Author/Authors :
Malakouti, Kazem Mental Health Research Centre - Tehran Psychiatric Institute - Faculty of Behavioral Sciences and Mental Health - Iran University of Medical Sciences, Tehran, Iran , Mirabzadeh, Arash Department of Psychiatry - University of Social Welfare and Rehabilitation Sciences, Tehran, Iran , Nojomi, Marzieh Department of Community Medicine - Mental Health Research Centre - Iran University of Medical Sciences, Tehran, Iran , Ahmadi Tonkaboni, Ali Mental Health Research Centre - Tehran Psychiatric Institute - Faculty of Behavioral Sciences and Mental Health - Iran University of Medical Sciences, Tehran, Iran , Nadarkhani, Faranak Mental Health Research Centre - Tehran Psychiatric Institute - Faculty of Behavioral Sciences and Mental Health - Iran University of Medical Sciences; Tehran, Iran , Mirzaie, Mosleh Mental Health Research Centre - Tehran Psychiatric Institute - Faculty of Behavioral Sciences and Mental Health - Iran University of Medical Sciences, Tehran, Iran , Chimeh, Narges Family Research Institute - Shahid Beheshti University, Tehran, Iran
Abstract :
Background: Implementing community-based psychiatric services is one of the priorities of the
WHO/EMRO mental health programs. This study presents an aftercare service, as a community
based-service, for patients with severe mental illness (SMIs).
Methods: In this randomized controlled clinical trial design, 176 patients, who attended selective
hospitals with SMI, were allocated into three groups: clinical case managers provided by general
practitioners, nurses and the control group (usual treatment). The clients and their caregivers received
monthly home visits (education and treatment supervision). The effectiveness of the intervention was
measured by indicators of psychopathology such as scores of YOUNG, caregivers’ knowledge and
satisfaction with the services. Health-related quality of life (SF-36) was considered as the primary
outcome variable. Data were collected at baseline and at 12 months follow-up. Direct and indirect
medical costs were obtained through a periodic completion of questionnaires and interviews by caregivers.
Cost effectiveness ratio was estimated as cost per QALY gained in each group. SPSS 16.0
was used in this survey and statistical methods were chi-square, ANOVA, Scheffe as post-Hoc test
and paired sample t-test with 95% confidence interval and 0.05 significance level.
Results: The results of our study revealed that the score of YOUNG, caregivers’ knowledge and
satisfaction with service were improved in both intervention groups after 12 months. Improvement in
health-related quality of life was observed in the general practitioner and nurse group. The incremental
cost effectiveness ratio was 5740807 IRR and 5048459 IRR per QALYs gained in the general
practitioner and nurse groups, respectively.
Conclusion: The model of aftercare services provided by trained nurses is the most cost- effective
and feasible model for Iran’s socio-economic conditions with low resource allocations.
Keywords :
Community , Mental Health , Service , Aftercare , Severe Mental Illness
