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

BACKGROUND

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

METHOD

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

RESULT

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

CONCLUSION

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

Mourning During Corona: A Phenomenological Study of Grief Experience Among Close Relatives During COVID-19 Pandemics

Considering the need for observing health protocols, the experience of the loss and the grieving process has changed in nature during this disease. Therefore, this study aims to gain a deep understanding of the experience of mourning during COVID-19 pandemic by exploring the experiences of survivors of the death of their loved. During COVID-19 pandemic, the inability to hold the usual ceremonies for mourning and receive the social support needed in this period, the relatives of the deceased encounter various conditions that disrupt the grieving process and may lead to the spread of unresolved grief in future.

Psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form

Background: Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran. Methods: In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software. Results: Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples. Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated. Conclusion: Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.

The prevalence of attention deficit hyperactivity disorder in Iran: An updated systematic review

Background: Attention deficit hyperactivity disorder (ADHD) is among the most common neurodevelopmental disorders in children and adolescents. There is a controversy over the true prevalence of ADHD in Iran, the knowledge of which is crucial for allocating health care resources and identifying research priorities. This is an updated systematic review of the prevalence of ADHD in Iranian children and adolescents. Methods: For this systematic review, PubMed/Medline, Web of Science, Scopus, PsycINFO, IranPsych, IranMedex, Irandoc, Google Scholar, and grey literature were reached for publications between January 1990 and December 2018 that reported prevalence estimates of ADHD in Iran. Parallel independent assessments were conducted. The Quality Assessment Checklist for Prevalence Studies was used to assess the overall quality of studies. Results: A total of 34 original studies covering 33 621 Iranian children, adolescents, and adults were included. The included studies were mostly conducted on the population of preschool, elementary, middle, and high school-aged children as well as adolescents. Also, 6 studies addressed university students. Prevalence estimates of ADHD reported varied substantially across the studies and offered a range of heterogeneous data. Conclusion: Overall, making exact comparisons among studies was not easy because the assessment method and the type of sampling could impact prevalence estimates. These factors need to be considered when comparing data from different studies.

Gender role conflict: Is it a predictor of marital dissatisfaction? A cross sectional study in Tehran

Background: Gender role, sex-oriented attitudes, behaviors, cognitions, and emotions play an essential role in interpersonal relationships. Along with other factors, marital relationships and satisfaction can also be affected by a person’s gender role. The increased rate of divorce is related to a decrease in marital satisfaction. The aim of this study was to evaluate the predictor power of gender role conflict on marital satisfaction considering the role of demographic variables (age, income, number of children, and number of family members), marriage-related factors (duration of the marriage, family functioning), and mental health disorder.

Methods: This was a cross sectional study. Participants were selected from couples who were attending West of Tehran health center. A total of 123 married couples aged 18 to 60 years who did not have mental or other medical disorders were recruited. Data gathering tools were McMaster Family Assessment Device (FAD), ENRICH Marital Satisfaction Scale, Bem Sex-Role Inventory (BSRI), a sociodemographic questionnaire, and Brief Symptom Inventory (BSI). Pearson correlation, chi-square, t test, ANOVA, Scheffe post hoc, and linear regression tests were used to analyze the data. Data were analyzed using SPSS 16, and in all statistical tests, significance level was set at p<0.05.

Results: No significant correlations were observed between marital satisfaction and age, number of family members, duration of the marriage, number of children, and income (p>0.05). The presence of gender role conflict was correlated with lower marital satisfaction. Family functioning, gender role conflict, and presence of psychotic problems were predictors of marital satisfaction (p<0.001, R2=0.419).

Conclusion: Screening couples who applied for divorce due to psychiatric problems and gender role conflict and evaluating their family functioning may have a positive effect on reduction of divorce rate.

