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There is a lack of available evidence in relation to the effectiveness of
interventions for adults with mild to moderate intellectual disability
and mental health problems.
To evaluate the efficacy of interventions for adults with mild to
moderate intellectual disabilities and co-occurring mental health
An electronic literature search of the databases Medline, EMBASE,
PsycINFO and EBM Reviews aimed at identifying randomised controlled
trials (RCTs) and controlled trials testing any type of intervention
(psychotherapy, biological or system level) for people with mild to
moderate intellectual disabilities (IQ score 35–69) targeting comorbid
mental health problems. Additionally a meta-analysis was conducted.
Twelve studies met the inclusion criteria. No significant effect was
found for the predefined outcome domains behavioural problems,
depression, anxiety, quality of life and functioning. The effect size for
depression (d = 0.49) was moderate but non-significant.
Quality of studies was moderate and heterogeneity was high.
There is no compelling evidence supporting interventions aiming at
improving mental health problems in people with mild to moderate
intellectual disability. The number of available trials is too low for
definite conclusions. Some interventions are promising and should be
evaluated further in larger and more rigorous trials.
Patient–clinician communication is central to mental healthcare but neglected in research.
To test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care.
In a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.
Of 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.
Structuring patient–clinician dialogue to focus on patients' views positively influenced quality of life, needs for care and treatment satisfaction.
Despite the tendency for harmonisation of strategies for mental health care delivery, rules and regulations for involuntary placement or treatment of mentally ill persons still differ remarkably internationally. Rapid European integration and other political developments require valid and reliable international overviews, sound studies and profound analyses of this controversial issue.
To give an overview of compulsory admission data from official sources across the European Union (EU).
Data on the legal frameworks for involuntary placement or treatment of people with mental illness and their outcomes were provided and assessed by experts from all EU member states.
Total frequencies of admission and compulsory admission rates vary remarkably across the EU. Variation hints at the influence of differences in legal frameworks or procedures. Time series suggest an overall tendency towards more or less stable quotas in most member states.
Further research is greatly needed in this field. Common international health reporting standards are essential to the compilation of basic data.
In community mental health care, knowledge about costs of care is very limited. Only few studies have related costs to outcome measures.
This German study assesses the cost of psychiatric care of 66 schizophrenic patients during one year of living in the community. Predictors of high cost were identified.
The average cost of comprehensive community care of one patient of the cohort was US$ 353 per week. This was only 43% of the cost of constant long-term care in a psychiatric hospital. Significant predictors of total cost of community care were the number of rehabilitative problems at the beginning and at the end of the study period, the type of accommodation before index hospitalisation and the gender of patients.
Results must be understood in terms of the characteristics of the special patient group and the catchment area we studied and are of high relevance in planning future care.
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