Overall resources for mental health are not distributed efficiently: globally about 60% of financial resources and over two-thirds of all available mental health staff are concentrated in mental hospitals, which serve only a small proportion of patients. Results indicate that outpatient care is the only effective means of increasing the coverage for mental disorders and is expanding, but it is strongly influenced by country income level. Two elements of the network of mental health facilities are particularly scarce in low- and middle-income countries: day treatment facilities and community residential facilities. CONCLUSIONS The WHO Mental Health Atlas 2014 survey provides basic mental health information at the level of WHO's Member States, concerning mental health resources and activities. Atlas promotes the use of information, usually underestimated not only in low- and middle-income countries but also in high-income countries. Information is needed not only for monitoring the scaling up of the mental health system at country level, but also for improving transparency and accountability for users, families and the public.
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Affiliation(s)
- A Lora
- Department of Mental Health,Lecco Hospital,Lecco,Italy
| | - F Hanna
- Department of Mental Health and Substance Abuse,World Health Organization,Geneva
| | - D Chisholm
- Department of Mental Health and Substance Abuse,World Health Organization,Geneva
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Saxena S, Funk MK, Chisholm D. Comprehensive mental health action plan 2013-2020. East Mediterr Health J 2015; 21:461-463. [PMID: 26442884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 06/05/2023]
Affiliation(s)
- S Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - M K Funk
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - D Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Ivbijaro G, Patel V, Chisholm D, Goldberg D, Khoja TAM, Edwards TM, Enum Y, Kolkiewic LA. Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care. East Mediterr Health J 2015; 21:486-92. [PMID: 26442888 DOI: 10.26719/2015.21.7.486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Abstract
For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.
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Affiliation(s)
- G Ivbijaro
- Wood Street Medical Centre, London, United Kingdom
| | - V Patel
- Department of International Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom & Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - D Chisholm
- Department of Mental Health and Substance Abuse,World Health Organization, Geneva, Switzerland
| | - D Goldberg
- Institute of Psychiatry, King's College, London, United Kingdom
| | - T A M Khoja
- General Executive Board, Health Ministers Council for Cooperation Council, Riyadh, Saudi Arabia
| | - T M Edwards
- Marital and Family Therapy Program, University of San Diego, San Diego, California, United States of America
| | - Y Enum
- Waltham Forest Town Hall, London, United Kingdom
| | - L A Kolkiewic
- East London NHS Foundation Trust, London, United Kingdom
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Gater R, Chisholm D, Dowrick C. Mental health surveillance and information systems. East Mediterr Health J 2015; 21:512-6. [PMID: 26442892 DOI: 10.26719/2015.21.7.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Abstract
Routine information systems for mental health in many Eastern Mediterranean Region countries are rudimentary or absent, making it difficult to understand the needs of local populations and to plan accordingly. Key components for mental health surveillance and information systems are: national commitment and leadership to ensure that relevant high quality information is collected and reported; a minimum data set of key mental health indicators; intersectoral collaboration with appropriate data sharing; routine data collection supplemented with periodic surveys; quality control and confidentiality; and technology and skills to support data collection, sharing and dissemination. Priority strategic interventions include: (1) periodically assessing and reporting the mental health resources and capacities available using standardized methodologies; (2) routine collection of information and reporting on service availability, coverage and continuity, for priority mental disorders disaggregated by age, sex and diagnosis; and (3) mandatory recording and reporting of suicides at the national level (using relevant ICD codes).
