A 6-Month Randomized Controlled Pilot Study on the Effects of the Clubhouse Model of Psychosocial Rehabilitation with Chinese Individuals with Schizophrenia

Effectiveness of video-based psychiatric rehabilitation for patients with early-phase schizophrenia spectrum: A randomized controlled trial

AIM

This study aimed to establish a comprehensive set of recovery-oriented rehabilitation programs for individuals with schizophrenia, comparing the efficacy of video-based rehabilitation to traditional face-to-face interventions. The primary objective was to assess whether video-based rehabilitation could serve as a viable alternative for individuals with schizophrenia residing in remote areas.

METHODS

A randomized controlled study was used to recruit 80 patients with schizophrenia in a stable post-hospitalization stage following discharge. Participants were categorized into three groups: 24 in the control group, 21 in the face-to-face group, and 35 in the remote group. Assessment parameters included psychiatric symptoms, social skills, family function and self-stigma.

RESULTS

A total of 68 participants completed the program. The findings indicated significant differences (p < .05) between the control group and intervention group, particularly in the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance Scale (PSP).

CONCLUSIONS

The rehabilitation program, tailored for patients in the early phase of the schizophrenia spectrum, demonstrates both effectiveness and feasibility in enhancing clinical symptoms and social functions. Notably, interventions conducted via video proved to be equally effective as those administered face-to-face.

Psychosocial Outcomes of Canadian Clubhouse Members: A Multi-Site Longitudinal Evaluation

The Clubhouse model of psychosocial rehabilitation supports individuals with mental health challenges using a person centered and recovery-oriented approach. Clubhouses around the world have been found to be effective in supporting their member's recovery. However, there is a lack of multi-site and longitudinal studies on the Clubhouse model. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes of Clubhouse members across six accredited Clubhouses in Canada. Due to the COVID-19 pandemic occurring midway through the study, a secondary aim was to assess the impact of the pandemic on the psychosocial outcomes of Clubhouse members. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Psychosocial outcomes included mental health symptoms, substance use, community integration, and satisfaction with life, and were analyzed using multilevel growth models. The results indicated that satisfaction with life and psychological integration increased over the study period, while mental health symptoms, substance use, and physical integration decreased. Examining Clubhouse participation, length of Clubhouse membership and frequency of Clubhouse use predicted higher life satisfaction, lower substance use, and fewer mental health symptoms over the study period. The results of the present study provide invaluable insight into the psychosocial impact of Clubhouses on Canadian Clubhouse members, particularly during COVID-19.

Effects of yoga on clinical symptoms, quality of life and social functioning in patients with schizophrenia: A systematic review and meta-analysis

BACKGROUND

Yoga is gradually being explored as a potential complementary intervention in addition to psychiatric drugs for schizophrenia. However, there are conflicts on the efficacy of yoga for schizophrenia. This meta-analysis was aimed to evaluate the association of yoga intervention with reductions on clinical symptoms and improvements in quality of life (QoL) as well as social functioning among schizophrenia.

METHOD

Systematic literature search was undertaken to identify all RCTs that compared yoga with active or passive controls for patients with schizophrenia from inception to July 2023. The outcomes were measurements of positive symptoms, negative symptoms, QoL and social functioning. Random-effects models were performed to calculate the effect sizes in the standardized mean differences reporting as Hedges' s g statistic.

RESULTS

19 studies enrolling 1274 participants with schizophrenia were included. Yoga had a medium effect on positive symptoms in the short term (Hedges's g = 0.31) and small effect in the long term (Hedges's g = 0.18). Medium significant effects were also found on negative symptoms in both the short term (Hedges's g = 0.44) and the long term (Hedges's g = 0.35). Yoga had a significant impact on improving both total QoL (Hedges's g = 0.34) and social functioning (Hedges's g = 0.45) with medium effect sizes.

CONCLUSIONS

Yoga was associated with significant reductions on negative and positive symptoms, and significant improvements in QoL as well as social functioning in patients with schizophrenia. Future research should explore the long-term efficacy of yoga for schizophrenia, encompassing more diverse populations.

