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Lawrence RE, Jaffe C, Zhao Y, Wang Y, Goldberg TE. Clinical Trials Studying Suicide Risk Reduction: Who is Excluded From Participation. Arch Suicide Res 2024:1-14. [PMID: 38419392 DOI: 10.1080/13811118.2024.2322128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The use of exclusion criteria in clinical trials can cause research participants to differ markedly from clinical populations, which negatively impacts generalizability of results. This study identifies and quantifies common and recurring exclusion criteria in clinical trials studying suicide risk reduction, and estimates their impact on eligibility among a clinical sample of adults in an emergency department with high suicide risk. METHOD Recent trials were identified by searching PubMed (terms suicide, efficacy, effectiveness, limited to clinical trials in prior 5 years). Common exclusion criteria were identified using Qualitative Content Analysis. A retrospective chart review examined a one-month sample of all adults receiving psychiatric evaluation in a large urban academic emergency department. RESULTS The search yielded 27 unique clinical trials studying suicide risk reduction as a primary or secondary outcome. After research fundamentals (e.g. informed consent, language fluency), the most common exclusion criteria involved psychosis (77.8%), cognitive problems (66.7%), and substance use (63.0%). In the clinical sample of adults with high suicide risk (N = 232), psychosis exclusions would exclude 53.0% of patients and substance use exclusions would exclude 67.2% of patients. Overall, 5.6% of emergency psychiatry patients would be eligible for clinical trials that use common exclusion criteria. CONCLUSIONS Recent clinical trials studying suicide risk reduction have low generalizability to emergency psychiatry patients with high suicide risk. Trials enrolling persons with psychosis and substance use in particular are needed to improve generalizability to this clinical population.
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Tholen MG, Martin A, Stemeseder T, Vikoler T, Wageneder B, Aichhorn W, Kaiser AK. Evaluation of a flexible assertive community treatment (FACT) program for patients with severe mental illness: an observational study in Salzburg, Austria. Int J Ment Health Syst 2024; 18:6. [PMID: 38336693 PMCID: PMC10858489 DOI: 10.1186/s13033-024-00628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Inpatient treatment of severe mentally ill patients binds substantial resources and creates the dilemma of "revolving-door hospitalizations". Evidence suggests that these patients benefit more from an assertive outreach community psychiatric treatment. This descriptive study evaluates the implementation of a new treatment program for severe mentally ill patients provided by a flexible assertive community treatment (FACT) team. METHODS An uncontrolled design with routine data was used to measure the total length of stays, readmission rates and number of contacts one year prior to the implementation of the FACT program and the following first three years of treatment. RESULTS A continuous decrease of hospitalization among patients with severe mental illness was observed with the implementation of the FACT program with declines in total length of stays and readmission rates and accompanied with a decreasing number of contacts per year. CONCLUSION Our findings indicate that this program may create effects in stabilizing patients with severe mental illness and may be highly relevant also for other patient groups.
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Affiliation(s)
- Matthias Gerhard Tholen
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria.
