1
|
Perry JM, Deutsch-Link S, Marfeo E, Serper M, Ladin K. Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study. Liver Transpl 2024; 30:356-366. [PMID: 37938131 DOI: 10.1097/lvt.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.
Collapse
Affiliation(s)
- Jennifer M Perry
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Marfeo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| |
Collapse
|
2
|
Semenova N. Psychosocial treatments for schizophrenia: insights from Russian theoretical psychology. Gen Psychiatr 2020; 33:e100234. [PMID: 32914054 PMCID: PMC7445329 DOI: 10.1136/gpsych-2020-100234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Natalia Semenova
- Laboratory of Psychological Counseling and Psychotherapy, Moscow Research Institute of Psychiatry, Moscow, Russian Federation.,Psychosocial Faculty, Pirogov Russian National Research Medical University Medical Faculty, Moscow, Russian Federation
| |
Collapse
|
3
|
Millner UC, Brandt D, Chan L, Jette A, Marfeo E, Ni P, Rasch E, Rogers ES. Exploring Counselor‐Client Agreement on Clients’ Work Capacity in Established and Consultative Dyads. JOURNAL OF EMPLOYMENT COUNSELING 2020. [DOI: 10.1002/joec.12148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Diane Brandt
- Rehabilitation Medicine Department National Institutes of Health (NIH)
| | - Leighton Chan
- Rehabilitation Medicine Department National Institutes of Health (NIH)
| | - Alan Jette
- School of Public Health Boston University
| | | | | | - Elizabeth Rasch
- Rehabilitation Medicine Department National Institutes of Health (NIH)
| | | |
Collapse
|
4
|
Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668. [PMID: 32880104 PMCID: PMC8094166 DOI: 10.1002/14651858.cd007668.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.
Collapse
Affiliation(s)
- Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| |
Collapse
|
5
|
Jordan G, Malla A, Iyer SN. Service provider perceptions of posttraumatic growth experienced by service users receiving treatment for a first episode of psychosis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1776458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gerald Jordan
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Yale Program for Recovery and Community Health, Yale University, New Haven, CT, USA
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| |
Collapse
|
6
|
Kashiwagi H, Yamada Y, Umegaki Y, Takeda K, Hirabayashi N. The Perspective of Forensic Inpatients With Psychotic Disorders on Protective Factors Against Risk of Violent Behavior. Front Psychiatry 2020; 11:575529. [PMID: 33240128 PMCID: PMC7678485 DOI: 10.3389/fpsyt.2020.575529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior. Aims: To understand the perspectives of forensic inpatients with psychotic disorders on protective factors against risk of violent behavior and compare them to factors identified by professional staff. Method: Using the Structured Assessment of Protective Factors (SAPROF) checklist for self-appraisal of violence risk, we conducted semi-structured interviews with 32 inpatients of the Medical Treatment and Supervision Act Ward and compared the results with those of professionals. Results: Inpatients scored higher in the SAPROF total score, the motivational factors of "life goals" and "motivation for treatment," and the protective level in general. Inpatients scored themselves lower in risk level than professionals. The degree of agreement between service users' and professionals' evaluations was low for all categories except external factors. Inpatients prioritized "life goals," "self-control," and "medication" as the top three key strengths currently preventing violent behavior, whereas the professionals selected "life goals" less often. The top three important future goals for preventing future violence selected by inpatients were "work," "intimate relationships," and "life goals," with the former two being selected significantly less often by the professionals. Conclusions: This is the first study to shed light on Japanese forensic inpatients' perspectives about preventing future violent behavior. Despite professionals' underestimation, inpatients viewed themselves as having high motivation for treatment and positive life goals. Inpatients prioritized personal values such as life goals, work, and intimate relationships, whereas professionals prioritized understanding, treating, and observing the disease. Our findings are consistent with past reports on patients' and clinicians' perspectives. Awareness of such gaps in perceptions can help build fruitful therapeutic alliances. We discuss the implications in terms of treatment, how to address the gap therapeutically, and how to design treatment accordingly. Directions for future research are also discussed.
