Psychosocial interventions are vital in treating severe mental illness, yet their use remains limited, and patients often lack adequate information about them. Patient-focused versions of clinical guidelines are designed to enhance mental health literacy and inform patients about available treatments, but these resources are underutilized. This study evaluated the impact of implementing a patient-focused psychosocial intervention guideline on empowerment, knowledge, and use of psychosocial interventions among individuals with severe mental illness.

Multicentre, cluster-randomised trial. The study population comprised adult patients with a severe mental disorder. The intervention group received a multimodal, structured, and protocol-led patient-focused guideline implementation, whereas the control group received treatment as usual. Data were analysed using hierarchical linear models. The primary outcome was the change in patients’ empowerment.

There was no significant intervention effect on empowerment (effect size=0.13, p=0.605), which increased slightly in both groups. The number of psychosocial interventions familiar to patients increased significantly more in the intervention group. Exploratory analyses suggest that patient empowerment could have been influenced by COVID-19-related stress, patient age, the severity of functional impairment, and migration background. The improvement in the utilisation of psychosocial interventions did not differ significantly between the intervention group (M=1.1, SD=2.5) and the control group (M=1.3, SD=2.4).

The implementation of a patient-focused psychosocial intervention guideline failed to enhance empowerment among service users. However, our analyses indicate that the intervention led to an improvement in patient knowledge with respect to guideline content. The availability of psychosocial interventions may have been significantly constrained by the COVID-19 pandemic.

The aim of the article is to undertake the first economic analysis exploring the costs of illness (COIs) and factors affecting COIs in people living with mental disorders using individual patient-level data across five countries with different national income levels. This is done by investigating diagnosis-related and sociodemographic factors for country-specific medical and psychosocial service use in these high, lower-middle and low-income countries.

Using data from the Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) study, a pragmatic randomized controlled trial, costs for medical and psychosocial services have been estimated over 6 months in 615 people with severe mental illness from Germany (n = 171), Uganda (n = 138), Tanzania (n = 110), India (n = 93) and Israel (n = 103). The primary economic analysis included (1) total COI expressed in 2021 international dollars and (2) proportional cost-type expenditures. Generalized linear regression models were also used to estimate the impact of psychiatric diagnosis, social disability, age and gender on the total COI.

Of the 615 participants (mean [SD] age 38.3 [11.2] years; 335 [54.5%] women), the total 6-month COI ranged from $311.48 [±547.47] in Tanzania to $10,493.19 [±13324.10] in Germany. High-income Germany and low-income Uganda both concentrated >70% of COIs on inpatient care. High-income Israel had the most balanced COI, with the lowest mean share (15.40%) on inpatient care, compared with community (35.12%) and primary care (33.01%). Female gender was associated with lower COI (eb = 0.215; p = 0.000) in Tanzania, while in India diagnosis of depression was associated with lower costs than schizophrenia (eb = 0.363; p = 0.017). Health of the Nation Outcome Scale scores (social disability) were not significantly associated with COIs in any country. In Tanzania, the total mean COI increased by 3.6% for every additional year of age. Compared to Germany, mean COIs were significantly lower by 90%, 99% and 86% in Uganda, Tanzania and India, respectively, and by 50% in Israel, although this difference was not significant.

National income is correlated with the total COI in people living with mental disorders but is a poor predictor of the sector-specific distribution of these expenditures.

Inpatient equivalent home treatment (IEHT), implemented in Germany since 2018, is a specific form of home treatment. Between 2021 and 2022, IEHT was compared to inpatient psychiatric treatment in a 12-months follow-up quasi-experimental study with two propensity score matched cohorts in 10 psychiatric centers in Germany. This article reports results on the treatment during the acute episode and focuses on involvement in decision-making, patient satisfaction, and drop-out rates.