| | - Anna Martin
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Theresa Stemeseder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Vikoler
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Barbara Wageneder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kurt Kaiser
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
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Asher L, Birhane R, Weiss HA, Medhin G, Selamu M, Patel V, De Silva M, Hanlon C, Fekadu A. 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. Glob Ment Health (Camb) 2023; 10:e70. [PMID: 38024800 PMCID: PMC10643237 DOI: 10.1017/gmh.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Laura Asher
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rahel Birhane
- WHO Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- WHO Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Charlotte Hanlon
- WHO Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Abebaw Fekadu
- WHO Collaborating Centre for Mental Health Research and Capacity-Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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Gong JW, Luo D, Liu WJ, Zhang J, Chen ZR, Wang QY, Yang XY, Yang BX, Huang HS, Wang XQ. Challenges faced when living with schizophrenia in the community: A narrative inquiry. Int J Soc Psychiatry 2023; 69:420-429. [PMID: 35943191 DOI: 10.1177/00207640221109168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Schizophrenia is a chronic and severe mental disorder. People with schizophrenia have transferred from hospital-based care to community-based care with the support of mental health legal policies. Challenges faced in the community should be emphasized. Limited qualitative studies have explored the challenges of living with schizophrenia. AIMS To explore the challenges of people living with schizophrenia in the community. METHODS A narrative method was used, including semi-structured, face-to-face interviews. Thematic analysis approach was used to analyze data. RESULTS Ten clients and their family members participated in the study. Analysis revealed three main themes related to their challenges in the community: deficits in self-management of illness; insufficient community mental health care; and the influence of policy. These challenges prevent those with schizophrenia from effectively managing their illness, returning to a productive role in society, and improving their quality of life. CONCLUSIONS There are challenges in mental health rehabilitation and social reintegration of individuals with schizophrenia. There is a need for continuous community mental rehabilitation services, appropriate policy support, and the need to educate the public to reduce social bias and discrimination which allows individuals with schizophrenia to assume a productive role in the community.
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Affiliation(s)
| | - Dan Luo
- School of Nursing, Wuhan University, China
| | - Wen Jia Liu
- School of Nursing, Wuhan University, China.,University of Washington School of Nursing, Seattle, USA
| | - Juan Zhang
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zi Ru Chen
- School of Nursing, Wuhan University, China
| | - Qin-Yu Wang
- Department of Psychology, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Bing Xiang Yang
- School of Nursing, Wuhan University, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, China.,Population and Health Research Center, Wuhan University, China
| | - Hai-Shan Huang
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Lestari R, Yusuf A, Setyawan FEB, Ahsan A, Hargono R. A societal adaptation model as a novel approach toward the recovery of people with schizophrenia. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: People with severe mental disorders strain those involved, including families, societies, entire communities, and the government, due to decreased productivity. Understanding the roles to be played in caring for such people necessitates a societal adaptation process. Good adaptations boost societal resilience by caring for severe mental disorder sufferers. Therefore, this study aimed to create a societal adaptation model that would increase societal resilience in the care of people with schizophrenia.
Design and Methods: An observational analytic approach was applied with 205 society members living in the working area of the Community Integrated Health Center in Malang, East Java, Indonesia. Furthermore, several questionnaires were employed and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM).
Results: According to the results, social adaptation was a significant indicator of societal adaptation. It was discovered that coping strategies influenced adaptation (p=0.007), society problem appraisal influenced coping strategies (p=0.000), and social support (p=0.005), while societal adaptation influenced societal resilience (p=0.022). The novelty of this study is that the societal adaptation model increases societal resilience in caring for people with schizophrenia, leading to a more adaptive community by increasing social capital.
Conclusions: In conclusion, the adaptation model improves societal resilience by increasing social capital and stigma prevention, thereby promoting participation in the sufferers’ recovery process.
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Chai J, Liu F, Liu L, Hu N, Huang W, Wang H, Cui Y, Liu H, Li X, Li Y. The efficacy of homestyle rehabilitation on negative symptoms in chronic schizophrenia: A randomized controlled trial. Front Psychiatry 2023; 14:1138794. [PMID: 37139315 PMCID: PMC10149672 DOI: 10.3389/fpsyt.2023.1138794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Schizophrenia is a debilitating mental disorder with a high disability rate that is characterized by negative symptoms such as apathy, hyperactivity, and anhedonia that can make daily life challenging and impair social functioning. In this study, we aim to investigate the effectiveness of homestyle rehabilitation in mitigating these negative symptoms and associated factors. Methods A randomized controlled trial was conducted to compare the efficacy of hospital rehabilitation and homestyle rehabilitation for negative symptoms in 100 individuals diagnosed with schizophrenia. The participants were divided randomly into two groups, each persisting for 3 months. The primary outcome measures were the Scale for Assessment of Negative Symptoms (SANS) and Global Assessment of Functioning (GAF). The secondary outcome measures included the Positive Symptom Assessment Scale (SAPS), Calgary Schizophrenia Depression Scale (CDSS), Simpson-Angus Scale (SAS), and Abnormal Involuntary Movement Scale (AIMS). The trial aimed to compare the effectiveness of the two rehabilitation methods. Results Homestyle rehabilitation for negative symptoms was found to be more effective than hospital rehabilitation, according to the changes in SANS (T = 2.07, p = 0.04). Further analysis using multiple regression indicated that improvements in depressive symptoms (T = 6.88, p < 0.001) and involuntary motor symptoms (T = 2.75, p = 0.007) were associated with a reduction in negative symptoms. Conclusion Homestyle rehabilitation may have greater potential than hospital rehabilitation in improving negative symptoms, making it an effective rehabilitation model. Further research is necessary to investigate factors such as depressive symptoms and involuntary motor symptoms, which may be associated with the improvement of negative symptoms. Additionally, more attention should be given to addressing secondary negative symptoms in rehabilitation interventions.