Collapse
Affiliation(s)
- Hiroko Kashiwagi
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Yuji Yamada
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Yayoi Umegaki
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Koji Takeda
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Naotsugu Hirabayashi
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Palma C, Farriols N, Frías A, Cañete J, Gomis O, Fernández M, Alonso I, Signo S. Randomized controlled trial of cognitive-motivational therapy program (PIPE) for the initial phase of schizophrenia: Maintenance of efficacy at 5-year follow up ✰. Psychiatry Res 2019; 273:586-594. [PMID: 30716598 DOI: 10.1016/j.psychres.2019.01.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
AIM The main goal of this study was to evaluate the effectiveness of a cognitive motivational treatment program. METHOD A randomized, controlled, single-blind clinical trial was carried out. A total of 104 patients were recruited to take part in the trial, of whom ultimately 62 patients were allocated into two groups and finished the study. An initial assessment was carried out before patients were randomly placed in one of two groups for the clinical trial: (a) PIPE program plus routine care; and (b) routine care only. Clinical assessments were performed at baseline at 6 months, 1 year and follow-ups, at 18 months and 5 years). RESULTS MANCOVA analysis of tests repeated 18 months after the start of the intervention detected significant differences between the two groups in terms of clinical variables, everyday functioning and relapses. These differences remained upon follow-up measurements taken five years after the start of the trial. CONCLUSIONS The present study offers scientific evidence for cognitive-motivational therapy's effectiveness as a treatment for clinical symptoms in the early stages of psychosis. PIPE intervention may contribute to long-term clinical improvement and stability.
Collapse
Affiliation(s)
- C Palma
- Department of Psychology, FPCEE Blanquerna, Ramon Llull University, Císter, 34 (08022), Barcelona Spain; Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain.
| | - N Farriols
- Department of Psychology, FPCEE Blanquerna, Ramon Llull University, Císter, 34 (08022), Barcelona Spain; Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| | - A Frías
- Department of Psychology, FPCEE Blanquerna, Ramon Llull University, Císter, 34 (08022), Barcelona Spain; Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| | - J Cañete
- Department of Psychology, FPCEE Blanquerna, Ramon Llull University, Císter, 34 (08022), Barcelona Spain; Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| | - O Gomis
- Department of Psychology, FPCEE Blanquerna, Ramon Llull University, Císter, 34 (08022), Barcelona Spain
| | - M Fernández
- Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| | - I Alonso
- Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| | - S Signo
- Department of Mental health, Hospital de Mataró, Carretera de Cirera s/n (08304), Barcelona Spain
| |
Collapse
|
8
|
Hauenstein EJ, Clark RS, Merwin EI. Modeling Health Disparities and Outcomes in Disenfranchised Populations. Community Ment Health J 2019; 55:9-23. [PMID: 30136013 PMCID: PMC8751484 DOI: 10.1007/s10597-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.
Collapse
Affiliation(s)
| | - Rachael S Clark
- University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Elizabeth I Merwin
- School of Nursing, Duke University, 3027A Pearson Building, Durham, NC, 27710, USA
| |
Collapse
|
9
|
Jochems EC, Duivenvoorden HJ, van Dam A, Mulder CL, van der Feltz-Cornelis CM. Testing the Integral Model of treatment motivation in outpatients with severe mental illness. MOTIVATION AND EMOTION 2018; 42:816-830. [PMID: 30416227 PMCID: PMC6208637 DOI: 10.1007/s11031-018-9708-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current study tested the Integral Model of treatment motivation (IM) in a sample of 294 outpatients with severe mental illness, using structural equation modelling. The obtained structural model was not consistent with original theory, nor was the model invariant across time and patient groups (psychotic disorders and personality disorders). The patient’s perceived suitability of treatment, perceived costs of treatment and outcome expectancy were most strongly associated with motivation and treatment engagement. The model explained between 22 and 86% of variance in clinical outcomes, depending on the timing of the assessment. Currently, the IM does not constitute a robust framework for patterns through which patients become motivated to engage in treatment, but does explain substantial amounts of variance in clinical outcomes. The future potential of IM as a basis for interventions in the mental health care is discussed, including suggestions for subsequent research and potential alterations of the IM to improve its utility for application in clinical practice.
