Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system

Digital mental health interventions for chronic serious mental illness: Findings from a qualitative study on usability and scale-up of the Life Goals app for bipolar disorder

The Life Goals (LG) application is an evidence-based self-management tool intended to help individuals with bipolar disorder (BD) by aligning symptom coping strategies with personal goals. The program has traditionally been offered in-person or via the web, but has recently been translated into an individualized, customizable mobile intervention to improve access to care and reduce provider burden. The LG app previously showed acceptability with ease of use and satisfaction with user interface, but less success in encouraging self-management. To better understand patient needs, our team conducted semi-structured interviews with 18 individuals with BD who used the LG app for 6 months. These interviews also investigated participant interest in sharing LG app data with their provider through an online dashboard. Using affinity mapping, a collaborative, qualitative data analysis technique, our team identified emerging common themes in the interviews. Through this process, team members identified 494 pieces of salient information from interviews that were mapped and translated into three main findings: (1) many participants found Mood Monitoring and LG modules helpful/interesting and stated the app overall had positive impacts on their mental health, (2) some components of the app were too rudimentary or impersonal to be beneficial, and (3) feedback was mixed regarding future implementation of an LG provider dashboard, with some participants seeing potential positive impacts and others hesitating due to perceived efficacy and privacy concerns. These findings can help researchers improve app-based interventions for individuals with BD by increasing app usage and improving care overall.

The Contribution of a Music and Arts Rehabilitation Program to the Creative Identity, Well-Being, and Community Integration of People With Mental Health Conditions

The United Nations highlighted the importance of promoting the rights of people with mental health conditions (MHC) to education, employment, and citizenship. One related initiative in Israel is the Garage pre-academic music and arts school for individuals with musical and artistic abilities coping with MHC. This process–outcome study examined whether and how the Garage contributes to participants’ creative self-concept, mental health, alleviates loneliness, and promotes postsecondary education and work integration. It also probed the participants’ initial expectations and the extent to which these were fulfilled. Using a single-group pretest–posttest design, quantitative data on the outcome variables were collected, along with mid-test data on process variables from the Garage students ( N = 44). Supplementary qualitative data were collected at pretest on the students’ expectations. The results suggest a significant increase in creative personal identity and mental health, a decrease in loneliness, and promotion of postsecondary education and work integration. These findings were associated with persistent attendance, basic psychological needs satisfaction, and expectation fulfillment. A merged analysis indicated that the students’ qualitative expectations were generally congruent with the quantitative results. Overall, the findings show how the program corresponds to humanistic values, targets service users’ needs and rights, and promotes personal recovery and community integration.

Barriers and Facilitators for Mental Health Service Use Among Racial/Ethnic Minority Adolescents: A Systematic Review of Literature

Introduction: Mental disorders represent serious public health concerns in the U.S. Compared with Whites, racial/ethnic minority adolescents are more likely to be affected by mental disorders but less likely to use mental health services. This systematic review aimed to summarize factors related to mental health service use among minority adolescents in the U.S. as identified in previous research.

Methodology: Following the PRISMA guideline, we systematically searched seven databases for peer reviewed articles related to barriers and facilitators of mental health service use among racial/ethnic minority adolescents.

Results: Thirty-two quantitative studies met our inclusion criteria, among which 12 studies (37.5%) sampled mostly Blacks or African Americans, 6 studies (18.7%) focused primarily on Hispanics or Latin/a/x, including Mexican Americans and Puerto Ricans, and 4 studies (12.5%) were mostly Asian Americans (e.g., Chinese, Vietnamese). Based on the socio-ecological framework, 21 studies (65.6%) identified adolescent-related barriers and facilitators of mental health service use, including biological (e.g., age, gender), clinical (e.g., symptom severity), behavioral (e.g., drug/alcohol use), and psychological characteristics (e.g., internal asset) of minority youth. Ten studies (31.3%) identified parents-related factors that influenced minority adolescent mental health service use, including parental perceptions and beliefs, family and parenting issues, and demographic characteristics. Primary factors at the therapist level included ethnic match between patient and practitioner, relationship with healthcare practitioners, and patient-therapist co-endorsement of etiological beliefs. Fifteen studies (46.9%) identified factors influencing minority adolescent mental health service use at the contextual/structural level, including household income, insurance status, and family structure. Lastly, acculturation and school experiences were major factors at the social/cultural level that influence minority adolescent service use.