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Affiliation(s)
- Jiabao Chai
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Fuquan Liu
- Department of Psychiatry, Beijing Jishuitan Hospital, Beijing, China
| | - Lin Liu
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Na Hu
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Wenqian Huang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hong Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Hongyan Liu
- Mental Health Center of Haidian in Beijing, Beijing, China
| | - Xiaojun Li
- Department of Psychiatry, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xiaojun Li, ; Ying Li,
| | - Ying Li
- Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
- *Correspondence: Xiaojun Li, ; Ying Li,
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Fit for Work and Life—an eight-week program for improvement of functionality and quality of life. NEUROPSYCHIATRIE 2022; 36:104-115. [PMID: 35428933 PMCID: PMC9012433 DOI: 10.1007/s40211-022-00415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/13/2022] [Indexed: 11/18/2022]
Abstract
Background The current two-stage study focused on work integration and quality of life of patients in an acute psychiatric day care unit. There is evidence that a longer absence from work due to illness negatively affects job retention, life satisfaction and clinical prognosis. Furthermore, there are individual supportive methods that proved to be effective in work integration. We therefore developed a specific group program Fit for Work and Life (FWL) for patients in an acute psychiatric day care unit focusing on work integration in the first labor market (in contrast to work in institutions for people with disabilities/second labor market). Methods Between 2018 and 2020, 62 patients (intervention group; IG) were enrolled in an 8‑week prospective job integration program and compared to 74 patients (control group; CG) who received treatment as usual (partly retrospective survey). Patients of both groups held a job when entering treatment. Main outcome was defined as their working status 4 weeks after the end of treatment as well as self-reported life satisfaction. Results At the end of treatment (i.e. the week prior to discharge), the IG participants reported higher overall life satisfaction as well as higher health-, self- and living condition-related satisfaction than controls. Functional and clinical improvement during treatment was linked to subsequently returning to work. Functional improvement was further linked to higher life satisfaction. Mediational analysis revealed an indirect path from functional improvement on life satisfaction via working status, i.e. the higher functional improvement during treatment, the higher the chance of successfully returning to work, which in turn increased life satisfaction. Conclusion Our findings suggest that programs such as FWL are useful interventions for employed patients to improve reintegration into work and life and to help to increase life satisfaction.
