International Journal of Mental Health Systems最新文献

{"title":"From coordinated services to learning mental health systems: advancing mental healthcare for the 21st century.","authors":"Jesse T Young, Craig Cumming","doi":"10.1186/s13033-026-00745-6","DOIUrl":"https://doi.org/10.1186/s13033-026-00745-6","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global cost of schizophrenia: a health economic modelling study.","authors":"Luisa S Welter, Mateo Montes-Martínez, Lara Bohr, Marjan Arvandi, Nikolai Mühlberger, Paul Boon, Günther Deuschl, Claudio L A Bassetti, Thomas Berger, Thomas G Schulze, David H V Vogel, Alexandra Philipsen, Miriam P L John, Uwe Siebert, Richard Dodel, Frank Jessen, Peter Falkai","doi":"10.1186/s13033-026-00740-x","DOIUrl":"https://doi.org/10.1186/s13033-026-00740-x","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is a chronic psychiatric disorder that leads to substantial disability, impaired quality of life, and reduced life expectancy. In addition to its profound impact on affected individuals, the disorder places a considerable financial burden on health care systems, caregivers, and society. Although the cost of schizophrenia has been studied in several individual countries, comprehensive global estimates across multiple cost categories remain scarce. This study aimed to estimate the global socioeconomic burden of schizophrenia using health economic modelling.</p><p><strong>Methods: </strong>We conducted a prevalence-based cost-of-illness analysis for 204 countries in 2019, focusing on adults aged 20 years and older. Data on direct (medical and nonmedical), indirect (productivity losses), and informal (nonprofessional, unpaid) care costs were systematically retrieved through a PubMed-based literature search covering records published between 02/2010 and 04/2023. Extracted per-patient costs were standardized to 2019 purchasing power parity (PPP) USD, and missing data were imputed using a stratification approach based on four gross national income (GNI) groups. Costs were scaled to the national level by multiplying the per-patient costs by country-specific prevalence estimates from the Global Burden of Disease Study. Costs were additionally expressed as a proportion of gross domestic product (GDP). To ensure data validity from a clinical perspective, all estimates were scrutinized by a panel of psychiatry experts.</p><p><strong>Results: </strong>An estimated 22.1 million adults were living with schizophrenia in 2019 (0.39% prevalence). Total economic costs across upper-middle, lower-middle, and high-income regions reached $243.2 billion (PPP), with direct costs representing 47%, indirect costs 29%, and informal care costs 24%. Upper-middle-income countries bore the greatest burden relative to GDP, whereas high-income countries had the highest per-patient and national costs.</p><p><strong>Conclusions: </strong>This study provides the most comprehensive global assessment to date of the economic burden of schizophrenia. Per-patient costs were identified as the main driver of the absolute global burden, underscoring the importance of effective disease management strategies. Policy-makers and other stakeholders should prioritize interventions that enhance patient functioning and societal participation.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the utility of exploratory 'factors associated with' studies in global mental health: the importance of context in Sub-Saharan Africa.","authors":"Joan Abaatyo, Wilber Ssembajjwe, Emmanuel Kiiza Mwesiga","doi":"10.1186/s13033-026-00741-w","DOIUrl":"10.1186/s13033-026-00741-w","url":null,"abstract":"<p><p>\"Factors associated with\" studies, exploratory multivariable regression analyses that do not begin with a prespecified primary exposure, have recently come under increasing criticism, with some arguing that they are methodologically weak and contribute little to scientific knowledge. Much of this criticism is justified. Many published studies in global mental health (GMH) rely on small samples, inconsistent adjustment strategies, automated variable-selection methods, and interpretations that imply causality where none can be established. These limitations deserve attention and should not be overlooked. However, abandoning exploratory association studies altogether would ignore the realities of research in many low- and middle-income countries and could further marginalize evidence from the Global South. In global mental health, particularly in Sub-Saharan Africa, limited data systems, poorly understood causal pathways, and resource constraints often make longitudinal and experimental studies difficult to conduct. In these settings, exploratory analyses remain an important starting point for identifying patterns, generating hypotheses, and informing future research. Indeed, many important advances in epidemiology have emerged through an iterative process of observation, exploration, and subsequent causal investigation. We argue that the central issue is therefore not the use of exploratory association studies, but how they are designed, analysed, and reported. Rather than discarding them, researchers should clearly present their findings as hypothesis-generating, avoid automated stepwise variable selection, justify adjustment decisions using directed acyclic graphs (DAGs), adhere to established reporting guidelines, and interpret results within their local context. This is not a call to lower methodological standards in the Global South. Instead, it is a call to apply rigorous methods in ways that are appropriate to the realities of under-resourced settings while strengthening local capacity for causal inference. Silencing exploratory research would risk reducing the visibility of evidence from precisely those settings where stronger representation in global mental health research is most needed. Enhancing the quality of exploratory research can help advance global mental health research, particularly in settings where relevant evidence remains limited.