Conclusion: More empirical studies are needed to understand the mechanism underlying minority adolescents' unmet mental health service needs. Culturally competent interventions are warranted to engage minority adolescents with mental disorders into treatment.

Realizing the Promise of Learning Organizations to Transform Mental Health Care: Telepsychiatry Care As an Exemplar

To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.

Prevalence and associated factors of common mental disorders among residents of Illu Ababore zone, southwest Ethiopia: a cross-sectional study

Background

A common mental disorder is characterized by anxiety, depression, and unexplained somatic symptoms that usually encountered in community and primary care settings. Both short and long term bio psychosocial disabilities are inevitable if common mental disorder is not treated. Despite its impact, the prevalence of common mental disorder in the Illu Ababore zone is not well known. Therefore, this study aimed to assess the prevalence and associated factors of common mental disorder among Ilu Ababore zone residents, Southwest Ethiopia.

Method

A community based cross-sectional study was conducted from July 1 to August 30, 2018. A multi-stage sampling technique was applied to recruit participants. Self-Reporting Questionnaire (SRQ-20) was used to assess the presence of common mental disorder. The data were entered into Epidata version 3.1 and analyzed by using SPSS version 23 software. Bivariate and multivariate binary logistic regressions were computed to identify the associated factors. Statistical significance was considered at P value < 0.05.

Result

A total of 690 participants were enrolled in this study with a response rate of 91.39%. The prevalence of common mental disorder was 27.2% (95% CI, 23.9, 31.0%). Being female (AOR = 1.76, 95% CI = 1.15, 2.69), unable to read and write (AOR = 3.06, 95% CI = 1.37, 6.82), living in the rural area (AOR = 3.53, 95% CI = 2.01, 6.18), having a family member with mental illness (AOR = 2.68, 95% CI = 1.6, 4.5), having a chronic physical illness (AOR = 3.48, 95% CI = 2.26, 5.34) and lifetime alcohol use (AOR = 4.55, 95% CI = 2.93, 7.0) had a significant association with common mental disorder.

Conclusion

The current study showed that the proportion of the common mental disorder was high. Females showed a higher prevalence of the common mental disorder. Having a chronic physical illness, resides in the rural areas and history of lifetime alcohol use were also significantly associated with CMD. Psychological and social interventions with greater emphasis on females who have low educational status and residing in the rural area are recommended. Strategies that focus on the proper treatment of chronic physical illness can be also helpful to minimize the occurrence of common mental disorder.

'Effective' at What? On Effective Intervention in Serious Mental Illness

The term "effective," on its own, is honorific but vague. Interventions against serious mental illness may be "effective" at goals as diverse as reducing "apparent sadness" or providing housing. Underexamined use of "effective" and other success terms often obfuscates differences and incompatibilities in interventions, degrees of effectiveness, key omissions in effectiveness standards, and values involved in determining what counts as "effective." Yet vague use of such success terms is common in the research, clinical, and policy realms, with consequences that negatively affect the care offered to individuals experiencing serious mental illness. A pragmatist-oriented solution to these problems suggests that when people use success terms, they need to explain and defend the goals and supporting values embedded in the terms, asking and answering the questions, "Effective at what? For whom? How effective? And why that goal?" Practical and epistemic standards for effectiveness will likely remain plural for good reasons, but each standard should be well explained and well justified.

Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries

Background

The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it.

Methods

Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners.

Results

The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative ‘chain of care’. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence.

Conclusions

The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people’s needs throughout their lives is an essential aspect of optimal care provision.

Process and outcomes evaluation of a pre-academic arts program for individuals with mental health conditions: a mixed methods study protocol

INTRODUCTION

The Garage is a multidisciplinary pre-academic arts school for people with artistic abilities who are coping with mental health conditions (MHC). The programme, supported by the National Insurance Institute and the Ministry of Health in Israel, is an innovative rehabilitation service designed to impart and enhance artistic-professional skills and socioemotional abilities to ultimately facilitate participants' integration into higher education and the job market.