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Asher L, Birhane R, Weiss HA, Medhin G, Selamu M, Patel V, De Silva M, Hanlon C, Fekadu A. Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): results of a 12-month cluster-randomised controlled trial. Lancet Glob Health 2022; 10:e530-e542. [PMID: 35303462 PMCID: PMC8938762 DOI: 10.1016/s2214-109x(22)00027-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Laura Asher
- Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Rahel Birhane
- WHO Collaborating Centre for Mental Health Research & Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Girmay Medhin
- Akililu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- WHO Collaborating Centre for Mental Health Research & Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Harvard Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Charlotte Hanlon
- WHO Collaborating Centre for Mental Health Research & Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abebaw Fekadu
- WHO Collaborating Centre for Mental Health Research & Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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The adaptation of the community integration scale for adults with psychiatric disorders into Chinese: Cross-cultural adaptation, reliability and validity. Asian J Psychiatr 2021; 65:102847. [PMID: 34509900 DOI: 10.1016/j.ajp.2021.102847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
Community integration problems are fundamental to psychosis and are part of the diagnostic criteria for schizophrenia, but there is a lack of relevant researches and validated scales available for use in China. We intend to translate and assess the reliability and validity of the Community Integration Scale for Adults with Psychiatric Disorders (CIS-APP) scale. A cross-sectional study was conducted on a sample of 612 schizophrenic patients in China. The CIS-APP was used to collect data, and the raw data were randomly divided into two parts for an exploratory factor analysis and a confirmatory factor analysis, to evaluate construct validity. Content validity and reliability were tested by content validity index and Cronbach's α coefficients、split-half reliability respectively. A six-factor structure was emerged, and it explained 61.762% of the total variance. The fit of the six-factor model was acceptable, and the standardized factor loadings ranged from 0.412 to 0.903. The computed reliability of the scale was 0.915. The CIS-APP has excellent psychometric properties, and can be applied to measure community integration levels in people with schizophrenia.
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Ogawa T, Tachikawa H, Shiratori Y, Sodeyama N, Taguchi T, Hori T, Arai T. Use of Blonanserin Transdermal Patch in Home Treatment of Schizophrenia: A Case Study. J Clin Psychopharmacol 2021; 41:603-605. [PMID: 34433201 DOI: 10.1097/jcp.0000000000001453] [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: 11/25/2022]
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Abstract
China accounts for 17% of the global disease burden attributable to mental, neurological and substance use disorders. As a country undergoing profound societal change, China faces growing challenges to reduce the disease burden caused by psychiatric disorders. In this review, we aim to present an overview of progress in neuroscience research and clinical services for psychiatric disorders in China during the past three decades, analysing contributing factors and potential challenges to the field development. We first review studies in the epidemiological, genetic and neuroimaging fields as examples to illustrate a growing contribution of studies from China to the neuroscience research. Next, we introduce large-scale, open-access imaging genetic cohorts and recently initiated brain banks in China as platforms to study healthy brain functions and brain disorders. Then, we show progress in clinical services, including an integration of hospital and community-based healthcare systems and early intervention schemes. We finally discuss opportunities and existing challenges: achievements in research and clinical services are indispensable to the growing funding investment and continued engagement in international collaborations. The unique aspect of traditional Chinese medicine may provide insights to develop a novel treatment for psychiatric disorders. Yet obstacles still remain to promote research quality and to provide ubiquitous clinical services to vulnerable populations. Taken together, we expect to see a sustained advancement in psychiatric research and healthcare system in China. These achievements will contribute to the global efforts to realize good physical, mental and social well-being for all individuals.