A Contemporary Review of the Clubhouse Model of Psychosocial Rehabilitation: Past, Present, and Emerging Directions

Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) cluster-randomised controlled trial: An exploratory analysis of impact on food insecurity, underweight, alcohol use disorder and depressive symptoms

We evaluated the effectiveness of community-based rehabilitation (CBR) in reducing depressive symptoms, alcohol use disorder, food insecurity and underweight in people with schizophrenia. This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Fifty-four sub-districts were allocated in a 1:1 ratio to the facility-based care [FBC] plus CBR arm and the FBC alone arm. Lay workers delivered CBR over 12 months. We assessed food insecurity (self-reported hunger), underweight (BMI< 18.5 kg/m2), depressive symptoms (PHQ-9) and alcohol use disorder (AUDIT ≥ 8) at 6 and 12 months. Seventy-nine participants with schizophrenia in 24 sub-districts were assigned to CBR plus FBC and 87 participants in 24 sub-districts were assigned to FBC only. There was no evidence of an intervention effect on food insecurity (aOR 0.52, 95% CI 0.16-1.67; p = 0.27), underweight (aOR 0.44, 95% CI 0.17-1.12; p = 0.08), alcohol use disorder (aOR 0.82, 95% CI 0.24-2.74; p = 0.74) or depressive symptoms (adjusted mean difference - 0.06, 95% CI -1.35, 1.22; p = 0.92). Psychosocial interventions in low-resource settings should support access to treatment amongst people with schizophrenia, and further research should explore how impacts on economic, physical and mental health outcomes can be achieved.

The Impact of COVID-19 on Clubhouse Employment Programs

The Clubhouse model of psychosocial rehabilitation provides several employment opportunities to individuals who experience mental health concerns, including transitional, supported, and independent employment. The COVID-19 pandemic resulted in Clubhouses having to adapt existing programs to online formats. Employment programs were further impacted, as many workplaces in the community closed or reduced capacity. The present study aimed to examine the rates of involvement in transitional, supported, and independent employment across six Clubhouses in Canada throughout the pandemic. 462 members completed surveys at five time points pertaining to participation in Clubhouse employment programs. The data was analyzed using Cochran's Q tests to determine differences in employment rates across time points. The results demonstrated an overall decrease in transitional and supported employment rates throughout the pandemic. Conversely, rates of independent employment were unchanged. It is evident that Clubhouse employment programs assist members in obtaining employment. The results suggest Clubhouses may benefit from exploring novel employment opportunities to support their members, such as remote work.

Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review

The needs of people with severe mental illness are complex and require a range of services embedded in well-coordinated systems of care to enable recovery, promote well-being and optimise social integration. The concept of recovery is strongly rooted in the centrality of multi and intersectoral systems of care, and, while multi and -intersectoral dimensions of mental health systems have been highlighted in analyses focusing on high-income regions, little has been elaborated in terms of these approaches in the recovery of people with severe mental illness (SMI) in low- and middle-income countries (LMICs). The aim of this review was to identify and describe multi and intersectoral approaches underpinning community-based SMI recovery interventions in LMICs. A scoping review was carried out following the following steps: (1) Objectives for the review were developed and refined; (2) A systematic search of databases (EbscoHost, PubMed, Google Scholar) and previous reviews were undertaken from 2012 to 2022, where relevant papers were identified; (3) Papers with a focus on SMI and recovery, a specific description of an intervention, located in LMICs, with explicit linkages between sectors, and published in English, were selected for inclusion; (4) Data were extracted and charted and (5) Findings were analysed and reported thematically. Thirty-six papers were included for analysis, from 18 countries, including qualitative studies, trials, desktop and secondary data reviews and case studies. Examples of multi- and intersectoral action included collaboration between healthcare and community support systems, collaboration in providing supported housing and supportive community spaces for recovery, and linkages between biomedical and social spheres of care. Barriers included the dominance of mental health professions in delivering care, community-based stigmatising attitudes towards SMI. Multi- and intersectoral collaboration for SMI recovery requires investments in financing, education and coordination by a governing body.

The effects of group-based cognitive behavioral therapy in the rehabilitation of patients with chronic schizophrenia with more than two years of community-based mental health group rehabilitation

BACKGROUND

Studies have shown that community-based group rehabilitation activities can have a positive impact on patients.