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Affiliation(s)
- R Gater
- Institute of Brain, Behaviour and Mental Health, University of Manchester, and Lancashire Care NHS Foundation Trust, United Kingdom
| | - D Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - C Dowrick
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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Chisholm D. Investing in mental health. East Mediterr Health J 2015; 21:531-534. [PMID: 26442896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Gildengers AG, Chisholm D, Butters MA, Anderson SJ, Begley A, Holm M, Rogers JC, Reynolds CF, Mulsant BH. Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression? Psychol Med 2013; 43:801-11. [PMID: 22846332 PMCID: PMC3593938 DOI: 10.1017/s0033291712001614] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD. Method We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects ('controls') were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs. RESULTS The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years. CONCLUSIONS Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
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Affiliation(s)
- A. G. Gildengers
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - D. Chisholm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - M. A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - S. J. Anderson
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, USA
| | - A. Begley
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - M. Holm
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - J. C. Rogers
- University of Pittsburgh School of Rehabilitation Sciences, Department of Occupational Therapy, Pittsburgh, PA, USA
| | - C. F. Reynolds
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - B. H. Mulsant
- Centre for Addiction and Mental Health and the University of Toronto, Department of Psychiatry, Toronto, ON, Canada
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Baltussen R, Smith A, Chisholm D. Authors' reply to Solomon writing on behalf of 18 others. Assoc Med J 2012. [DOI: 10.1136/bmj.e2588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chisholm D, Baltussen R, Evans DB, Ginsberg G, Lauer JA, Lim S, Ortegon M, Salomon J, Stanciole A, Edejer TTT. What are the priorities for prevention and control of non-communicable diseases and injuries in sub-Saharan Africa and South East Asia? BMJ 2012; 344:e586. [PMID: 22389336 DOI: 10.1136/bmj.e586] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Chisholm
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland.
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16
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Babul S, Frendo T, Winters M, Brubacher JR, Chipman ML, Chisholm D, Cripton PA, Cusimano MD, Friedman SM, Harris MA, Hunte GS, Reynolds CCO, Teschke K. Injuries to adult cyclists in Toronto and Vancouver: describing the circumstances as a first step towards injury prevention. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
We call for the global health community, governments, donors, multilateral agencies, and other mental health stakeholders, such as professional bodies and consumer groups, to scale up the coverage of services for mental disorders in all countries, but especially in low-income and middle-income countries. We argue that a basic, evidence-based package of services for core mental disorders should be scaled up, and that protection of the human rights of people with mental disorders and their families should be strengthened. Three questions are critical to the scaling-up process. What resources are needed? How can progress towards these goals be monitored? What should be the priorities for mental health research? To address these questions, we first estimated that the amount needed to provide services on the necessary scale would be US$2 per person per year in low-income countries and $3-4 in lower middle-income countries, which is modest compared with the requirements for scaling-up of services for other major contributors to the global burden of disease. Second, we identified a series of core and secondary indicators to track the progress that countries make toward achievement of mental health goals; many of these indicators are already routinely monitored in many countries. Third, we did a priority-setting exercise to identify gaps in the evidence base in global mental health for four categories of mental disorders. We show that funding should be given to research that develops and assesses interventions that can be delivered by people who are not mental health professionals, and that assesses how health systems can scale up such interventions across all routine-care settings. We discuss strategies to overcome the five main barriers to scaling-up of services for mental disorders; one major strategy will be sustained advocacy by diverse stakeholders, especially to target multilateral agencies, donors, and governments. This Series has provided the evidence for advocacy. Now we need political will and solidarity, above all from the global health community, to translate this evidence into action. The time to act is now.
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Gutierrez-Recacha P, Chisholm D, Haro JM, Salvador-Carulla L, Ayuso-Mateos JL. Cost-effectiveness of different clinical interventions for reducing the burden of schizophrenia in Spain. Acta Psychiatr Scand 2006:29-38. [PMID: 17087813 DOI: 10.1111/j.1600-0447.2006.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of interventions for reducing the burden of schizophrenia in Spain. METHOD The study examined the cost-effectiveness of seven different types of clinical interventions at the level of Spanish population: i) current situation; ii) older antipsychotics alone; iii) new antipsychotics alone (risperidone); iv) older antipsychotics plus psychosocial treatment; v) new antipsychotics plus psychosocial treatment; vi) older antipsychotics plus case management and psychosocial treatment; vii) new antipsychotics plus case management and psychosocial treatment. RESULTS Interventions based on the combination of haloperidol with psychosocial treatment or psychosocial treatment plus case management proved to be the most efficient strategies. CONCLUSION The relatively modest additional cost of concurrent psychosocial treatment has significant health gains, thereby making such a combined strategy for schizophrenia more cost-effective than pharmacology alone.
