Michael P Hengartner1, Silvia Passalacqua2, Gisela Heim3, Andreas Andreae3, Wulf Rössler4,5, Agnes von Wyl2. 1. Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland. michaelpascal.hengartner@zhaw.ch. 2. Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland. 3. Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (Ipw), Winterthur, Switzerland. 4. Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland. 5. Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paolo, Sao Paulo, Brazil.
Abstract
PURPOSE: The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. METHODS:RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18-64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). RESULTS: Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. CONCLUSIONS: According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks. FUNDING: This study was supported by a private foundation. TRIAL REGISTRATION: ISRCTN58280620.
RCT Entities:
PURPOSE: The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. METHODS: RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18-64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). RESULTS:Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. CONCLUSIONS: According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks. FUNDING: This study was supported by a private foundation. TRIAL REGISTRATION: ISRCTN58280620.
Entities:
Keywords:
Case management; Discharge intervention; Randomized controlled trial; Recovery; Social support
Authors: Rita Z Goldstein; A D Bud Craig; Antoine Bechara; Hugh Garavan; Anna Rose Childress; Martin P Paulus; Nora D Volkow Journal: Trends Cogn Sci Date: 2009-08-27 Impact factor: 20.229