Wiley-Exley Elizabeth
Health Policy and Administration, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411, USA.
Soc Sci Med. 2007 Mar;64(6):1231-41. doi: 10.1016/j.socscimed.2006.11.009. Epub 2006 Dec 28.
Community-based models of providing mental health services are widely considered effective ways of serving individuals diagnosed with mental illness, but more comprehensive literature on these models in low- and middle-income countries is needed. This study is a systematic review of the effects of community-based models on health outcomes of adults with depression, schizophrenia, panic disorder, or bipolar disorders in middle- and low-income countries. PubMed, PsycINFO, and Cochrane Reviews were searched, returning 500 articles. The seventeen interventions included in this review in 14 countries show us that community-based mental health services can provide improvements in mental health outcomes, and the limited cost analyses suggest cost savings associated with community models of care. These findings are in line with much of the research on higher income countries. In addition, the studies also point to the gaps in the literature on costs, rural areas, bipolar disorders, and panic disorders, and note the need for further reviews of interventions targeting additional diseases, children, and adolescents as well as studies published in languages other than English. This review of the literature serves as a stepping stone for further research in community-based mental health services in low- and middle-income countries. The works reviewed here provide a base of knowledge that will assist us in taking the important next steps in program implementation and evaluation.
基于社区的心理健康服务模式被广泛认为是为被诊断患有精神疾病的个人提供服务的有效方式，但低收入和中等收入国家需要有关于这些模式的更全面文献。本研究是对低收入和中等收入国家基于社区的模式对患有抑郁症、精神分裂症、恐慌症或双相情感障碍的成年人健康结果影响的系统评价。检索了PubMed、PsycINFO和Cochrane综述，共检索到500篇文章。本综述纳入的来自14个国家的17项干预措施表明，基于社区的心理健康服务可以改善心理健康结果，有限的成本分析表明与社区护理模式相关的成本节约。这些发现与高收入国家的许多研究一致。此外，这些研究还指出了在成本、农村地区、双相情感障碍和恐慌症方面文献存在的差距，并指出需要进一步综述针对其他疾病、儿童和青少年的干预措施以及以英语以外语言发表的研究。本综述作为低收入和中等收入国家基于社区的心理健康服务进一步研究的垫脚石。这里综述的研究成果提供了一个知识基础，将有助于我们在项目实施和评估方面迈出重要的下一步。