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Affiliation(s)
- P Gutierrez-Recacha
- Department of Psychiatry, Hospital Universitario de la Princesa, Autónoma University, Madrid, Spain
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Ayuso-Mateos JL, Gutierrez-Recacha P, Haro JM, Chisholm D. Estimating the prevalence of schizophrenia in Spain using a disease model. Schizophr Res 2006; 86:194-201. [PMID: 16859895 DOI: 10.1016/j.schres.2006.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 05/28/2006] [Accepted: 06/05/2006] [Indexed: 11/20/2022]
Abstract
There are two main sources of information on the epidemiology of schizophrenia: prevalence and incidence studies. Prevalence rates can be estimated from incidence figures, and vice versa. The present article aims to provide an estimate of the prevalence of schizophrenia in Spain, calculated from epidemiological and demographic data, using a disease model of schizophrenia which applies the specific methodology of the WHO Global Burden of Disease project. Our model assumes a causal relationship between incidence and prevalence, but takes into account other competing risk factors of mortality; this approach is more realistic than one assuming a simple linear relationship between both parameters. Our findings indicate an estimated mean prevalence of 3.0 per 1000 inhabitants per year for men, but slightly lower for women: 2.86 per 1000. Our model enables us to compare incidence figures with those provided by prevalence studies and obtain accurate estimates of the distribution of schizophrenia in the general population, which can be used to better identify treatment needs and the consequent allocation of resources.
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Affiliation(s)
- J L Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, c/ Diego de Leon 62 28006, Madrid, Spain.
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22
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Abstract
An equation is developed which enables procedures for predicting the friction pressure gradient during turbulent two-phase flow in smooth pipes to be extrapolated to pipes with rough surfaces.
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Affiliation(s)
- D. Chisholm
- National Engineering Laboratory, East Kilbride. Member of the Institution
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23
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Abstract
Equations are developed for the pressure drop over sharp-edged orifices during the flow of incompressible two-phase mixtures. The velocity ratio is assumed constant during flow through the orifice, and on this basis analysis of the data leads to the following equations for the velocity ratio: for X ≥ 1, K = ( pL/pHOM)1/2 for X ≤ 1, K = ( pL/ pG)1/4.
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Affiliation(s)
- D. Chisholm
- National Engineering Laboratory, East Kilbride. Member of the Institution
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24
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Abstract
A method of predicting the pressure drop during steam/water flow through orifices is presented, which extends an existing procedure to give improved agreement with experiment at conditions of low dryness fraction.
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Affiliation(s)
- D. Chisholm
- National Engineering Laboratory, East Kilbride, Glasgow. Member of the Institution
| | - D. H. Rooney
- University of Strathclyde, Glasgow. Member of the Institution
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25
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Abstract
From consideration of the homogeneous equation for frictional pressure gradient, and the relation between friction and void fraction, an equation for the ratio of the phase velocities during two-phase flow, is developed which is interesting in form, easy to use, and agrees with experiment.
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Affiliation(s)
- D. Chisholm
- National Engineering Laboratory, East Kilbride, Glasgow. Member of the Institution
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Ayuso-Mateos JL, Salvador-Carulla L, Chisholm D. [Use of quality of life measures in mental health economics and care planning]. Actas Esp Psiquiatr 2006; 34:1-6. [PMID: 16525899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Quality of life measurement is a key element in health economics and healthcare planning, particularly in chronic diseases associated to high morbidity and disability (i.e., mental disorders). This paper provides a critical review on the theoretical background of utility, on the methods for developing measures based on health preferences or values, and the composite indexes derived from them (DALY and QALY). Then the practical use in mental health is revised both in burden of disease studies and cost-utility analysis. There is an important requirement on the part of mental health researchers and policy makers alike to pay close attention to the underlying methods and construction of utility-based estimates of health outcome.
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Affiliation(s)
- J L Ayuso-Mateos
- Departamento de Psiquiatría, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid.
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27
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Horner A, Boasen J, Chisholm D, Lebet L. House Dust Extracts Elicit Toll Like Receptor Dependent Dendritic Cell Responses. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2005.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Srinivasa Murthy R, Kishore Kumar KV, Chisholm D, Thomas T, Sekar K, Chandrashekari CR. Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs. Psychol Med 2005; 35:341-351. [PMID: 15841870 DOI: 10.1017/s0033291704003551] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India. METHOD Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period. RESULTS A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time. CONCLUSIONS Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.
