The Comparison of Four Models of Community Psychiatry—A Systematic Review and Preliminary Meta-Analysis of the ACT Model

IF 3.2 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical psychology & psychotherapy Pub Date : 2025-02-18 DOI:10.1002/cpp.70048

Kacper Wilk, Ewelina Kowalewska, Małgorzata Jakubowska, Maria Załuska, Michał Lew-Starowicz

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Abstract

Background

The aim of this systematic review and preliminary meta-analysis is to summarize the effectiveness of selected models of community psychiatry: community mental health center, flexible assertive community treatment, community mental health team and assertive community treatment.

Methods

In order to determine the results of therapeutic interventions, comparison of symptom severity, level of functioning, use of institutional care, quality of life/well-being/recovery and satisfaction at baseline and during follow-up was conducted. Thirty-seven quantitative studies were selected, grouped according to the study model and compared in terms of positive, neutral and negative impact on patients according to efficacy factors. Additionally, a preliminary random-effects meta-analysis was performed on 11 studies to investigate the effectiveness of assertive community treatment.

Results

Review shows the overall positive results of the selected models. The best documented effects were an increase in the level of functioning and a reduction in institutional care. The number of articles collected indicates that community mental health center and assertive community treatment are better researched than community mental health team and flexible assertive community treatment models. Meta-analysis on assertive community treatment studies showed significant pooled effect sizes for domains of functioning, quality of life, hospitalizations and symptom severity.

Conclusions

The community mental health center and assertive community treatment are most likely to indicate efficiency and safety. The community mental health team and flexible assertive community treatment models should be explored in future studies. Results of the preliminary meta-analysis provide further evidence for the effectiveness of assertive community treatment.

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四种社区精神病学模型的比较——ACT模型的系统评价与初步元分析

本系统综述和初步荟萃分析的目的是总结选定的社区精神病学模式：社区精神卫生中心、灵活果断的社区治疗、社区精神卫生团队和果断的社区治疗的有效性。方法在基线和随访期间比较症状严重程度、功能水平、机构护理使用、生活质量/幸福感/恢复和满意度，以确定治疗干预的结果。选取37项定量研究，按照研究模型进行分组，根据疗效因素对患者的正面、中性和负面影响进行比较。此外，对11项研究进行了初步的随机效应荟萃分析，以调查自信社区治疗的有效性。结果综述显示所选模型的总体积极结果。记录在案的最佳效果是功能水平的提高和机构护理的减少。收集的文章数量表明，社区精神卫生中心和果断的社区治疗比社区精神卫生团队和灵活果断的社区治疗模式更值得研究。对自信的社区治疗研究的荟萃分析显示，在功能、生活质量、住院和症状严重程度等领域有显著的综合效应大小。结论社区心理健康中心和果断的社区治疗最有效、最安全。社区心理健康团队和灵活果断的社区治疗模式在未来的研究中值得探索。初步荟萃分析的结果为自信社区治疗的有效性提供了进一步的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical psychology & psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

6.30

自引率

5.60%

发文量

106

期刊介绍： Clinical Psychology & Psychotherapy aims to keep clinical psychologists and psychotherapists up to date with new developments in their fields. The Journal will provide an integrative impetus both between theory and practice and between different orientations within clinical psychology and psychotherapy. Clinical Psychology & Psychotherapy will be a forum in which practitioners can present their wealth of expertise and innovations in order to make these available to a wider audience. Equally, the Journal will contain reports from researchers who want to address a larger clinical audience with clinically relevant issues and clinically valid research.