Methamphetamine-induced psychosis is associated with DNA hypomethylation and increased expression of AKT1 and key dopaminergic genes

Methamphetamine, one of the most frequently used illicit drugs worldwide, can induce psychosis in a large fraction of abusers and it is becoming a major problem for the health care institutions. There is some evidence that genetic and epigenetic factors may play roles in methamphetamine psychosis. In this study, we examined methamphetamine-induced epigenetic and expression changes of several key genes involved in psychosis. RNA and DNA extracted from the saliva samples of patients with methamphetamine dependency with and without psychosis as well as control subjects (each group 25) were analyzed for expression and promoter DNA methylation status of DRD1, DRD2, DRD3, DRD4, MB-COMT, GAD1, and AKT1 using qRT-PCR and q-MSP, respectively. We found statistically significant DNA hypomethylation of the promoter regions of DRD3 (P = 0.032), DRD4 (P = 0.05), MB-COMT (P = 0.009), and AKT1 (P = 0.0008) associated with increased expression of the corresponding genes in patients with methamphetamine psychosis (P = 0.022, P = 0.034, P = 0.035, P = 0.038, respectively), and to a lesser degree in some of the candidate genes in non-psychotic patients versus the control subjects. In general, methamphetamine dependency is associated with reduced DNA methylation and corresponding increase in expression of several key genes involved in the pathogenesis of psychotic disorders. While these epigenetic changes can be useful diagnostic biomarkers for psychosis in methamphetamine abusers, it is also consistent with the use of methyl rich diet for prevention or suppression of psychosis in these patients. However, this needs to be confirmed in future studies. © 2016 Wiley Periodicals, Inc.

National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran: 1990 - 2013, study protocol

BACKGROUND

The measurement of population-based dimensions of mental disorders and their effects on the population health is one of the major public health concerns.  There is some evidence on the trend and point estimations of mental disease and substance abuse for many specific groups of Iranian population but there is a progressive requirement to documents on their exposure distribution at sub-national level, information about their trends, and their effects on the population health. 

METHODS

The present protocol is aimed to provide the standards of data collection and methodology processes for estimating the trends of selected mental disorders and their attributed burden at national and sub-national levels. For nine categories of mental disorders, we will estimate 1990 to 2013 trends of prevalence, Years of Life Lost due to premature mortality (YLLs), and Years Lived with Disability (YLDs) and Disability-Adjusted Life Years DALYs by sex, age group, and province. We will also quantify the uncertainty intervals for the estimates of interest.

CONCLUSION

The study of National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran provides valuable convincing evidences for policy makers and other stakeholders for more evidence-based priority setting, resource allocation, interventions, service providing, and evaluation at both national and sub-national levels. The results also could be used for future complementary global, regional, national, and sub national studies.

Mania precipitated by opioid withdrawal: a retrospective study

OBJECTIVE

Little evidence is available on the occurrence of mania following opioid withdrawal. This is the first report on clinical and demographic characteristics of mania precipitated by opioid withdrawal in a relatively large sample.

METHOD

In this study, we assessed the files of the patients admitted to a large referral psychiatric hospital during a 3-year period with a presentation of manic episode shortly after opioid withdrawal. Forty-five relevant cases (one woman) were found, including 28 patients with their first manic episode, and 17 patients with a previous history of bipolar disorder.

RESULTS

Most of the identified cases had a long history (mean = 11.8 years) of opium dependence (24 cases used only opium and 16 cases opium and other opioids) and had recently experienced an intense withdrawal (25 cases). These associations were present in both first-episode patients and those with recurrent episodes.

CONCLUSION

Emergence of mania following opioid withdrawal could be partly explained by mood stabilizing effects of opioids. Other than the type of opioid, it seems that the duration of use and withdrawal method might play a role. Caution should be used while detoxifying patients with a long history of opioid use.

Ocular findings following trauma from paintball sports

PURPOSE

To raise awareness of potential significant ocular damage and visual loss secondary to paintballs in those not wearing ocular protection and to report high incidence of chorioretinitis sclopetaria from paintball contusion.