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Affiliation(s)
- R Srinivasa Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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29
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McCrone P, Fitzpatrick NK, Mathieson E, Chisholm D, Nourmand S. Economic implications of shared care arrangements. A primary care based study of patients in an inner city sample. Soc Psychiatry Psychiatr Epidemiol 2004; 39:553-9. [PMID: 15243693 DOI: 10.1007/s00127-004-0780-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Providing care for people with serious and enduring mental health problems has been prioritised in a number of countries. It has been recognised that good liaison between primary and secondary care services is required for care to be effective. However, little is known about the resource implications of different levels of 'shared care'. The aim of this study is to compare service use and costs of different levels of shared care between primary and secondary care services. METHOD Service use data were collected at baseline and one year later for participants with severe mental illness and costs were calculated. Levels of shared care were categorised into low, medium and high tertiles. Comparisons were made between the groups using multivariate analysis to control for participant characteristics. RESULTS Participants receiving a low level of shared care used residential care less and were less likely to have contacts with a psychiatrist or social worker than those receiving medium or high levels of shared care. Mean costs for a low level of shared care were significantly lower than for a medium level (a difference of pound 2606, 90% CI pound 452 to pound 4923), but not significantly lower than for a high level of shared care (difference of pound 1867, 90% CI- pound 287 to pound 3903). CONCLUSION Different levels of shared care are associated with different patterns of service use, with greater resource consumption associated with a medium level of shared care. Further work is required to investigate the causal links between integrated care and service use and costs.
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Affiliation(s)
- P McCrone
- Centre for the Economics of Mental Health, Health Services Research Dept., Institute of Psychiatry, London, UK.
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Abstract
Prevalence of complications of type 2 diabetes in a remote Australian Indigenous community was measured as part of a population survey of risk factors for diabetes and cardiovascular disease. Information was obtained from history, clinical examination, blood sample and medical records. Forty-three diabetic participants (six newly diagnosed) were assessed from a sample of 339 (12% diabetes prevalence); mean age 50 (range 31-67), duration of diabetes 5.6 (0-15) years, 40% male. Risk factors/complications: 70% with >/= 25, 50% cigarette smokers, HbA1c 8.5 (S.D. 2.9)%, cholesterol 4.8 (0.8)mmol/l, triglycerides 2.7 (1.6)mmol/l, HDL 0.83 (0.2)mmol/l; 60% had albuminuria (micro 38%, macro 22%), 47% were hypertensive, 7% (n = 2) had retinopathy, 24% had peripheral neuropathy, none had peripheral vascular disease, 14% had documented coronary vascular and one participant cerebrovascular disease. Of 37 with previously diagnosed diabetes: 43% were on aspirin, 65% on metformin, 80% with albuminuria on ACE inhibitors. Four additional diabetic participants (not studied) were receiving renal dialysis elsewhere. The results demonstrate on the one hand, very high indices of cardiovascular risk (smoking, hypertension, dyslipidaemia and albuminuria) and on the other, good quality primary health care providing good detection and follow up management of type 2 diabetic patients.
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Affiliation(s)
- L J Maple-Brown
- Menzies School of Health Research, P.O. Box 41096, Casuarina, NT 0811, Australia
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31
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Rhee C, Lebit L, Chisholm D, Horner A, Raz E. Immunostimulatory sequence oligodeoxynucleotides (ISS) provide allergen-independent protection from allergic rhinitis. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schmalzing D, Koutny L, Adourian A, Chisholm D, Matsudaira P, Ehrlich D. Genotyping by microdevice electrophoresis. Methods Mol Biol 2001; 163:163-73. [PMID: 11242941 DOI: 10.1385/1-59259-116-7:163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D Schmalzing
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
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Abstract
The Global Burden of Disease (GBD) study was conducted to provide a set of summary health measures that would be comprehensive and make available information on disease and injury, including non-fatal health outcomes. The main objective of the GBD approach was to inform global priority setting for health research and to influence international health policy and planning. One of the summary measures used was the Disability Adjusted Life Year (DALY). DALYs are a common metric for fatal and non-fatal health outcomes and are based on years of life lost because of premature death (YLL) and years of life lived with disability (YLD). Thus DALYs = YLL + YLD or Burden = Mortality + Disability. Therefore, a DALY is one lost year of healthy life. The DALY methodology provides a way to link information on disease burden to cost-effectiveness analysis. This feature would assist comparative assessments. The WHO plans to refine this framework for assessing the outcomes of interventions and their related costs.
