Valentina Iemmi

Dementia care costs and outcomes: a systematic review.

We reviewed evidence on the cost‐effectiveness of prevention, care and treatment strategies in relation to dementia.

Dementia care costs and outcomes

We reviewed evidence on the cost‐effectiveness of prevention, care and treatment strategies in relation to dementia.

Suicide and poverty in low-income and middle-income countries: a systematic review

Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low-income and middle-income countries. Nonetheless, evidence on the association between suicide and poverty in low-income and middle-income countries is scarce. We did a systematic review to understand the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries. We included studies testing the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries using bivariate or multivariate analysis and published in English between January, 2004, and April, 2014. We identified 37 studies meeting these inclusion criteria. In 18 studies reporting the association between completed suicide and poverty, 31 associations were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal suicidal ideations and behaviours and poverty, 36 associations were explored. Again, almost all studies reported a positive association. However, when considering each poverty dimension separately, we found substantial variations. These findings show a consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth, and unemployment is associated with suicidal ideations and behaviours. At the country level, there are insufficient data to draw clear conclusions. Available data show a potential benefit in addressing economic poverty within suicide prevention strategies, with particular attention to both chronic poverty and acute economic events.

Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda

Approximately 75% of suicides occur in low- and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature, and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.

Mental and neurological health research priorities setting in developing countries

IntroductionA multi-region consultation process designed to generate locally produced regional and global research priorities on mental and neurological health in low- and middle-income countries.MethodsBetween 2003 and 2005, priority setting exercises on MNH research, using the systematic combined approach matrix (CAM) were held in the six regions of the developing world. One regional meeting per region was convened, and a global meeting was organized before and after the regional exercises.ResultsDuring regional meetings, regional agendas were created listing both research priorities and local problems in MNH. During global meetings, a global research agenda was established and four crucial areas of research priorities were identified: awareness and advocacy, enhancement of research capacity, training for service delivery, and development of evidence based policy.ConclusionsThe combined matrix approach enabled the development of regional and global MNH research agendas, derived from bottom up consultations within and between low- and middle-income countries. Collaboration between regions with similar priorities was instituted. Such research agendas are designed to assist policy-makers and donors in the allocation of scarce resources, but they require regular review to reflect changing needs.

Community-based rehabilitation for people with physical and mental disabilities in low- and middle-income countries: a systematic review and meta-analysis

ABSTRACT We conducted a systematic review to assess the effectiveness of community-based rehabilitation (CBR) for people with physical and mental disabilities in low- and middle-income countries, and/or their family/carers and community. We identified 15 eligible studies, 10 of which were randomised controlled studies. Overall, the studies suggested that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer. However, this conclusion must be interpreted with caution due to the small number of studies, concerns about study quality and lack of information on cost-effectiveness of the interventions.

An evaluation of peer-led self-management training for people with severe psychiatric diagnoses

Purpose – The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services. Design/methodology/approach – A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months). Findings – Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses. Research limitations/implications – Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies. Practical implications – The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group. Social implications – This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services. Originality/value – This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.

Peer-led self-management for people with severe mental disorders: an economic evaluation

Purpose – The purpose of this paper is to evaluate the effectiveness and cost-effectiveness of a peer-led self-management intervention for people with severe mental disorders. Design/methodology/approach – This is a one-arm longitudinal study without control group. In all, 262 adults with (self-reported) severe mental disorders, who have used secondary mental health services and were living in the community were evaluated at three time points (baseline, six and 12 months). Socio-demographic data were collected at baseline. Wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), functional living skills (Health Promoting Lifestyle Profile II) and service use (Client Service Receipt Inventory) data were assessed over time. Findings – Self-management for people with severe mental disorders improved wellbeing and health-promoting lifestyles. After an increase in the short term, costs appeared to decrease in the longer term, although this change was not statistically significant. Due to the lack of a control gro...

The role of youth mental health services in the treatment of young people with serious mental illness: 2-year outcomes and economic implications.

This study aims to evaluate the outcomes and economic case for a UK innovative youth‐specific mental health service for 16–25 year olds.

Positive Behavioural Support in Schools for Children and Adolescents with Intellectual Disabilities Whose Behaviour Challenges: An Exploration of the Economic Case.

Decision-makers with limited budgets want to know the economic consequences of their decisions. Is there an economic case for positive behavioural support (PBS)? A small before–after study assessing the impact of PBS on challenging behaviours and positive social and communication skills in children and adolescents with intellectual disabilities and behaviours that challenge was followed by an evaluation of costs. Results were compared with the costs of alternative packages of care currently available in England obtained from a Delphi exercise conducted alongside the study. Children and adolescents supported with PBS showed improvement in challenging behaviours and social and communication skills, at a total weekly cost of GBP 1909 (and GBP 1951 including carer-related costs). PBS in schools for children and adolescents with intellectual disabilities and behaviours that challenge may help to support them in the community with potential improvements in outcomes and also cost advantages.