METHODS

We reviewed cases of eye injury presenting to a single institution from 2000 to 2005. Those cases in which the injury was attributed to paintballs were identified and evaluated to determine ocular findings and visual prognosis.

RESULTS

Ocular paintball injuries occurred in eight male subjects and one female subject (nine eyes) with an average age of 16 years (range, 11-26). None had ocular protection at the time of ocular injury. On initial examination, vitreous haemorrhage was present in six eyes (67%), maculopathy, hyphema, cataract, and commotio retinae were each present in four eyes (44%). Two eyes suffered retinal detachment and one eye an optic nerve avulsion. Chorioretinitis sclopetaria occurred in four eyes (44%). The final visual acuity was > or =20/40 in three eyes, 20/50 to 20/150 in two eyes, and < or =20/200 in four eyes.

CONCLUSION

Injuries owing to paintballs can result in severe ocular damage and visual loss. Increased awareness and need for proper ocular protection should be emphasized by ophthalmologists. Chorioretinitis sclopetaria occurs with a high frequency and its presence should be recognized, as its management is different from retinal tear or detachment.

Ciliary body naevus

PURPOSE

To describe clinical, ultrasound biomicroscopy (UBM), and histopathologic characteristics of benign melanocytic tumors of the ciliary body.

DESIGN

Consecutive case series.

METHODS

Six patients with a pigmented ciliary body tumour underwent complete ophthalmic examination and UBM, with histopathologic examination carried out on three cases.

RESULTS

Six patients presented with a pigmented iridociliary mass, with central displacement of iris root. UBM revealed a stromal mass arising in pars plicata and/or pars plana in all six with a cyst in three cases (intrinsic=1 and extrinsic=2). Iridocyclectomy was performed because of documented growth in three cases, and all three cases proved to be ciliary body spindle-cell naevus. The other three patients have remained stable.

CONCLUSIONS

On clinical basis and with available ancillary studies, ciliary body naevi cannot be reliably differentiated from ciliary body melanocytoma and ciliary body melanoma. Even with clinically documented growth, the lesions may prove to be ciliary body naevi.

Histopathology and ultrastructural examination of optic nerve sheath biopsies after optic nerve sheath decompression with and without mitomycin

PURPOSE

We chose to compare histologically and ultrastructurally changes in the optic nerve sheath after optic nerve sheath decompression, initially after a second surgery and after treatment with mitomycin-C. The mechanism by which optic nerve sheath decompression alleviates papilledema can be further understood in consideration of the results.

METHODS

Tissue was obtained by biopsy from 3 first-time surgical and 4 reoperative cases with and without mitomycin-C in patients with idiopathic intracranial hypertension. The sheaths were fixed in a mixture of 2% paraformaldehyde and 2% glutaraldehyde, osmicated and dehydrated in a series of ethanol, and finally embedded in epon. Tissue blocks were sectioned at 1 microm and stained with both PPD and toluidine blue. Thin sections were examined by transmission electron microscopy.

RESULTS

Normal meningeal tissue obtained at the time at optic nerve sheath decompression consisted mainly of collagen, closely packed and roughly parallel to the axis of the optic nerve. Collagen deposition seen in scar tissue after secondary optic nerve sheath decompression was extremely disorganized and irregular, with the individual fibers laid down seemingly at random. There was little sense of layering or of parallel arrays. Mitomycin-C appeared to influence collagen deposition in such a way that the collagen was more regularly packed and more closely resembled unoperated tissue.

CONCLUSIONS

The regular well-organized collagen packing seen in normal sheath tissue is disrupted and replaced by less organized but compact scar tissue after optic nerve sheath decompression. With mitomycin use, more regular collagen packing closely approximating that found in unoperated sheath occurs. This configuration of fibers lends support for the filtration mechanism of optic nerve sheath decompression in treating papilledema.