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching staff as gatekeepers for student mental health in higher education: findings from an exploratory sequential mixed-methods study on mental health promotion, psychological crises, and stigma.","authors":"Maria Koschig, Michéle Müller, Steffi G Riedel-Heller, Ines Conrad","doi":"10.1186/s13033-026-00738-5","DOIUrl":"10.1186/s13033-026-00738-5","url":null,"abstract":"<p><strong>Background: </strong>Mental health problems among university students are highly prevalent, while stigma and limited help-seeking remain major barriers to support utilization. Teaching staff can act as important gatekeepers who recognise distress, encourage help-seeking, and contribute to psychologically supportive learning environments. However, their role in student mental health promotion remains insufficiently understood.</p><p><strong>Methods: </strong>This exploratory sequential mixed-methods study combined a qualitative focus group involving five students from two German universities and an anonymous online survey of teaching staff from four German higher education institutions (n = 187). Insights from the focus group informed the development and content of the subsequent survey of teaching staff. Qualitative data were analysed using structured content analysis according to Kuckartz. Quantitative analyses included descriptive statistics and assessment of stigma-related attitudes using the Self-Stigma of Mental Illness Scale Short Form (SSMIS-SF).</p><p><strong>Results: </strong>The qualitative findings revealed four interrelated areas of expectation: psychologically sensitive communication, mental health literacy among teaching staff, accessible institutional support structures, and a university culture that normalises help-seeking. Among teaching staff, only 30.9% considered student mental health promotion part of their formal professional role, while 45.8% reported uncertainty when interacting with students experiencing psychological crises. Qualitative findings indicated substantial variation in perceived preparedness and support practices. Teaching staff primarily described recognising distress, offering initial support, and referring students to professional services. Personal endorsement of stigmatizing beliefs was low, whereas perceived public stigma was significantly higher (mean difference = 12.42, 95% CI 11.02-13.83; t(131) = 17.51, p < .001; Cohen's d = 1.52, 95% CI 1.27-1.77).</p><p><strong>Conclusions: </strong>Teaching staff may represent important gatekeepers for student mental health. However, unclear role expectations, limited institutional guidance, and insufficient training may restrict their capacity to support students effectively. Universities should strengthen staff training, establish clear referral pathways, and implement institution-wide mental health strategies.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Participatory systems modelling to improve mental health systems in Bogotá, Colombia: stakeholders' perspectives, experiences and networks.","authors":"Adriane Martin Hilber, Salvador Camacho, Mónica Natalí Sánchez Nítola, Dèbora L Shambo-Rodríguez, Grace Yeeun Lee, Laura Ospina-Pinillos, Jo-An Occhipinti","doi":"10.1186/s13033-026-00734-9","DOIUrl":"10.1186/s13033-026-00734-9","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction of home-based mobile specialist psychiatric nursing teams: Experiences of mental healthcare professionals.","authors":"Susann Arnell, Agneta Schröder, Ylva Nilsagård, Linda Ryen, Maria Fogelkvist","doi":"10.1186/s13033-026-00733-w","DOIUrl":"10.1186/s13033-026-00733-w","url":null,"abstract":"<p><strong>Background: </strong>The number of adults in need of psychiatric care is increasing in Sweden. To meet this need, new working methods are implemented. Home-based mobile specialist psychiatric nursing teams (SPOT) are being introduced to function as a complement to outpatient care and inpatient care, but still little is known about how healthcare professionals experience such efforts. The purpose of this study was thus to capture mental healthcare professionals' experiences of the early phase of the introduction of SPOT.</p><p><strong>Methods: </strong>Focus group discussions and semi-structured interviews were conducted with 11 mental healthcare professionals, including nurses, psychiatric aides working within psychiatric care and on the SPOT team and psychiatrists who had a consultative role in SPOT. The data was inductively analysed through reflexive thematic analysis.</p><p><strong>Results: </strong>The discussions and interviews revolved around three themes: The phases and conditions of the change, Opportunities and challenges in the new form of intermediate care and Care in the patient's home for patient empowerment and engagement. Different perspectives on the new form of care emerged and many were positive about patients' increased engagement in care when it was offered in the home environment. However, it was also emphasised that the need for different forms of care remains and that a new level of care should not exclude other forms of care. The results further showed a need to engage and offer continuous support to healthcare professionals at different levels when new working methods are introduced. Specifically, support from managers and increased competence and skills development in performing new work tasks were requested.