A total of 200 service users receiving IEHT were compared with 200 matched statistical “twins” in standard inpatient treatment. Premature termination of treatment as well as reasons for this was assessed using routine data and a questionnaire. In addition, we measured patient satisfaction with care with a specific scale. For the evaluation of patient involvement in treatment decisions, we used the 9-item Shared Decision Making Questionnaire (SDM-Q-9).

Patients were comparable in both groups with regard to sociodemographic and clinical characteristics. Mean length-of-stay was 37 days for IEHT and 28 days for inpatient treatment. In both groups, a similar proportion of participants stopped treatment prematurely. At the end of the acute episode, patient involvement in decision-making (SDM-Q-9) as well as treatment satisfaction scores were significantly higher for IEHT patients compared to inpatients.

Compared to inpatient care, IEHT treatment for acute psychiatric episodes was associated with higher treatment satisfaction and more involvement in clinical decisions.

Only two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU).

We used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU.

No significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU.

The employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.

If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on “common mental disorders” and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment.

The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued.

A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040).

The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.

Our aim was to identify possible patterns of change or durability in sources of meaning for family caregivers of terminally ill patients after the onset of support at home by an outreach palliative nursing team during a three-month survey period.

The Sources of Meaning and Meaning in Life Questionnaire (SoMe) was administered to 100 caregivers of terminally ill patients at four measurement timepoints: immediately before the onset of the palliative care (t0), and at 1 week, 1 month, and 3 months after t0. Time-dependent changes were assessed for the completed subsample (n = 24) by means of bivariate linear as well as quadratic regression models. Multivariate regressions with dimensions of meaning in life as dependent variables were performed for the whole sample by means of random-effects models: dependent variables changed over time (four timepoints), whereas regressors remained constant.

No significant differences were found for psychosocial and clinical variables or for sources of meaning between the uncompleted and completed subsamples. Growth curve analyses revealed no statistically significant but tendentiously parabolic changes for any dimensions or for single sources of meaning. In multivariate models, a negative association was found between patient age, psychological burden of family caregivers, and changes in total SoMe score, as well as for the superordinate dimensions.

According to our hypothesis, sources of meaning and meaning in life seem to remain robust in relatives caring for terminally ill family members during the three-month survey period. A parabolic development pattern of single sources of meaning indicates an adjustment process. An important limitation of our study is the small number of participants compared with larger multivariate models because of high dropout rates, primarily due to the death of three-quarters of the participants during the survey period.

Little is known about international variations in employment rates among people with schizophrenia or about the factors associated with employment in this disorder.

To describe employment patterns and the variables associated with working in an international sample of people with schizophrenia.

An analysis was made of baseline data from the European Schizophrenia Cohort study, a 2-year investigation of people with schizophrenia in contact with secondary services and living in France, Germany and the UK (n = 1208).

Participants were working in all sections of the job market. People who had a degree, were living with their families or had experienced only a single episode of illness were more likely to be working. A continuous illness course, more severe non-psychotic symptoms and drug misuse reduced the odds of employment. There were large variations between centres in employment rates, which were highest in the three German study sites. These differences persisted after adjustment for individual characteristics.

Local social contexts may be as important as individual or illness-related factors in explaining employment status.

Burden on the relatives of patients with schizophrenia may be influenced not only by patient and caregiver characteristics, but also by differences in mental health service provision.

To analyse whether family burden is affected by national differences in the provision of mental health services.

Patients with schizophrenia and their key relatives were examined in Germany (n=333) and Britain (n = 170). Differences in family burden in both countries were analysed with regression models controlling for patient and caregiver characteristics.

Family burden was associated with patients' symptoms, male gender, unemployment and marital status, as well as caregivers' coping abilities, patient contact and being a patient's parent. However, even when these attributes were controlled for, British caregivers reported more burden than German caregivers.

National differences in family burden may be related to different healthcare systems in Germany and Britain. Support for patients with schizophrenia may be shifted from the professional to the informal healthcare sector more in Britain than in Germany.