METHODS AND ANALYSIS

This mixed methods longitudinal study will include an embedded design in which the qualitative data are primary and the quantitative data are secondary, thus providing complementary information. The study will examine the contribution of the Garage to changes in participants' personal recovery, well-being, creative self-concept and community integration as well as possible mechanisms that may account for these changes. Qualitative data will be collected using focus groups with graduates and students (a total of ~60 participants). Quantitative data will be ‎collected by self-report questionnaires only from students attending the programme (before, during and at the end of the academic year). Data on the graduates' integration into higher education and the job market after completing the programme will also be collected from the management team. The qualitative data will be analysed following the grounded theory approach and the quantitative data will be analysed with correlations, paired tests to examine pre-post changes and regression analyses. A merged data analysis will be conducted for data integration.

ETHICS AND DISSEMINATION

The University's Human Research Ethics Committee approved the design and procedures of the study (approval #357-16). All participants will sign an informed consent form where it is clarified that participation in the study is on a voluntary basis, and anonymity and confidentiality are guaranteed. The results will be submitted for peer-reviewed journal publications, presented at conferences and disseminated to the funder and the programme's management team.

Comparing Educational Music Therapy Interventions via Stages of Recovery with Adults in an Acute Care Mental Health Setting: A Cluster-Randomized Pilot Effectiveness Study

The purpose of this cluster-randomized pilot effectiveness study was to compare two different group-based educational music therapy interventions with a control condition as measured by the stage model of recovery in adults on an acute care mental health unit. Participants (N = 69) were cluster-randomized to one of three single-session conditions: educational lyric analysis (ELA), educational songwriting (ESW), or control. ELA and ESW conditions targeted motivations for and factors contributing to recovery. Results indicated no significant between-group difference. However, ELA and ESW conditions tended to have slightly more favorable stage of recovery mean scores than the control condition. Generally, educational music therapy may be clinically relevant for impacting stage of recovery within the temporal parameters of a single session. As ELA and ESW conditions had similar results, the specific educational music therapy intervention did not affect results. Implications for clinical practice, limitations, and suggestions for future research are provided.

Association of participant preferences on work and school participation after a first episode of psychosis

AIM

To explore baseline ratings of importance (ROI) across life domains for participants in the Recovery After an Initial Schizophrenia Episode Connection Program (RAISE CP), and investigate whether ratings were correlated with intervention outcomes over time.

METHODS

At baseline, 63 participants rated the importance of reducing symptoms, side-effects, confusion, increasing energy and school/work functioning and improving social relations. ROIs were examined in relation to work/school participation (n = 41) and occupational functioning (n = 37) after 12 months. Participants' mean age was 22.3 (±4.2).

RESULTS

The ROI domain rated as most important was school/work functioning, and higher school/work ROI at baseline predicted work/school participation after 12 months of participation.

CONCLUSIONS

It is particularly important to assess participant preferences and priorities when treating psychotic disorders because most areas of life are affected. Understanding the impact of participant goals on outcomes is essential as programs design patient-centred treatment plans.

The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods

OBJECTIVES

This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3-5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support.

METHODS

The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3-5 months after discharge.

RESULTS

One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics.

CONCLUSION

The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.

Understanding Pathways to Care of Individuals Entering a Specialized Early Intervention Service for First-Episode Psychosis

OBJECTIVE

This study aimed to understand the pathways to care from the onset of a first episode of psychosis to entry into a specialized early intervention service (EIS) for individuals with nonaffective psychosis.

METHODS

A sample of 20 individuals who participated in an EIS and ten of their family members were enrolled. Semistructured qualitative interviews were used to characterize participants' lives during the onset of psychosis and explore their help-seeking events from the onset of psychosis to entry into the EIS. Data were analyzed by using grounded theory and a case study methodology.

RESULTS

The median duration between the onset of psychosis and EIS entry was 4.5 months. A grounded model emerged from the analysis that captured how help-seeking decisions were influenced by the misattribution of symptoms, stigma, and self-reliance. These factors created a cloud of uncertainty in which individuals experiencing early psychosis and their family members struggled to make sense of what was happening, how and when to seek help, and what to expect from treatment. Contacts with the health care system were critical junctures in the pathway to care that could reduce or increase uncertainty and expedite or delay EIS entry.

CONCLUSIONS

Findings indicate that efforts to expedite EIS entry should focus on reducing the uncertainty that affected individuals and their family members face when seeking care by improving their experiences with mental health services.