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Han X, Jiang F, Needleman J, Guo M, Chen Y, Zhou H, Liu Y, Yao C, Tang Y. A sequence analysis of hospitalization patterns and service utilization in patients with major psychiatric disorders in China. BMC Psychiatry 2021; 21:245. [PMID: 33975564 PMCID: PMC8111895 DOI: 10.1186/s12888-021-03251-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/29/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Understanding the long-term inpatient service cost and utilization of psychiatric patients may provide insight into service demand for these patients and guide the design of targeted mental health programs. This study assesses 3-year hospitalization patterns and quantifies service utilization intensity of psychiatric patients in Beijing, China. METHODS We identified patients admitted for one of three major psychiatric disorders (schizophrenia, bipolar and depressive disorders) between January 1 and December 31, 2013 in Beijing, China. Inpatient admissions during the following 3 years were extracted and analyzed using sequence analysis. Clinical characteristics, psychiatric and non-psychiatric service use of included patients were analyzed. RESULTS The study included 3443 patients (7657 hospitalizations). The patient hospitalization sequences were grouped into 4 clusters: short stay (N = 2741 (79.61% of patients), who had 126,911 or 26.82% of the hospital days within the sample), repeated long stay (N = 404 (11.73%), 76,915 (16.26%) days), long-term stay (N = 101 (2.93%), 59,909 (12.66%) days) and permanent stay (N = 197 (5.72%), 209,402 (44.26%) days). Length and frequency of hospitalization, as well as readmission rates were significantly different across the 4 clusters. Over the 3-year period, hospitalization days per year decreased for patients in the short stay and repeated long stay clusters. Patients with schizophrenia (1705 (49.52%)) had 78.4% of cumulative psychiatric stays, with 11.14% of them in the permanent stay cluster. Among patients with depression, 23.11% had non-psychiatric hospitalizations, and on average 46.65% of their total inpatient expenses were for non-psychiatric care, the highest among three diagnostic groups. CONCLUSION Hospitalization patterns varied significantly among psychiatric patients and across diagnostic categories. The high psychiatric care service use of the long-term and permanent stay patients underlines the need for evidence-based interventions to reduce cost and improve care quality.
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Affiliation(s)
- Xueyan Han
- Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China.
| | - Feng Jiang
- grid.16821.3c0000 0004 0368 8293Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, 1954 Huashan Road, Xuhui District, Shanghai, China
| | - Jack Needleman
- grid.19006.3e0000 0000 9632 6718Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772 USA
| | - Moning Guo
- Beijing Municipal Health Commission Information Centre, 277 Zhao Deng Yu Road, Xicheng District, Beijing, China
| | - Yin Chen
- grid.449412.ePeking University International Hospital, 29 Sheng Ming Yuan Road, Haidian District, Beijing, China
| | - Huixuan Zhou
- grid.411614.70000 0001 2223 5394School of Sport Science, Beijing Sport University, 48 Xinxi Road, Haidian Street, Beijing, China
| | - Yuanli Liu
- grid.506261.60000 0001 0706 7839School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Dongcheng District, Beijing, China
| | - Chen Yao
- grid.411472.50000 0004 1764 1621Peking University First Hospital, 8 Xishiku Road, Xicheng District, Beijing, China ,grid.11135.370000 0001 2256 9319Peking University Clinical Research Institute, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Yilang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite 300, Atlanta, GA, USA; Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA USA ,grid.414026.50000 0004 0419 4084Atlanta VA Medical Center, Decatur, GA USA
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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Wang L, Fan XW, Zhao XD, Zhu BG, Qin HY. Correlation Analysis of the Quality of Family Functioning and Subjective Quality of Life in Rehabilitation Patients Living with Schizophrenia in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072481. [PMID: 32260490 PMCID: PMC7177814 DOI: 10.3390/ijerph17072481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/30/2022]
Abstract
Background: Recently, the community rehabilitation model for schizophrenia patients has become increasingly popular, and the Shanghai Pudong New Area has developed a relatively complete community rehabilitation model. This study analyzed the correlation between family function and subjective quality of life in the rehabilitation of patients living with schizophrenia in the community. Methods: This study evaluated persons living with schizophrenia using the Family Assessment Device and the Subjective Quality of Life Scale. A convenient sampling method was used to select 281 rehabilitation patients living with schizophrenia in the community and 166 hospitalized persons living with schizophrenia. Results: There was a significant difference in the Family Assessment Device scores between rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia (p < 0.0001). The difference in the scores of the subjective quality of life assessment between rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia was not statistically significant (p > 0.05). The regression analysis showed that quality of family function had a significant effect on the subjective quality of life in rehabilitation patients living with schizophrenia in the community and hospitalized persons living with schizophrenia. (F = 10.770 p < 0.001), (F = 2.960 p < 0.01). Conclusions: The quality of family function plays an important role in improving the subjective quality of life in rehabilitation patients living with schizophrenia in the community. It may be beneficial to add some methods to improve family function in the current model of rehabilitation in the community.
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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