{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Utrecht University, Utrecht, The Netherlands",
        "Trimbos Institute, Utrecht, The Netherlands"
      ],
      "name": "Laura Shields-Zeeman"
    },
    {
      "affiliations": [
        "Trimbos Institute, Utrecht, The Netherlands",
        "Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands"
      ],
      "name": "Filip Smit"
    },
    {
      "affiliations": [
        "Trimbos Institute, Utrecht, The Netherlands"
      ],
      "name": "Ben Wijnen"
    },
    {
      "affiliations": [
        "Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany"
      ],
      "name": "Catharina Roth"
    },
    {
      "affiliations": [
        "Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany"
      ],
      "name": "Michel Wensing"
    },
    {
      "affiliations": [
        "INSIGHT International, London, UK"
      ],
      "name": "Ionela Petrea"
    },
    {
      "affiliations": [
        "Utrecht University, Utrecht, The Netherlands",
        "Trimbos Institute, Utrecht, The Netherlands",
        "Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands",
        "Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany",
        "INSIGHT International, London, UK",
        "University Clinic of Psychiatry, Skopje, North Macedonia",
        "Special Psychiatric Hospital Dobrota, Kotor, Montenegro",
        "GGZ Noord-Holland-Noord FIT-Academy, Heerhugowaard, The Netherlands",
        "University of Zagreb School of Medicine, Zagreb, Croatia",
        "National Center of Public Health and Analyses, Sofia, Bulgaria",
        "Romanian League for Mental Health, Bucharest, Romania",
        "Institute of Public Health of Montenegro, Podgorica, Montenegro",
        "Fundación Mundo Bipolar, Madrid, Spain",
        "Siret Psychiatric Hospital, Siret, Romania"
      ],
      "name": "on behalf of the RECOVER-E consortium"
    },
    {
      "affiliations": [
        "Trimbos Institute, Utrecht, The Netherlands"
      ],
      "name": "Felix Bolinski"
    },
    {
      "affiliations": [
        "University Clinic of Psychiatry, Skopje, North Macedonia"
      ],
      "name": "Stojan Bajraktarov"
    },
    {
      "affiliations": [
        "Special Psychiatric Hospital Dobrota, Kotor, Montenegro"
      ],
      "name": "Jovo Dedovic"
    },
    {
      "affiliations": [
        "GGZ Noord-Holland-Noord FIT-Academy, Heerhugowaard, The Netherlands"
      ],
      "name": "René Keet"
    },
    {
      "affiliations": [
        "University of Zagreb School of Medicine, Zagreb, Croatia"
      ],
      "name": "Martina Rojnic Kuzman"
    },
    {
      "affiliations": [
        "National Center of Public Health and Analyses, Sofia, Bulgaria"
      ],
      "name": "Vladimir Nakov"
    },
    {
      "affiliations": [
        "Romanian League for Mental Health, Bucharest, Romania"
      ],
      "name": "Raluca Nica"
    },
    {
      "affiliations": [
        "University Clinic of Psychiatry, Skopje, North Macedonia"
      ],
      "name": "Antoni Novotni"
    },
    {
      "affiliations": [
        "Special Psychiatric Hospital Dobrota, Kotor, Montenegro"
      ],
      "name": "Aleksandar Tomcuk"
    },
    {
      "affiliations": [
        "Institute of Public Health of Montenegro, Podgorica, Montenegro"
      ],
      "name": "Tatjana Djurisic"
    },
    {
      "affiliations": [
        "Fundación Mundo Bipolar, Madrid, Spain"
      ],
      "name": "Guadalupe Morales"
    },
    {
      "affiliations": [
        "Siret Psychiatric Hospital, Siret, Romania"
      ],
      "name": "Tiberiu Rotaru Anghelescu"
    }
  ],
  "title": "Community versus institutionalised care for people with severe mental illness in five countries in Southeast Europe: pooled analysis of five randomised trials",
  "uid": "927f85c0-d852-5ac6-b3a6-dd5a4bbd8f48"
}