A Qualitative Study of the Subjective Appraisal of Recovery Among People with Lived Experience of Schizophrenia in Poland

The objective of this study was to explore definitions of recovery among Polish service users with lived experience of schizophrenia and to hear their recommendations regarding elements that should be considered in the planning of a recovery oriented psychosocial intervention. Four semi-structured focus groups were conducted in the Institute of Psychiatry and Neurology in Warsaw, Poland. A total of 28 service users' narratives were examined using the inductive thematic analysis approach. Five main recovery themes emerged from the combined users accounts, listed in order of frequency: psychological dimension of recovery, relationships with others, wellness strategies, clinical understanding of recovery and support systems. Service user recommendations referred to the above identified recovery themes as well as indications that the intervention should be flexible, individualized, and facilitative of personal growth. The findings indicate that for service users with lived experience of schizophrenia in Poland it is culturally feasible to embrace the person-oriented approach to practice and develop a recovery-oriented psychosocial intervention emphasizing psychological domains of recovery such as positive identity, personal strengths, or meaning and purpose in life alongside the other relevant recovery dimensions. Actions regarding the system level of change are also required.

Mental Health Service Provision in Low- and Middle-Income Countries

This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.

Case Formulation in Young People with Post-Traumatic Stress Disorder and First-Episode Psychosis

BACKGROUND

Evidence based treatment interventions for young people with first-episode psychosis (FEP) and trauma histories is lacking. Although case formulation (CF) has been widely regarded in cognitive behavioural therapy manuals as beneficial, there is limited empirical research examining how clients and therapists experience the process.

AIM

This study aimed to explore young people's reactions to CF in treatment for PTSD (post-traumatic stress disorder) and FEP.

METHOD

Semi-structured interviews were conducted with three participants (aged 19-20) with FEP and PTSD and their therapists, after they had completed a trauma-focused treatment program with a CF component. Transcripts were analysed using an interpretative phenomenological approach and themes were derived.

RESULTS

Two themes related to participants' experiences were identified from the analysis: (1) Developing Insight; (2) A challenging experience; and two themes from the therapists: (1) Doing the case formulation; (2) Value of case formulation. Participants and therapists reported benefits in making connections between current symptoms and past trauma. Participants viewed the process as challenging.

CONCLUSION

Results suggest a potential discrepancy between the experience of the case formulation process for clients and therapists.

Why do mental health consumers who receive rehabilitation services, are not using them? A Qualitative Investigation of Users' Perspectives in Israel

A recovery-oriented approach to mental health involves creating person centered services and enhancing engagement in psychiatric rehabilitation. Israel's Rehabilitation in the Community of Persons with Mental Disabilities Law is a progressive initiative that shifted the locus of psychiatric care to community care supporting individualized rehabilitation and recovery-oriented processes. Yet over a quarter of applicants do not implement their assigned rehabilitation plans and services. This qualitative study investigated reasons and experiences related to lack of utilization from applicants' perspectives. Fifteen service users were interviewed face to face in semi-structured interviews analyzed using Grounded theory approach. Seven categories emerged: (1) Lack of knowledge and orientation; (2) Negative perceptions about rehabilitation services (3) Lack of active participation/shared decision-making; (4) Not feeling heard by the committee; (5) Lack of congruence between participants' goals and committee's final decisions; (6) Lack of escorting professionals' competencies; and (7) Family members' influence. The results are interpreted at the structural and human process levels. Suggestions are provided for augmenting systemic procedures and human interactions processes.

A critical interpretive synthesis of the most commonly used self-report measures in Australian mental health research

OBJECTIVE

To critically examine the self-report measures most commonly used in Australian mental health research in the last 10 years.

METHOD

A critical interpretive synthesis was conducted using seven outcome measures that were identified as most popular in 43 studies from three mental health journals.

RESULTS

Results suggest that the amount and type of language used in outcome measures is important in both increasing the accuracy of the data collected and fostering positive experiences of data collection for participants.

CONCLUSIONS

Results indicate that many of the measures most often used in Australian mental health research may not align with the current contemporary philosophy of mental health clinical practice in Australia.

Getting by, getting back, and getting on: Matching mental health services to consumers' recovery goals

OBJECTIVE

The goal of this study was to better understand mental health recovery from the point of view of mental health consumers to identify opportunities for practice improvements that closely align services with consumer goals and consumer-preferred outcomes.