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Affiliation(s)
- T B Ustün
- Global Programme on Evidence for Health Policy, World Health Organization, Geneva, Switzerland
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34
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Affiliation(s)
- S K Gan
- Diabetes and Metabolism Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, NSW, Australia
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35
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Chisholm D, Godfrey E, Ridsdale L, Chalder T, King M, Seed P, Wallace P, Wessely S. Chronic fatigue in general practice: economic evaluation of counselling versus cognitive behaviour therapy. Br J Gen Pract 2001; 51:15-8. [PMID: 11271867 PMCID: PMC1313893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND There is a paucity of evidence relating to the cost-effectiveness of alternative treatment responses to chronic fatigue. AIM To compare the relative costs and outcomes of counselling versus cognitive behaviour therapy (CBT) provided in primary care settings for the treatment of fatigue. DESIGN OF STUDY A randomised controlled trial incorporating a cost-consequences analysis. SETTING One hundred and twenty-nine patients from 10 general practices across London and the South Thames region who had experienced symptoms of fatigue for at least three months. METHOD An economic analysis was performed to measure costs of therapy, other use of health services, informal care-giving, and lost employment. The principal outcome measure was the Fatigue Questionnaire; secondary measures were the Hospital Anxiety and Depression Scale and a social adjustment scale. RESULTS Although the mean cost of treatment was higher for the CBT group (164 Pounds, standard deviation = 67) than the counselling group (109 Pounds, SD = 49; 95% confidence interval = 35 to 76, P < 0.001), a comparison of change scores between baseline and six-month assessment revealed no statistically significant differences between the two groups in terms of aggregate health care costs, patient and family costs or incremental cost-effectiveness (cost per unit of improvement on the fatigue score). CONCLUSIONS Counselling and CBT both led to improvements in fatigue and related symptoms, while slightly reducing informal care and lost productivity costs. Counselling represents a less costly (and more widely available) intervention but no overall cost-effectiveness advantage was found for either form of therapy.
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Affiliation(s)
- D Chisholm
- Department of Neurology, King's College of Medicine, London.
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36
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Chisholm D, Thornicroft G, Knapp M, Becker T. S02.02 Epsilon study of schizophrenia: Outcome measures, care and service costs. Eur Psychiatry 2000. [DOI: 10.1016/s0924-9338(00)93915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Knudsen HC, Vázquez-Barquero JL, Welcher B, Gaite L, Becker T, Chisholm D, Ruggeri M, Schene AH, Thornicroft G. Translation and cross-cultural adaptation of outcome measurements for schizophrenia. EPSILON Study 2. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl 2000:s8-14. [PMID: 10945072 DOI: 10.1192/bjp.177.39.s8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research on the comparison of mental health services has identified the need for internationally standardised and reliable measurements. AIMS To describe the strategies adopted in the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study for the translation and cross-cultural adaptation of five European versions of the instruments. METHOD A protocol was developed for translation of the outcome scales, describing each step in the translation procedure. Disputed items were discussed in focus groups, which faced seven tasks: a list of topics to be discussed; choosing where the group should meet; composition of participants; conducting the group; data collection; data completion afterwards; reporting results. RESULTS Modifications made to instruments were: changes in the instrument structure, contents and concepts; adjustments to the instrument structure; and modifications to the instrument manual. CONCLUSION Use of focus groups is an adequate method to apply if concepts, constructs and translation issues are to be addressed; otherwise, less time-consuming methods should be considered.
