Community versus institutionalised care for people with severe mental illness in five countries in Southeast Europe: pooled analysis of five randomised trials
Background The RECOVER-E project implemented community-based mental healthcare (CMH) oriented at functional recovery in people with schizophrenia, bipolar and severe major depressive disorder in five countries: Bulgaria, Croatia, Montenegro, North Macedonia and Romania, with the aim to shift care fr...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
23 October 2025
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| In: |
BMJ global health
Year: 2025, Jahrgang: 10, Heft: 10, Pages: 1-9 |
| ISSN: | 2059-7908 |
| DOI: | 10.1136/bmjgh-2024-018594 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1136/bmjgh-2024-018594 Verlag, kostenfrei, Volltext: https://gh.bmj.com/content/10/10/e018594 
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| Verfasserangaben: | Laura Shields-Zeeman, Filip Smit, Ben Wijnen, Catharina Roth, Michel Wensing, Ionela Petrea, on behalf of the RECOVER-E consortium, Felix Bolinski, Stojan Bajraktarov, Jovo Dedovic, René Keet, Martina Rojnic Kuzman, Vladimir Nakov, Raluca Nica, Antoni Novotni, Aleksandar Tomcuk, Tatjana Djurisic, Guadalupe Morales, Tiberiu Rotaru Anghelescu |
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| 245 | 1 | 0 | |a Community versus institutionalised care for people with severe mental illness in five countries in Southeast Europe |b pooled analysis of five randomised trials |c Laura Shields-Zeeman, Filip Smit, Ben Wijnen, Catharina Roth, Michel Wensing, Ionela Petrea, on behalf of the RECOVER-E consortium, Felix Bolinski, Stojan Bajraktarov, Jovo Dedovic, René Keet, Martina Rojnic Kuzman, Vladimir Nakov, Raluca Nica, Antoni Novotni, Aleksandar Tomcuk, Tatjana Djurisic, Guadalupe Morales, Tiberiu Rotaru Anghelescu |
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| 520 | |a Background The RECOVER-E project implemented community-based mental healthcare (CMH) oriented at functional recovery in people with schizophrenia, bipolar and severe major depressive disorder in five countries: Bulgaria, Croatia, Montenegro, North Macedonia and Romania, with the aim to shift care from institutions to communities.Objective To evaluate the effectiveness of CMH under real-world circumstances across various healthcare ecologies and contexts.Methods A randomised comparison of CMH versus treatment as usual (TAU) based on pooled data from all five RECOVER-E trials (N=931). Outcomes were personal and social role functioning (WHO Disability Assessment Schedule, WHODAS 2.0) and health-related quality of life (EuroQoL-5 Dimensions-3 Levels) at baseline, 12 and 18 months postbaseline. Intention-to-treat analysis was conducted with mixed modelling and a sensitivity analysis adjusted for the impact of COVID-19 on healthcare delivery and outcomes.Findings At 18-month follow-up, CMH had a 4.55 lower WHODAS disability score than TAU, which was significant (b=−4.55, SE=1.21, z=−3.75, p<0.001), and improved quality of life by 0.07 utility (b=0.07, SE=0.014, z=4.56, p<0.001) equivalent to an additional 25 days in full health. Similar effects were observed in each of the five countries and for all WHODAS subdomains (cognition, mobility, self-care, getting along with people, life activities, participation). Sensitivity analyses adjusting for the confounding effect of COVID-19 showed similar effects.Clinical implications Recovery-oriented CMH for people with severe mental illness was effective in improving functioning and quality of life for people with schizophrenia, bipolar disorder and severe depression in five South-Eastern European countries and could be implemented across different health systems.Trial registration numbers Bulgaria: NCT03922425, Croatia: NCT03862209, Macedonia: NCT03892473, Montenegro: NCT03837340, Romania: NCT03884933. | ||
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