A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol

Ahmad Hajebi,Mohammad Ghadiri Vasfi,Masud Yunesian,Arash Rashidian,Yasaman Mottaghipour,Homayoun Amini,Maziar Moradi-Lakeh,Seyed Kazem Malakouti,Vandad Sharifi,Mehdi Tehranidoost

doi:10.1186/1471-244x-13-178

Abstract

BackgroundSevere mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country’s urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.Method/DesignThis is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services.DiscussionThis paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.Trial registrationIRCT201009052557N2

Highlights

Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population
This paper presents a protocol for an Randomized clinical trial (RCT) of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department
The primary objectives are to compare 1) of length of hospital and 2,) readmission rates between intervention and control (TAU) groups in a 12 months follow-up of patients with severe mental illnesses discharged from psychiatric hospitals

Summary

Introduction

Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. Situation analysis Studies across the globe report the lifetime prevalence of schizophrenia and bipolar I disorder to be around 1% and 0.72%, respectively [1]. It is estimated that there are at least 400,000 patients suffering from severe. Improving the services provided for patients with mental disorders is the main priority of mental health care system in the world. Every year up to 30% of the worldwide population suffer from some kind of mental disorders and at least two third of them do not receive any kind of treatment even in developed countries [4]. For example in China, 11.1% of cases with severe psychiatric disorders received any treatment during the past 12 months and in Nigeria a minority (10.4%) of patients who sought treatment received adequate therapy [7]

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