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Affiliation(s)
- H C Knudsen
- Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
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Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client Socio-Demographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl 2000:s28-33. [PMID: 10945075 DOI: 10.1192/bjp.177.39.s28] [Citation(s) in RCA: 359] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cross-cultural comparison of mental health service utilisation and costs is complicated by the heterogeneity of service systems. For data to be locally meaningful yet internationally comparable, a carefully constructed approach to its collection is required. AIMS To develop a research method and instrument for the collection of data on the service utilisation and related characteristics of people with mental disorders, as the basis for calculating the costs of care. METHOD Various approaches to the collection of service use data and key stages of instrument development were identified in order to select the most appropriate methods. RESULTS Based on previous work, and following translation and cross-cultural validation, an instrument was developed: the Client Socio-Demographic and Service Receipt Inventory--European Version (CSSRI-EU). This was subsequently administered to 404 people with schizophrenia across five countries. CONCLUSION The CSSRI-EU provides a standardised yet adaptable method for collating service receipt and associated data alongside assessment of patient outcomes.
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Affiliation(s)
- D Chisholm
- Centre for the Economics of Mental Health, King's College, London
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Abstract
BACKGROUND The York resource allocation formula includes a calculation of the amount needed to purchase mental health services equitably in each health authority in England. However, the amount which is actually spent on services is at the discretion of the authority. AIMS To compare expenditure on mental health services with allocation, and test the hypothesis that differences between them are to the disadvantage of services in deprived areas. METHOD A comparison of routine expenditure and allocation data, and linear regression modelling of the ratio of expenditure to allocation. RESULTS The ratio of expenditure to allocation varies widely. Relative underspending occurs more frequently in deprived areas, although not in the four inner-London health authorities. CONCLUSIONS The intentions of the York formula are not achieved in practice. The implications of the formula for mental health should be made explicit to health authorities, and shortfalls in mental health expenditure relative to allocation should be justified at a local level.
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Affiliation(s)
- J Bindman
- Section of Community Psychiatry (PRiSM), Institute of Psychiatry, Denmark Hill, London, UK
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Bonizzato P, Bisoffi G, Amaddeo F, Chisholm D, Tansella M. Community-based mental health care: to what extent are service costs associated with clinical, social and service history variables? Psychol Med 2000; 30:1205-1215. [PMID: 12027055 DOI: 10.1017/s0033291799002536] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The growing movement in many European countries towards capitation-based systems for financing mental health care has generated increasing interest in developing appropriate models capitation formulae. The aims of the study were: to detect and compare any differences in service costs between patients with different diagnoses; and to analyse the associations between patient characteristics and service costs. METHODS All patients in contact with the South-Verona Community Mental Health Service during the last quarter of 1996 were included in the study. Clinical and service-related variables were collected at first index contact; 3 months later, patients were interviewed using the Client Services Recipient Interview. For those who completed both the clinical assessments and the services receipt schedule (N = 339), 1-year psychiatric and non-psychiatric direct care costs were calculated. Weighted backward regression analyses were performed. RESULTS The most significant variables associated with psychiatric costs were: admission to hospital in the previous year; intensity and duration of previous contacts with South-Verona CMHS; being unemployed; having a diagnosis of affective disorder; and, Global Assessment of Functioning score. The final model explained 66% of the variation in costs of psychiatric care and 13 % of variation in non-psychiatric medical costs. CONCLUSIONS The model presented in this study explains a higher degree of cost variance than previously published studies. In community-based services more resources are targeted towards the most disabled patients. Previous psychiatric history (number of admissions in the previous year and intensity of psychiatric contacts lifetime) is strongly associated with psychiatric costs.
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Affiliation(s)
- P Bonizzato
- Department of Medicine and Public Health, University of Verona, Italy
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41
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Leff J, Vearnals S, Brewin CR, Wolff G, Alexander B, Asen E, Dayson D, Jones E, Chisholm D, Everitt B. The London Depression Intervention Trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs. Br J Psychiatry 2000; 177:95-100. [PMID: 11026946 DOI: 10.1192/bjp.177.2.95] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relapse of depression is associated with a criticising attitude of the patient's partner. AIMS To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner. METHOD A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner. RESULTS Drop-outs were 56.8% [corrected] from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments. CONCLUSIONS For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.
