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. 2009 Jan 21;2009(1):CD005963. doi: 10.1002/14651858.CD005963.pub2

Comparison 1. ADVANCE DIRECTIVES versus USUAL CARE.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Death 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.1 suicide 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 0.49 [0.05, 5.26]
1.2 cancer 1 161 Risk Ratio (M‐H, Fixed, 95% CI) 3.04 [0.13, 73.46]
1.3 cardiac 1 160 Risk Ratio (M‐H, Fixed, 95% CI) 3.0 [0.12, 72.56]
2 Overall psychiatric admissions 1 160 Risk Ratio (M‐H, Fixed, 95% CI) 0.69 [0.45, 1.04]
3 Involuntary psychiatric admissions within 15 months 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
3.1 Number of patients re‐admitted involuntarily 2 316 Risk Ratio (M‐H, Fixed, 95% CI) 0.67 [0.42, 1.06]
3.2 Number of patients with 1‐100 days subsequent involuntary admission 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 0.70 [0.33, 1.47]
3.3 Number of patients with > 100 days subsequent involuntary admission 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 2.44 [0.49, 12.18]
4 Voluntary psychiatric admissions within 15 months 2   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
4.1 Number of patients re‐admitted voluntarily 2 316 Risk Ratio (M‐H, Fixed, 95% CI) 1.03 [0.63, 1.68]
4.2 Number of patients with 1‐100 days subsequent voluntary admission 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 0.89 [0.53, 1.49]
4.3 Number of patients with >100 days subsequent voluntary admission 1 156 Risk Ratio (M‐H, Fixed, 95% CI) 1.14 [0.40, 3.23]
5 Involuntary bed days 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
5.1 Involuntary bed days among those on section at any point during admission 1 31 Mean Difference (IV, Fixed, 95% CI) ‐3.08 [‐66.77, 60.61]
5.2 Involuntary bed days among entire sample 1 160 Mean Difference (IV, Fixed, 95% CI) ‐16.52 [‐34.68, 1.64]
6 Outpatient contacts 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
6.1 Psychiatric outpatient attendances 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.10 [‐0.72, 0.52]
6.2 Community psychiatric nursing contacts 1 160 Mean Difference (IV, Fixed, 95% CI) 15.0 [‐75.49, 105.49]
6.3 Psychiatric day service contacts 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.5 [‐3.79, 2.79]
6.4 Other community day centre contacts 1 160 Mean Difference (IV, Fixed, 95% CI) ‐8.0 [‐17.97, 1.97]
6.5 Mental health act assessments 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.20 [‐0.32, ‐0.08]
7 Compliance with mental health treatment 1 121 Mean Difference (IV, Fixed, 95% CI) ‐0.10 [‐0.62, 0.42]
8 Self harm 1 160 Risk Ratio (M‐H, Fixed, 95% CI) 0.14 [0.02, 1.13]
9 Violence 1 160 Risk Ratio (M‐H, Fixed, 95% CI) 0.27 [0.08, 0.94]
10 Criminal justice contacts 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
10.1 Arrests 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.1 [‐0.32, 0.12]
10.2 Contacts with lawyer 1 160 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐0.45, 0.45]
10.3 Contacts with police officer 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.20 [‐0.62, 0.22]
10.4 Nights in police cell 1 160 Mean Difference (IV, Fixed, 95% CI) 0.0 [‐0.11, 0.11]
10.5 Nights in prison 1 160 Mean Difference (IV, Fixed, 95% CI) ‐6.6 [‐16.68, 3.48]
11 Social services 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
11.1 Social work hours 1 160 Mean Difference (IV, Fixed, 95% CI) ‐106.0 [‐156.24, ‐55.76]
11.2 Specialised accommodation weeks 1 160 Mean Difference (IV, Fixed, 95% CI) 0.10 [‐0.02, 0.22]
12 Other health services 1   Mean Difference (IV, Fixed, 95% CI) Subtotals only
12.1 Non‐psychiatric inpatient days 1 160 Mean Difference (IV, Fixed, 95% CI) 15.5 [9.79, 21.21]
12.2 Non‐psychiatric outpatient attendances 1 160 Mean Difference (IV, Fixed, 95% CI) ‐15.0 [‐37.06, 7.06]
12.3 Accident and emergency contacts (non‐psychiatric) 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.1 [‐0.32, 0.12]
12.4 Accident and emergency contacts (psychiatric) 1 160 Mean Difference (IV, Fixed, 95% CI) ‐0.1 [‐0.24, 0.04]
12.5 General practitioner contacts 1 160 Mean Difference (IV, Fixed, 95% CI) 0.60 [‐0.38, 1.58]
12.6 Number of different medications prescribed 1 160 Mean Difference (IV, Fixed, 95% CI) 0.20 [‐0.30, 0.70]
13 Leaving the study early 2 316 Risk Ratio (M‐H, Fixed, 95% CI) 1.06 [0.81, 1.38]