OBJECTIVE

This study attempted to improve schizophrenia patients' social and self-cognition through short-term group-based cognitive behavioral therapy (G-CBT), break negative coping styles, and improve the patients' quality of life.

METHODS

The patients with schizophrenia who participated in long-term community-based group rehabilitation were treated with G-CBT. Training on coping styles was conducted to improve their self-cognition and social cognition, and the rehabilitation effects of G-CBT on these patients were evaluated.

RESULTS

Compared with the control group, patient scores for self-esteem, self-efficacy, and positive coping in the G-CBT group increased, while patient scores for negative coping decreased. Compared with the control group, the differences in the total scores for mental health and the five dimensions of physical functioning, general health, vitality, social functioning, and emotional role function in the short-form (SF-12) survey were statistically significant. Compared with the baseline data, the differences in self-esteem, self-efficacy, positive coping, negative coping, and quality of life scores were statistically significant.

CONCLUSION

Short-term G-CBT had a good effect on patients with chronic schizophrenia who participated in community-based group rehabilitation for the long-term.

"Why I stay in community psychiatric rehabilitation": a semi-structured survey in persons with schizophrenia

AIMS

Although community psychiatric rehabilitation plays an important role in returning persons with schizophrenia to the society, many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study is aimed to explore the underlying causes of this trend and identify possible solutions.

METHODS

This study used a qualitative descriptive design to examine the persons with schizophrenia who stay in rehabilitation centers for longer periods of time. The researchers conducted semi-structured telephone interviews with the patients recruited through purposeful sampling. The audio-recorded interviews were transcribed in transcripts in Chinese. Thematic analysis was performed using Colaizzi's 7-step method.

RESULTS

Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.

CONCLUSIONS

Persons with schizophrenia with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): results of a 12-month cluster-randomised controlled trial

BACKGROUND

Community-based rehabilitation (CBR) is recommended to address the social and clinical needs of people with schizophrenia in resource-poor settings. We evaluated the effectiveness of CBR at reducing disability at 12 months in people with schizophrenia who had disabling illness after having had the opportunity to access facility-based care for 6 months METHODS: This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Eligible clusters were subdistricts in Sodo district that had not participated in the pilot study. Available subdistricts were randomised (in a 1:1 ratio) to either the intervention group (CBR plus facility-based care) or to the control group (facility-based care alone). An optimisation procedure (accounting for the subdistrict mean WHO Disability Assessment Schedule (WHODAS) score and the potential number of participants per subdistrict) was applied for each of the eight health facilities in the district. An independent statistician, masked to the intervention or control label, used a computer programme to randomly choose the allocation sequence from the set of optimal ones. We recruited adults with disabling illness as a result of schizophrenia. The subdistricts were eligible for inclusion if they included participants that met the eligibility criteria. Researchers recruiting and assessing participants were masked to allocation status. Facility-based care was a task-shared model of mental health care integrated within primary care. CBR was delivered by lay workers over a 12-month period, comprising of home visits (psychoeducation, adherence support, family intervention, and crisis management) and community mobilisation. The primary outcome was disability, measured with the proxy-rated 36-item WHODAS score at 12 months. The subdistricts that had primary outcome data available were included in the primary analysis. This study is registered with ClinicalTrials.gov, NCT02160249.

FINDINGS

Enrolment took place between Sept 16, 2015 and Mar 11, 2016. 54 subdistricts were randomised (27 to the CBR plus facility-based care group and 27 to the facility-based care group). After exclusion of subdistricts without eligible participants, we enrolled 79 participants (66% men and 34% women) from 24 subdistricts assigned to CBR plus facility-based care and 87 participants (59% men and 41% women) from 24 subdistricts assigned to facility-based care only. The primary analysis included 149 (90%) participants in 46 subdistricts (73 participants in 22 subdistricts in the CBR plus facility-based care group and 76 participants in 24 subdistricts in the facility-based care group). At 12 months, the mean WHODAS scores were 46·1 (SD 23·3) in the facility-based care group and 40·6 (22·5) in the CBR plus facility-based care group, indicating a favourable intervention effect (adjusted mean difference -8·13 [95% CI -15·85 to -0·40]; p=0·039; effect size 0·35). Four (5%) CBR plus facility-based care group participants and nine (10%) facility-based care group participants had one or more serious adverse events (death, suicide attempt, and hospitalisation).