METHOD

As part of an exploratory study of recovery, semistructured interviews were conducted with 177 integrated health plan members diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or affective psychosis. Transcripts of in-depth interviews were coded using Atlas.ti, and definitions of recovery were further subcoded. A qualitative analysis using a modified grounded theory approach and constant comparative method identified common themes and less common but potentially important recovery-related experiences and perspectives.

RESULTS

Three primary and 2 cross-cutting themes emerged. "Getting by" meant coping and meeting basic needs. "Getting back" meant learning to live with mental illness. "Getting on" meant living a life where mental illness was no longer prominent. Regaining control and recouping losses were cross-cutting themes.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Mental health recovery is complex and dynamic; individuals' recovery goals can be expected to change over time. Person-centered care must accommodate changing consumer priorities, services must be flexible and responsive, and outcomes need to match consumers' objectives. Clinicians can assist in (a) identifying recovery goals, (b) monitoring progress toward and recognizing movement away from goals, (c) tailoring support to different phases/stages, and (d) supporting transitions between phases/stages. (PsycINFO Database Record

Factors Associated with Providers' Perceptions of Mental Health Care in Santa Luzia's Family Health Strategy, Brazil

Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS-psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high levels of patient-centered mental health care and those who did not. In multivariate regression models, components of transdisciplinary collaboration were significantly associated with providers' perceptions of patient-centered mental health care (p < 0.05). CHWs were also significantly more likely to report providing patient-centered care than physicians and nurses. EBP engagement and sociodemographics were not associated with perceptions. Results suggest that training efforts to improve patient-centered mental health care in Brazil could build upon CHWs' skills and focus on transdisciplinary collaboration. Findings may inform practice in other countries with similar health care systems.

Costs of implementing a behavioral weight-loss and lifestyle-change program for individuals with serious mental illnesses in community settings

Little research has examined costs of adopting a successful lifestyle intervention for people with serious mental illnesses in community clinics. The study aims to calculate the real-world costs of implementing a group-based weight-loss and lifestyle intervention in community settings. We used empirically derived costs to estimate implementation costs and conducted sensitivity analyses to estimate costs: (1) when implementing the intervention in high/low resource-intensive environments and (2) assuming variability in participant enrollment. To implement the STRIDE program for 15 individuals with serious mental illnesses, we estimated costs for the 12-month (30-session) intervention, with materials available in the public domain, at $16,427 or $1095 per participant. The majority of costs, $12,767, were associated with direct labor costs. Replication costs are largely associated with labor. Community health centers offer an untapped resource for implementing behavioral-lifestyle interventions, particularly under the Affordable Care Act, though additional payment reforms or incentives may be needed.

What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders

OBJECTIVE

To investigate patients' preferences for outcomes associated with psychoactive medications.

SETTING/DESIGN

Systematic review of stated preference studies. No settings restrictions were applied.

PARTICIPANTS/ELIGIBILITY CRITERIA

We included studies containing quantitative data regarding the relative value adults with mental disorders place on treatment outcomes. Studies with high risk of bias were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

We restricted the scope of our review to preferences for outcomes, including the consequences from, attributes of, and health states associated with particular medications or medication classes, and process outcomes.

RESULTS

After reviewing 11 215 citations, 16 studies were included in the systematic review. These studies reported the stated preferences from patients with schizophrenia (n=9), depression (n=4), bipolar disorder (n=2) and attention deficit hyperactive disorder (n=1). The median sample size was 81. Side effects and symptom outcomes outnumbered functioning and process outcomes. Severe disease and hospitalisation were reported to be least desirable. Patients with schizophrenia tended to value disease states as higher and side effects as lower, compared to other stakeholder groups. In depression, the ability to cope with activities was found to be more important than a depressed mood, per se. Patient preferences could not consistently be predicted from demographic or disease variables. Only a limited number of potentially important outcomes had been investigated. Benefits to patients were not part of the purpose in 9 of the 16 studies, and in 10 studies patients were not involved when the outcomes to present were selected.

CONCLUSIONS

Insufficient evidence exists on the relative value patients with mental disorders place on medication-associated outcomes. To increase patient-centredness in decisions involving psychoactive drugs, further research-with outcomes elicited from patients, and for a larger number of conditions-should be undertaken.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42013005685.