Crisis-planning interventions for people with psychotic illness or bipolar disorder: systematic review and meta-analyses.
Inpatient treatment
bipolar affective disorders
psychotic disorders
Journal
BJPsych open
ISSN: 2056-4724
Titre abrégé: BJPsych Open
Pays: England
ID NLM: 101667931
Informations de publication
Date de publication:
13 Jun 2019
13 Jun 2019
Historique:
entrez:
19
9
2019
pubmed:
19
9
2019
medline:
19
9
2019
Statut:
epublish
Résumé
Mental health services lack a strong evidence base on the most effective interventions to reduce compulsory admissions. However, some research suggests a positive impact of crisis-planning interventions in which patients are involved in planning for their future care during a mental health crisis. This review aimed to synthesise randomised controlled trial (RCT) evidence on the effectiveness of crisis-planning interventions (for example advance statements and joint crisis plans) in reducing rates of compulsory hospital admissions for people with psychotic illness or bipolar disorder, compared with usual care (PROSPERO registration number: CRD42018084808). Six online databases were searched in October 2018. The primary outcome was compulsory psychiatric admissions and secondary outcomes included other psychiatric admissions, therapeutic alliance, perceived coercion and cost-effectiveness. Bias was assessed using the Cochrane collaboration tool. The search identified 1428 studies and 5 RCTs were eligible. One study had high risk of bias because of incomplete primary outcome data. Random-effects meta-analysis showed a 25% reduction in compulsory admissions for those receiving crisis-planning interventions compared with usual care (risk ratio 0.75, 95% CI 0.61-0.93, P = 0.008; from five studies). There was no statistical evidence that the intervention reduced the risk of voluntary or combined voluntary and compulsory psychiatric admissions. Few studies assessed other secondary outcomes. Our meta-analysis suggests that crisis-planning interventions substantially reduce the risk of compulsory admissions among individuals with psychotic illness or bipolar disorder. Despite common components, interventions varied in their content and intensity across the trials. The optimal models and implementation of these interventions require further investigation. E.M., S.L., S.J. and B.L.-E. received funding from the National Institute for Health Research during the conduct of the study.
Sections du résumé
BACKGROUND
BACKGROUND
Mental health services lack a strong evidence base on the most effective interventions to reduce compulsory admissions. However, some research suggests a positive impact of crisis-planning interventions in which patients are involved in planning for their future care during a mental health crisis.
AIMS
OBJECTIVE
This review aimed to synthesise randomised controlled trial (RCT) evidence on the effectiveness of crisis-planning interventions (for example advance statements and joint crisis plans) in reducing rates of compulsory hospital admissions for people with psychotic illness or bipolar disorder, compared with usual care (PROSPERO registration number: CRD42018084808).
METHOD
METHODS
Six online databases were searched in October 2018. The primary outcome was compulsory psychiatric admissions and secondary outcomes included other psychiatric admissions, therapeutic alliance, perceived coercion and cost-effectiveness. Bias was assessed using the Cochrane collaboration tool.
RESULTS
RESULTS
The search identified 1428 studies and 5 RCTs were eligible. One study had high risk of bias because of incomplete primary outcome data. Random-effects meta-analysis showed a 25% reduction in compulsory admissions for those receiving crisis-planning interventions compared with usual care (risk ratio 0.75, 95% CI 0.61-0.93, P = 0.008; from five studies). There was no statistical evidence that the intervention reduced the risk of voluntary or combined voluntary and compulsory psychiatric admissions. Few studies assessed other secondary outcomes.
CONCLUSIONS
CONCLUSIONS
Our meta-analysis suggests that crisis-planning interventions substantially reduce the risk of compulsory admissions among individuals with psychotic illness or bipolar disorder. Despite common components, interventions varied in their content and intensity across the trials. The optimal models and implementation of these interventions require further investigation.
DECLARATION OF INTEREST
BACKGROUND
E.M., S.L., S.J. and B.L.-E. received funding from the National Institute for Health Research during the conduct of the study.
Identifiants
pubmed: 31530302
doi: 10.1192/bjo.2019.28
pii: S2056472419000280
pmc: PMC6582216
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e53Subventions
Organisme : Marie Curie
ID : MCCC-FCO-11-U
Pays : United Kingdom
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