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Affiliation(s)
- J Leff
- Social Psychiatry Section, Institute of Psychiatry, London
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42
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Chisholm D, Sekar K, Kumar KK, Saeed K, James S, Mubbashar M, Murthy RS. Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan. Br J Psychiatry 2000; 176:581-8. [PMID: 10974966 DOI: 10.1192/bjp.176.6.581] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Targeting resources on cost-effective care strategies is important for the global mental health burden. AIMS To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries. METHOD Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use. RESULTS Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced. CONCLUSION Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.
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Affiliation(s)
- D Chisholm
- Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London
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Schmalzing D, Tsao N, Koutny L, Chisholm D, Srivastava A, Adourian A, Linton L, McEwan P, Matsudaira P, Ehrlich D. Toward real-world sequencing by microdevice electrophoresis. Genome Res 1999; 9:853-8. [PMID: 10508844 PMCID: PMC310810 DOI: 10.1101/gr.9.9.853] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report results using a microdevice for DNA sequencing using samples from chromosome 17, obtained from the Whitehead Institute Center for Genome Research (WICGR) production line. The device had an effective separation distance of 11.5 cm and a lithographically defined injection width of 150 microm. The four-color raw data were processed, base-called by the sequencing software Trout, and compared to the corresponding ABI 377 sequence from WICGR. With a criteria of 99% accuracy, we achieved average continuous reads of 505 bases in 27 min with 3% linear polyacrylamide (LPA) at 150 V/cm, and 460 bases in 22 min with 4% LPA at 200 V/cm at a temperature of 45 degrees C. In the best case, up to 565 bases could be base-called with the same accuracy in <25 min. In some instances, Trout allowed for accurate base-calling down to a resolution R as low as R = 0.35. This may be due in part to the high signal-to-noise ratio of the microdevice. Unlike many results reported on capillary machines, no additional sample cleanup other than ethanol precipitation was required. In addition, DNA fragment biasing (i.e., discrimination against larger fragments) was reduced significantly through the unique sample injection mechanism of the microfabricated device. This led to increased signal strength for long fragments, which is of great importance for the high performance of the microdevice.
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Affiliation(s)
- D Schmalzing
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts 02142, USA
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Schmalzing D, Koutny L, Chisholm D, Adourian A, Matsudaira P, Ehrlich D. Two-color multiplexed analysis of eight short tandem repeat loci with an electrophoretic microdevice. Anal Biochem 1999; 270:148-52. [PMID: 10328776 DOI: 10.1006/abio.1999.4067] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Single-channel microfabricated electrophoretic devices equipped with a dual-wavelength laser-induced fluorescence detection system were used for the fast analysis of an eight-loci, two-color multiplex short tandem repeat (STR) system for human identification. Routine analyses of the eight loci (CSF1PO, TPOX, TH01, vWA and D16S539, D7S820, D13S317, D5S818), requiring four-base resolution, were performed in only 2 min. Specific analyses for a microvariant allele (allele 9.3 of the TH01 locus) demanded single-base resolution and was performed in less than 10 min. The high accuracy of the microdevice for real-world STR sample analyses was demonstrated by comparison with conventional slab-gel electrophoresis. Our results show that a fast multiwavelength multichannel electrophoretic microsystem will be capable of routinely processing thousands of complex STR samples per day.
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Affiliation(s)
- D Schmalzing
- Whitehead Institute for Biomedical Research, Nine Cambridge Center, Massachusetts 02142, USA
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Chisholm D. Challenges for the international application of mental health economics. Epidemiol Psichiatr Soc 1999; 8:11-5. [PMID: 10504771 DOI: 10.1017/s1121189x00007478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lucas B, Audini B, Chisholm D, Knapp M, Lelliott P. Does a hostel's managing agency determine the access to psychiatric services of its residents? Soc Psychiatry Psychiatr Epidemiol 1998; 33:497-500. [PMID: 9780813 DOI: 10.1007/s001270050085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.
