1,721,061 research outputs found
THE RE-DEFINE PROJECT AND THE EFFECTIVENESS OF SH+ IN PREVENTING MENTAL DISORDERS IN REFUGEES AND ASYLUM SEEKERS RESETTLED IN EUROPE: A MULTICENTRE RANDOMISED CONTROLLED TRIAL
Full text linkBackground: The RE-DEFINE project aims to provide effective community-based health care implementation strategies to scale-up the delivery and uptake of psychosocial interventions for preventing the onset of mental disorders in refugees and asylum seekers (RAS) resettled in middle-income and in high-income countries (HICs). Self Help Plus (SH+) is a group-based psychosocial intervention developed by the World Health Organization for managing psychological distress in conditions of adversity. RE-DEFINE aimed to assess the effectiveness of SH+ in preventing the development of mental disorders in RAS resettled in Europe. Methods: A randomized controlled trial was conducted at six sites in five European countries. Participants were adult asylum seekers and refugees with psychological distress (General Health Questionnaire ≥ 3), but without a formal psychiatric diagnosis as assessed with the Mini International Neuropsychiatric Interview (M.I.N.I.). The intervention comprised five group-based audio-recorded sessions on stress management, complemented with an illustrated book. Sessions were led by peer-facilitators receiving appropriate training. Participants were randomized to either SH+ or treatment as usual (TAU) on a 1:1 basis. The frequency of any mental disorder was measured with the M.I.N.I. at post-intervention (secondary outcome) and six months after start of the intervention (primary outcome) in the intention-to-treat population. Secondary outcomes also included self-identified problems, symptoms of depression and post-traumatic stress disorder, functional impairment, quality of life, and subjective wellbeing at post-intervention and at six-month follow-up. Assessors were masked to allocation. Findings: Of 1475 individuals assessed for eligibility, 459 were included in the trial and randomly assigned to SH+ or TAU. Compared with controls, we found lower incidence of any mental disorders at post-intervention for SH+ (Cramer’s V 0.13, p= 0.01, Risk Ratio (RR) 0.50, 95% Confidence Interval (CI) 0.29 to 0.87), but not at follow-up (Cramer’s V 0.007, p= 0.90, RR 0.96, 95% CI 0.52 to 1.78). We also found statistically significant improvements for SH+ for four out of six secondary outcomes at post-intervention, and for the outcome wellbeing at six-month follow-up. Eight adverse events were reported, none of which was considered to be associated with the intervention. Interpretation: This is the first study showing that it is possible to prevent the development of mental disorders in asylum seekers and refugees resettled in HICs. As the preventative effect was observed at post-intervention only, modalities to maintain the beneficial effect of SH+ in the long-term need to be identified. SH+ may be safely offered as a public health indicated prevention strategy to RAS resettled in HICs
Errors in network meta-analysis of generalized anxiety disorder psychotherapies
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Leave no one behind: rethinking policy and practice at the national level to prevent mental disorders
Full text linkThe global burden of mental disorders is increasing, in line with the shift from communicable to chronic non-communicable diseases. Mental disorders affect the functioning of individuals, resulting not only in enormous emotional suffering and diminished quality of life, but also in stigma and discrimination. This burden extends to the community and society, with far-reaching economic and social consequences. Even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental disorders, so a shift in focus from treatment to prevention of mental disorders should be promoted at the central level in the form of legislation, policy formulation and resource allocation. Universal and selective prevention programs should be prioritized nationally, as they aim to change the risk profile of the entire population and specifically target populations at risk for mental disorders, respectively. In this article, we review the key risk factors for mental disorders and the measures that can be taken at the national level to prevent them, taking into due consideration that prevention efforts can vary based on the audience they are addressing, level of intensity they are providing, and the life phase they target. By adopting a human rights perspective and placing the social determinants of health at the center of our narrative, we maintain that improving mental health cannot be achieved by strengthening health services alone. Coordination across government departments is needed to implement multi-level public health interventions across a wide range of settings, programs, and policies. Focusing on children's mental health and addressing poverty, gender inequality and social discrimination should be absolute priorities for national mental health policies and plans
Towards person-centered care in global mental health: implications for meta-analyses and clinical trials
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Calling for policy actions to increase access to long-acting antipsychotics in low-income and middle-income countries
Full text linkSchizophrenia-spectrum disorders are associated with substantial impairment and disability. Lack of treatment adherence is a major issue, especially in low- and middle-income countries (LMICs). Despite growing evidence supporting second-generation long-acting antipsychotics (LAIs) as an effective strategy to ensure continued maintenance treatment in schizophrenia, access to these technologies has been very limited in constrained-resource settings. Including second-generation LAIs in national and international essential medicines lists and evidence-based guidelines, promoting public health-oriented patent pooling and extending their availability to primary health care settings, are key actions that should urgently be implemented to increase access to long-acting technologies. Implementing these policy actions can pragmatically improve treatment adherence, ultimately tackling schizophrenia-related impairment and disability in LMICs, which can be regarded as a global health priority
Does baseline severity interact with the effects of psychotherapy for depression? A meta-analytic review
Full text linkIntroduction: It is not yet clear whether baseline severity is associated with the effects of psychotherapies. We examined baseline severity at the study level in a large sample of randomized controlled trials comparing psychotherapies against a control condition for the treatment of depression. Methods: We used an existing large database of randomized trials comparing psychotherapies for depression with control groups (www.metapsy.org). We converted baseline severity scores across different depression measures into a common metric. We ran bivariable and multivariable meta-regression analyses to examine the association of effect sizes with baseline severity. We also examined response rates in treatment and control conditions. Results: We included 387 randomized trials (463 comparisons; 47,315 patients). The pooled effect size of the psychotherapies was g = 0.77 (95 % CI, 0.70; 0.84). In the main analyses, we found a highly significant association between the effect size and baseline severity (bivariable coefficient: 0.024 (SE = 0.006; p < 0.0001), multivariable coefficient: 0.022 (SE = 0.007; p = 0.002)). This was confirmed in some but not all sensitivity analyses. Absolute response rates in the control conditions remained stable across different levels of baseline severity (bivariable metaregression analyses: p = 0.545), or showed a negative association (multivariable analyses: p = 0.002). In the therapy conditions the response rates were significantly larger with increasing levels of baseline severity (bivariable: p ≤0.0001; multivariable: p = 0.006). Conclusion: The effects of psychotherapies are probably associated with baseline severity. Response rates in control conditions remained relatively stable across different levels of baseline severity, while in the treatment conditions the response rates increased with increasing levels of baseline severity
Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries
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New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base
No full textThree-month long-acting paliperidone is a new, recently marketed, formulation of paliperidone, characterised by the longest available dosing interval among long-acting antipsychotics. The clinical profile of 3-month long-acting paliperidone was recently summarised by the European Medicines Agency (EMA) in a public assessment report, released in April 2016. In this commentary, the main strengths and limitations of the EMA assessment report were appraised and discussed, in order to highlight possible implications for clinical practice, future research and regulatory practices for drug approval
Antipsychotic drug exposure and risk of myocardial infarction
No full textPatients experiencing psychoses and in need of antipsychotic agents may be exposed to a higher risk of myocardial infarction (MI) than the general population. As there have been no randomised studies investigating this association, a recent systematic review and meta-analysis included all observational studies that compared the incidence of MI among patients receiving antipsychotics v. no treatment. It found nine studies and calculated that the odds (risk) for developing MI were 1.88-fold higher in antipsychotic users compared with individuals who had not taken antipsychotic drugs. In this commentary, the results of this systematic review are discussed in view of their clinical implications for everyday clinical practice
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