Cochrane · systematic review · CD007906
Intensive case management for severe mental illness
Dieterich, M, Irving, CB, Bergman, H, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
13
current version
GRADE rated
9
No studies
4
Included studies
NR
No studies 4 · 30.8%Ungraded 0 · 0%Very low 2 · 15.4%Low 5 · 38.5%Moderate 2 · 15.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyIntensive Case Management versus standard care for severe mental illness
Population: people with severe mental illness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Service use: 1. Average number of days in hospital per month ‐ by about 24 months Intensive Case Management vs standard care | no estimate extracted | 24 studies · 3595 participants | Low Downgraded: risk of bias, inconsistency |
Adverse event: 1b. Death ‐ suicide ‐ by long term Intensive Case Management vs standard care | RR 0.68 [0.31, 1.51] | 9 studies · 1456 participants | Low Downgraded: risk of bias, imprecision |
Global state: 1. Relapse ‐ by long term Intensive Case Management vs standard care | no estimate extracted | NR | No studies |
Global state: 1. Leaving the study early ‐ by long term Intensive Case Management vs standard care | RR 0.68 [0.58, 0.79] | 13 studies · 1798 participants | Low Downgraded: risk of bias |
Social functioning: 2. Employment status (various measurements) ‐ by long term ‐ not employed at the end of the trial Intensive Case Management vs standard care | RR 0.7 [0.49, 1] | 4 studies · 1129 participants | Very low Downgraded: risk of bias, inconsistency |
Mental state: not improved to an important extent ‐ by long term Intensive Case Management vs standard care | no estimate extracted | NR | No studies |
Intensive Case Management versus non‐Intensive Case Management for severe mental illness
Population: people with severe mental illness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Service use: 1. Average number of days in hospital per month ‐ by about 24 months Intensive Case Management vs non‐Intensive Case Management | no estimate extracted | 21 studies · 2220 participants | Moderate Downgraded: risk of bias |
Service use: 3b. Average number of admissions (skewed data ‐ sample size ≧ 200) ‐ by long term Intensive Case Management vs non‐Intensive Case Management | no estimate extracted | 1 study · 678 participants | Moderate Downgraded: risk of bias |
Adverse event: 1b. Death ‐ suicide ‐ by long term Intensive Case Management vs non‐Intensive Case Management | RR 0.88 [0.27, 2.84] | 3 studies · 1152 participants | Low Downgraded: risk of bias, imprecision |
Global state: 1. Relapse ‐ by long term Intensive Case Management vs non‐Intensive Case Management | no estimate extracted | NR | No studies |
Global state: 1. Leaving the study early ‐ by long term Intensive Case Management vs non‐Intensive Case Management | RR 0.7 [0.52, 0.95] | 7 studies · 1970 participants | Low Downgraded: risk of bias |
Social functioning 2. Employment status ‐ by medium term ‐ spent > 1 day employed Intensive Case Management vs non‐Intensive Case Management | RR 1.46 [0.45, 4.74] | 1 study · 73 participants | Very low Downgraded: risk of bias, imprecision |
Mental state: not improved to an important extent ‐ by long term Intensive Case Management vs non‐Intensive Case Management | no estimate extracted | NR | No studies |
INTENSIVE CASE MANAGEMENT compared with STANDARD CARE for severe mental illness
Population: patients with severe mental illness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Service use: Average number of days in hospital per month ‐ by about 24 months (any sample size) INTENSIVE CASE MANAGEMENT vs STANDARD CARE | no estimate extracted | 24 studies · 3595 participants | Low Downgraded: risk of bias |
Service use: Average number of admissions INTENSIVE CASE MANAGEMENT vs STANDARD CARE | RR 0 [0, 0] | 0 studies · 3 participants | Ungraded |
Global state: Relapse INTENSIVE CASE MANAGEMENT vs STANDARD CARE | no estimate extracted | 0 studies · 4 participants | Ungraded |
Global state: Leaving the study early ‐ by long term INTENSIVE CASE MANAGEMENT vs STANDARD CARE | RR 0.71 [0.59, 0.85] | 21 studies · 2766 participants | Low Downgraded: risk of bias |
Mental state: Not improved to an important extent INTENSIVE CASE MANAGEMENT vs STANDARD CARE | no estimate extracted | 0 studies · 4 participants | Ungraded |
Adverse event: Death ‐ suicide ‐ by long term INTENSIVE CASE MANAGEMENT vs STANDARD CARE | RR 0.71 [0.34, 1.51] | 12 studies · 1723 participants | Moderate |
Social functioning: Unemployed at the end of the trial ‐ by long term INTENSIVE CASE MANAGEMENT vs STANDARD CARE | RR 0.7 [0.49, 1] | 4 studies · 1129 participants | Very low Downgraded: risk of bias |
INTENSIVE CASE MANAGEMENT compared to NON‐INTENSIVE CASE MANAGEMENT for severe mental illness
Population: patients with severe mental illness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Service use: Average number of days in hospital per month ‐ by about 24 months (any sample size) INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | no estimate extracted | 21 studies · 2220 participants | Moderate Downgraded: risk of bias |
Service use: Average number of admissions (skewed data ‐ sample size ⧠200) ‐ by long term INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | no estimate extracted | 1 study · 678 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Global state: Relapse INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | no estimate extracted | 0 studies · 0 participants | Ungraded |
Global state: Leaving the study early ‐ by long term INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | RR 0.72 [0.52, 0.99] | 9 studies · 2195 participants | Low Downgraded: risk of bias |
Mental state: Not improved to an important extent INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse event: Death ‐ suicide ‐ by long term INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | RR 0.88 [0.27, 2.84] | 4 studies · 1180 participants | Low |
Social functioning: Employment status ‐ spent less than 1 day employed ‐ by medium term INTENSIVE CASE MANAGEMENT vs NON‐INTENSIVE CASE MANAGEMENT | RR 1.46 [0.45, 4.74] | 1 study · 73 participants | Low Downgraded: risk of bias, imprecision, inconsistency |