</p><p><strong>Conclusions: </strong>Providing care in the home environment through SPOT interventions can help increase patients' engagement in their own care. Preparing and equipping healthcare professionals at all levels and offering them knowledge support and influence in the introduction of new forms of care is important to reduce the vulnerability that professionals may initially experience in change processes and new ways of working.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global practices in adapting cognitive behavioral therapy for ethnoracial populations with substance use disorders: a scoping review of adaptation strategies, treatment outcomes, and geographic gaps.","authors":"Obi Onyegesi, Patrick M W Kennedy, Skyler Hamilton, Lesia M Ruglass, Fiona N Conway","doi":"10.1186/s13033-026-00730-z","DOIUrl":"10.1186/s13033-026-00730-z","url":null,"abstract":"<p><strong>Background: </strong>Cognitive behavioral therapy (CBT) is an evidence-based treatment for substance use disorders (SUDs), yet standard protocols may have limited cultural relevance for ethnoracially diverse populations. Cultural adaptation may enhance the fit and relevance of interventions; however, the scope, characteristics, and outcomes of ethnoracial adaptations of CBT for SUD remain underexamined. This scoping review mapped the global evidence on ethnoracially adapted CBT for SUDs, including strategies, implementation characteristics, and treatment outcomes.</p><p><strong>Methods: </strong>Following PRISMA-ScR guidelines, we systematically searched nine databases for peer-reviewed empirical studies evaluating ethnoracially adapted CBT interventions for SUDs. Studies were included if they explicitly described an ethnoracial adaptation to CBT. Extracted data included study design, population characteristics, strategies, comparator conditions, implementation indicators, and substance use outcomes.</p><p><strong>Results: </strong>Of 671 records identified, 12 studies met the inclusion criteria, representing populations in the United States and Kenya. Most studies focused on Latino/Hispanic populations living in the United States, with comparatively limited representation of other ethnoracial groups and low- and middle-income country contexts. Adaptations included both surface-structure modifications (e.g., language translation, culturally relevant examples, and tailored delivery formats) and deep-structure modifications that incorporated culturally relevant values, belief systems, and lived experiences into core CBT content and delivery. Most studies reported favorable substance use outcomes following participation in ethnoracially adapted CBT interventions. Several studies also identified culturally salient factors, including ethnic identity, familismo, and religiosity, as moderators or correlates of treatment response. However, implementation outcomes such as feasibility, fidelity, and acceptability were inconsistently reported, long-term follow-up data were limited, and only a small number of studies directly compared ethnoracially adapted CBT with standard CBT.</p><p><strong>Conclusions: </strong>The current literature suggests that ethnoracially adapted CBT is a promising approach for addressing SUDs among diverse populations. However, limitations in implementation reporting, long-term outcome assessment, geographic representation, and direct comparisons with standard CBT constrain conclusions regarding the specific contribution of cultural adaptation to treatment outcomes. Future research should expand representation across ethnoracial groups and geographic regions and clarify how cultural adaptations influence treatment engagement, implementation, and substance use outcomes.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPA governance restructuring and section autonomy: a case study in organizational resistance to structural diversity.","authors":"Sonya C Faber, Amy Bartlett, Monnica T Williams, Jude M Cénat","doi":"10.1186/s13033-026-00722-z","DOIUrl":"10.1186/s13033-026-00722-z","url":null,"abstract":"<p><p>This case study critically examines governance changes enacted within the Canadian Psychological Association (CPA) following internal advocacy for structural representation of Black, Indigenous, and People of Color (BIPOC) members. Drawing on qualitative document analysis, the study examines a series of bylaw amendments proposed and approved by the organization's leadership that centralize authority within the Board and Chief Executive Officer while reducing the autonomy of constituent member groups (CPA Sections). Using the lenses of power hoarding and the division of powers framework, the analysis explores how governance reforms may reshape organizational authority, representation, and accountability. The findings illustrate how the amendments systematically shifted decision-making power away from Sections and toward central leadership, despite emerging in a context of explicit calls for greater structural diversity and power sharing. As such, the reforms can reasonably be understood as a form of organizational resistance to structural diversity. This case contributes to understanding how governance reforms may influence equity initiatives within professional organizations and offers practical implications for organizational governance, diversity consulting, and institutional accountability.