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Knapp M, Chisholm D, Astin J, Lelliott P, Audini B. Public, private and voluntary residential mental health care: is there a cost difference? J Health Serv Res Policy 1998; 3:141-8. [PMID: 10185372 DOI: 10.1177/135581969800300304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine how public (NHS or local government), private (for-profit) and voluntary (non-profit) providers of residential mental health care compare. Do they support different clienteles? And do their services cost different amounts? METHODS Based on a cross-sectional survey of residential care facilities and their residents in eight English and Welsh localities, the characteristics and costs of care in the different sectors (NHS, local government, private, voluntary) were compared. Variations in cost were examined in relation to residents' characteristics using multiple regression analyses, which also allowed standardisation of results before making inter-sectoral comparisons. RESULTS Private and voluntary providers of residential care support different clienteles from the public sector. The patterns of inter-sectoral cost differences vary between London and non-London localities. In London, voluntary sector facilities may be more cost-efficient than the other sectors, but local government/private sector comparisons show no consistent difference. Outside London, the results suggest clear cost advantages for the private and voluntary sectors over the local government sector. CONCLUSIONS Private and voluntary providers may have some economic advantages over their public counterparts. However, outcomes for residents were not studied, leaving unanswered the question of comparative cost-effectiveness.
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Affiliation(s)
- M Knapp
- Centre for the Economics of Mental Health, Institute of Psychiatry, Royal College of Psychiatrists' Research Unit, London, UK
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Kuipers E, Fowler D, Garety P, Chisholm D, Freeman D, Dunn G, Bebbington P, Hadley C. London-east Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. III: Follow-up and economic evaluation at 18 months. Br J Psychiatry 1998; 173:61-8. [PMID: 9850205 DOI: 10.1192/bjp.173.1.61] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A randomised controlled trial of cognitive-behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline. METHOD Forty-seven (78% of original n = 60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed. RESULTS Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CBT appear to have been offset by reductions in service utilisation and associated costs during follow-up. CONCLUSIONS Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.
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Affiliation(s)
- E Kuipers
- Department of Clinical Psychology, Institute of Psychiatry, London
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Abstract
Nearly 20 years ago, it was suggested that individuals exist who are not obese on the basis of height and weight, but who, like people with overt obesity, are hyperinsulinemic, insulin-resistant, and predisposed to type 2 diabetes, hypertriglyceridemia, and premature coronary heart disease. Since then it has become increasingly clear that such metabolically obese, normal-weight (MONW) individuals are very common in the general population and that they probably represent one end of the spectrum of people with the insulin resistance syndrome. Available evidence also suggests that MONW individuals could account for the higher prevalence of type 2 diabetes, cardiovascular disease, and other disorders in people with a BMI in the 20-27 kg/m2 range who have gained modest amounts of weight (2-10 kg of adipose mass) in adult life. Specific factors that appear to predispose MONW, as well as more obese individuals, to insulin resistance include central fat distribution, inactivity, and a low VO2max. Because these factors are potentially reversible and because insulin resistance may contribute to the pathogenesis of many diseases, it is our premise that a compelling argument can be made for identifying MONW individuals and treating them with diet, exercise, and possibly pharmacological agents before these diseases become overt, or at least early after their onset. One reason for doing so is that disorders such as type 2 diabetes may be accompanied by irreversible consequences, e.g., ischemic heart disease and nephropathy, at the time of diagnosis or shortly thereafter. Another is that MONW individuals in general should be younger and more amenable and responsive to diet and exercise therapy than are obese patients with established disease. That long-term diet and exercise can work is suggested by two large studies in which, over 5-6 years, the incidence of diabetes was diminished in nonobese and minimally obese patients with impaired glucose tolerance. Based on these considerations and the emerging worldwide epidemic of type 2 diabetes, we believe that studies to assess whether therapies aimed at young MONW individuals can prevent the development of type 2 diabetes and other diseases, including perhaps obesity itself, are urgently needed.
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Affiliation(s)
- N Ruderman
- Evans Department of Medicine, Boston University Medical Center, Massachusetts 02118, USA.
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Chisholm D. All fired up--receptacle testing rule sparks debate. Health Facil Manage 1998; 11:36. [PMID: 10175834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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