Francis Vergunst1,2, Jorun Rugkåsa3,4, Constantinos Koshiaris5, Judit Simon6,7, Tom Burns8. 1. Research Unit On Children's Psychosocial Maladjustment, University of Montreal, 3175 Chemin de la Côte Ste-Catherine, Montreal, H3T 1C5, Canada. francis.vergunst@umontreal.ca. 2. Department of Psychiatry, University of Oxford, Oxford, UK. francis.vergunst@umontreal.ca. 3. Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. 4. Centre for Care Research, University College of Southeast Norway, Notodden, Norway. 5. Nuffield Department of Primary Healthcare Sciences, University of Oxford, Oxford, UK. 6. Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria. 7. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 8. Department of Psychiatry, University of Oxford, Oxford, UK.
Abstract
PURPOSE: Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients' social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients' long-term social outcomes. METHODS: A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health. RESULTS: No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = -0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives. CONCLUSIONS:CTO duration was not associated with improvements in patients' social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.
RCT Entities:
PURPOSE: Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients' social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients' long-term social outcomes. METHODS: A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health. RESULTS: No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = -0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives. CONCLUSIONS:CTO duration was not associated with improvements in patients' social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.
Entities:
Keywords:
Capabilities, OxCAP-MH; Health-related quality of life; Longitudinal; Objective social outcomes; Social networks