INTERPRETATION

CBR delivered by lay workers combined with task-shared facility-based care, was effective in reducing disability among people with schizophrenia. The RISE study CBR model is particularly relevant to low-income countries with few mental health specialists.

FUNDING

Wellcome Trust.

Organizational characteristics of Brain Injury Clubhouse Model programs

OBJECTIVE

We provide an overview of the Clubhouse Model and the history and development of Brain Injury Clubhouses. We describe organizational-level characteristics associated with eight Brain Injury Clubhouses to address gaps in the literature and inform future studies or program development.

METHODS

A electronic survey, the Clubhouse Profile Questionnaire (CPQ) was tailored for Brain Injury Clubhouses. The CPQ gathers program-level data that can be used to identify active ingredients of Clubhouses, understand best practices, examine, and evaluate program characteristics. The brain injury version of the CPQ was administered to a sample of eight Clubhouses affiliated with the International Brain Injury Clubhouse Association as part of a project designed to gather data on Clubhouse program characteristics and describe sociodemographic characteristics of people served by Brain Injury Clubhouses.

RESULTS

CPQ data from eight Brain Injury Clubhouses was analyzed. Brain Injury Clubhouse programs in this sample served approximately 17 members per day. There was wide variability in the size, funding and funding mechanisms, and length of operation of Brain Injury Clubhouses in this study.

CONCLUSIONS

Findings suggest that Brain Injury Clubhouses offer a wide range of services and supports. Additional research on the impact of Brain Injury Clubhouses is needed.

Community-based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence

People living with severe mental illness (SMI) are one of the most marginalized groups in society. Interventions which aim to improve their social and economic participation are of crucial importance to clinicians, policy-makers and people with SMI themselves. We conducted a systematic review of the literature on social interventions for people with SMI published since 2016 and collated our findings through narrative synthesis. We found an encouragingly large amount of research in this field, and 72 papers met our inclusion criteria. Over half reported on the effectiveness of interventions delivered at the service level (supported accommodation, education or employment), while the remainder targeted individuals directly (community participation, family interventions, peer-led/supported interventions, social skills training). We identified good evidence for the Housing First model of supported accommodation, for the Individual Placement and Support model of supported employment, and for family psychoeducation, with the caveat that a range of models are nonetheless required to meet the varied housing, employment and family-related needs of individuals. Our findings also highlighted the importance of contextual factors and the need to make local adaptations when "importing" interventions from elsewhere. We found that augmentation strategies to enhance the effectiveness of social interventions (particularly supported employment and social skills training) by addressing cognitive impairments did not lead to transferable "real life" skills despite improvements in cognitive function. We also identified an emerging evidence base for peer-led/supported interventions, recovery colleges and other interventions to support community participation. We concluded that social interventions have considerable benefits but are arguably the most complex in the mental health field, and require multi-level stakeholder commitment and investment for successful implementation.

Clubhouse Model of Psychiatric Rehabilitation in China to Promote Recovery of People With Schizophrenia: A Systematic Review and Meta-Analysis

Background: Whether the clubhouse model of psychiatric rehabilitation is well-implemented in China and whether patients with schizophrenia successfully achieve symptom remission and functional recovery through engaging in the clubhouse remain unclear. Methods: Seven electronic databases were searched for relevant articles from inception to April 21, 2021. Quality assessment, data synthesis, and subgroup analysis were performed on the included studies. Results: Seven randomized controlled studies with 682 participants were included in the present meta-analysis. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting the remission of psychiatric symptoms, especially negative symptoms. However, it does not show a definite effect on promoting recovery of positive symptoms. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting social functioning recovery, reducing the family burden, improving the quality of life, and promoting the remission of depressive and anxiety symptoms of patients with schizophrenia in China. Conclusions: Our findings suggest that the clubhouse model of psychiatric rehabilitation can promote the remission of symptoms and functional recovery of Chinese with schizophrenia. It may be suitable to address the urgent need for better mental health services in China.