Journal Article

Factors influencing patients’ recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial

Heim, Gisela, Passalacqua, Silvia, Hengartner, Michael P., Rössler, Wulf, Andreae, Andreas, von Wyl, Agnes

2016

Overview

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.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adolescent / Adult / Aftercare - statistics & numerical data / Analysis / Case management / Clinical trials / Epidemiology / Female / Health services / Hospitals, Psychiatric - statistics & numerical data / Humans / Intervention / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Mental Disorders - rehabilitation / Mental health care / Middle Aged / Original Paper / Patient Discharge - statistics & numerical data / Patient Outcome Assessment / Patients / Psychiatric hospital care / Psychiatric hospitals / Psychiatric research / Psychiatry / Psychological aspects / Psychopathology / Social networks / Social support / Social workers / Switzerland / Young Adult