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the structure of mental health service networks in Belgium: implications for recovery-oriented systems of care.","authors":"Mégane Chantry, Jürgen Magerman, Ilse Goethals, Jessica De Maeyer, Wouter Vanderplasschen, Vincent Lorant, Pablo Nicaise","doi":"10.1186/s13033-026-00721-0","DOIUrl":"10.1186/s13033-026-00721-0","url":null,"abstract":"<p><strong>Background: </strong>Service collaboration ensures care continuity and recovery-oriented care for individuals with mental disorders (MD). A recovery-oriented system of care (ROSC) encompasses diverse person-centred services that collaborate to address individual needs and foster social integration. We examined the characteristics of care provision for individuals with MD in Belgium with regard to ROSC principles. Specifically, we analysed the structure of collaboration within existing mental health service networks, focusing on the division between mental health services and specialised services for substance use disorders (SUD).</p><p><strong>Methods: </strong>We conducted an online survey involving 309 services across five networks, of which 190 participated. We collected data on referrals and service characteristics. We used Social Network Analysis (SNA) to assess collaboration patterns within service networks, considering network density (i.e. number of ties), transitivity (i.e. tendency toward clustered collaboration), degree distribution (i.e. concentration of ties around certain services), service attributes (e.g. category, care function, and exclusion criteria), and homophily (i.e. tendency to connect with similar services). Exponential Random Graph Model (ERGM) was used to test whether observed collaboration patterns differed from random collaboration.</p><p><strong>Results: </strong>Hospital units and specialised SUD services were central services. Specialised SUD services and generic mental health services were more likely to collaborate with similar services. Likewise, services with the same care function were more likely to collaborate, except hospital units. Networks showed significant transitivity.</p><p><strong>Conclusion: </strong>Mental health service networks appear to be structured around organisational boundaries, with limited collaboration between complementary services and a highly hospital-centred configuration. These patterns suggest a misalignment with ROSC principles and may constrain the capacity of care systems to support recovery processes.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of stepped versus usual care for mental health service delivery: a systematic review and meta-analysis.","authors":"Raphael Ohms, Jerneja Sveticic, Megan H Ross, Nicole Hartley, Peter Worthy, Trevor Russell","doi":"10.1186/s13033-026-00717-w","DOIUrl":"10.1186/s13033-026-00717-w","url":null,"abstract":"<p><strong>Background: </strong>Stepped models of care provide a sequential approach in the treatment of mental health conditions, with the level of care prescribed varying in intensity according to the severity of mental health concern for the individual. This systematic review and meta-analysis evaluate the effectiveness of stepped care compared to usual care for mental health-related clinical outcomes, quality of life, cost-effectiveness and satisfaction across mental health conditions.</p><p><strong>Methods: </strong>A systematic literature search across eight databases (February 2024) identified randomised controlled trials of stepped care models for diagnosed mental health conditions. Standardised mean differences (SMDs), risk ratios (RR) and 95% confidence intervals (CIs) were calculated using random effects models. Effect sizes were interpreted using Cohen's d (d < 0.5; small, 0.5 < d < 1.2; medium and d > 1.2; large).</p><p><strong>Results: </strong>Forty-one studies were eligible and 31 included in the meta-analyses. Stepped care showed large and statistically significant effects from baseline to post-treatment that was greater when compared to usual care for mental health-related quality of life and PTSD symptoms (SMD [95% CI] 3.13 [2.08 to 4.18] and 1.39 [0.61 to 2.17], respectively). Further, compared to usual care, stepped care had an increased likelihood of depression remission (RR [95% CI] 1.64 [1.24 to 2.16]) and response (RR [95% CI] 1.78 [1.35 to 2.35]). For general health-related quality of life, stepped care showed a statistically significant, medium effect from baseline to post-treatment compared to usual care (SMD [95% CI] 0.62 [0.19 to 1.06]). From baseline to post-treatment, stepped care showed medium, but non-significant improvements for depression and anxiety (SMD [95% CI] 0.73 [-0.26 to 1.72] and 0.92 [-0.20 to 2.03], respectively) when compared to usual care. There were no significant differences in direct costs (MD [95% CI] 195.16 [-137.96 to 528.28], however, indirect costs were significantly lower with stepped care (MD [95% CI] -962.19 [-1412.55 to -511.83]).</p><p><strong>Conclusions: </strong>Stepped care demonstrates better outcomes than usual care and is more cost-effective for indirect costs. Future research should standardise and compare outcomes, populations, and conditions to ensure meaningful results and reduce heterogeneity. More research is needed to develop personalised stepped care models.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}