Collapse
Affiliation(s)
- E C Jochems
- Department of Psychiatry, Erasmus MC University Medical Center, Epidemiological and Social Psychiatric Research Institute, Rotterdam, The Netherlands.,2GGz Breburg, Lage Witsiebaan 4, 5042 DA Tilburg, The Netherlands
| | | | - A van Dam
- 4Tranzo Department, Faculty of Social Sciences, Tilburg University, Tilburg, The Netherlands.,5GGZ West North Brabant, Bergen op Zoom, The Netherlands
| | - C L Mulder
- Department of Psychiatry, Erasmus MC University Medical Center, Epidemiological and Social Psychiatric Research Institute, Rotterdam, The Netherlands.,Department of Parnassia Psychiatric Institute, BavoEuropoort, Rotterdam, The Netherlands
| | - C M van der Feltz-Cornelis
- 4Tranzo Department, Faculty of Social Sciences, Tilburg University, Tilburg, The Netherlands.,7Mental Health and Addiction Research Group, University of York, York, UK
| |
Collapse
|
10
|
Kusec A, Velikonja D, DeMatteo C, Harris JE. Motivation in rehabilitation and acquired brain injury: can theory help us understand it? Disabil Rehabil 2018; 41:2343-2349. [PMID: 29693464 DOI: 10.1080/09638288.2018.1467504] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: In acquired brain injury (ABI) populations, low motivation to engage in rehabilitation is associated with poor rehabilitation outcomes. Motivation in ABI is thought to be influenced by internal and external factors. This is consistent with Self-determination Theory, which posits that motivation is intrinsic and extrinsic. This paper discusses the benefit of using Self-determination Theory to guide measurement of motivation in ABI. Methods: Using a narrative review of the Self-determination Theory literature and clinical rehabilitation research, this paper discusses the unique role intrinsic and extrinsic motivation has in healthcare settings and the importance of understanding both when providing rehabilitation in ABI. Results: Based on the extant literature, it is possible that two independently developed measures of motivation for ABI populations, the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self and the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, may assess intrinsic and extrinsic motivation, respectively. Conclusion: Intrinsic and extrinsic motivation in ABI may be two equally important but independent factors that could provide a comprehensive understanding of motivation in individuals with ABI. This increased understanding could help facilitate behavioural approaches in rehabilitation. Implications for Rehabilitation Conceptualization of motivation in ABI would benefit from drawing upon Self-determination Theory. External factors of motivation such as the therapeutic environment or social support should be carefully considered in rehabilitation in order to increase engagement. Assessing motivation as a dual rather than a global construct may provide more precise information about the extent to which a patient is motivated.
Collapse
Affiliation(s)
- Andrea Kusec
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| | - Diana Velikonja
- b Hamilton Health Sciences , Acquired Brain Injury Program , Hamilton , Canada.,c Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine , McMaster University , Hamilton , Canada
| | - Carol DeMatteo
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| | - Jocelyn E Harris
- a School of Rehabilitation Science, Institute for Applied Health Sciences , McMaster University , Hamilton , Canada
| |
Collapse
|
11
|
Jochems EC, van der Feltz-Cornelis CM, van Dam A, Duivenvoorden HJ, Mulder CL. The effects of motivation feedback in patients with severe mental illness: a cluster randomized controlled trial. Neuropsychiatr Dis Treat 2015; 11:3049-64. [PMID: 26715847 PMCID: PMC4686323 DOI: 10.2147/ndt.s95190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of providing clinicians with regular feedback on the patient's motivation for treatment in increasing treatment engagement in patients with severe mental illness. DESIGN cluster randomized controlled trial (Dutch Trials Registry NTR2968). PARTICIPANTS adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters) of two mental health institutions in the Netherlands. INTERVENTIONS monthly motivation feedback (MF) generated by clinicians additional to treatment as usual (TAU) and TAU by the community mental health teams. PRIMARY OUTCOME treatment engagement at patient level, assessed at 12 months by clinicians. RANDOMIZATION teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment. RESULTS The 294 randomized patients (148 MF, 146 TAU) and 57 clinicians (29 MF, 28 TAU) of 12 teams (6 MF, 6 TAU) were analyzed according to the intention-to-treat principle. No statistically significant differences between treatment groups on treatment engagement were found (adjusted mean difference =0.1, 95% confidence interval =-2.2 to 2.3, P=0.96, d=0). Preplanned ancillary analyses showed statistically significant interaction effects between treatment group and primary diagnosis on treatment motivation and quality of life (secondary outcomes), which were beneficial for patients with a primary diagnosis of a personality disorder but not for those with a psychotic disorder. There were no reports of adverse events. CONCLUSION The current findings imply that monitoring and discussing the patient's motivation is insufficient to improve motivation and treatment engagement, and suggests that more elaborate interventions for severe mental illness patients are needed.
Collapse
Affiliation(s)
- Eline C Jochems
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands
| | - Christina M van der Feltz-Cornelis
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands ; Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands
| | - Arno van Dam
- Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands ; GGZ Westelijk Noord Brabant, Bergen op Zoom, the Netherlands
| | | | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands ; BavoEuropoort, Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| |
Collapse
|