1
|
Bergamaschi V, Baumann F, Warnke I, Corbisiero S, Ludwig F, Riedel A, Gabriel-Felleiter K, Schmidt SJ. Who Benefits from Acute Psychiatric Home Treatment? A Systematic Review. Community Ment Health J 2024; 60:1408-1421. [PMID: 38940978 PMCID: PMC11408559 DOI: 10.1007/s10597-024-01297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
Home treatment (HT) treats patients in an acute crisis through an interdisciplinary team with daily appointments for a short treatment period. The effectiveness of HT has already been confirmed. However, only few studies addressed specific patient characteristics associated outcome of treatment. This study aimed to identify patient characteristics associated with successful outcomes of HT. A systematic literature search was conducted according to the PRISMA guidelines. A total of 13 studies were included in the systematic review. Being employed, having a regular income, having an anxiety disorder and family involvement were associated with a successful treatment outcome in HT. High symptom severity and former hospital admissions were associated with unsuccessful treatment outcome in HT in the selected studies. HT seems to be especially beneficial for patients with paid employment or regular income, patients with anxiety disorders, and patients with familial or other social support.
Collapse
Affiliation(s)
- Vera Bergamaschi
- Institue of Psychology, University of Bern, Bern, Switzerland.
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland.
| | - Felix Baumann
- Institue of Psychology, University of Bern, Bern, Switzerland
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | - Ingeborg Warnke
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | | | - Fabian Ludwig
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | - Andreas Riedel
- Luzerner Psychiatrie, Voltastrasse 42, 6005, Lucerne, Switzerland
| | | | | |
Collapse
|
2
|
Barakat A, Blankers M, Cornelis JE, Lommerse NM, Beekman AT, Dekker JJ. Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial. Int J Ment Health Syst 2024; 18:2. [PMID: 38172935 PMCID: PMC10763431 DOI: 10.1186/s13033-023-00619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. METHODS Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants' characteristics moderate the effect of IHT on the total BPRS score. RESULTS Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03-0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. CONCLUSIONS On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. TRIAL REGISTRATION This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).
Collapse
Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands.
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jack Jm Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Robins JE, Morley KI, Hayes RD, Pritchard M, Kornblum D, Kalk NJ. Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team. Int J Ment Health Nurs 2023; 32:590-602. [PMID: 36594457 DOI: 10.1111/inm.13105] [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] [Accepted: 11/30/2022] [Indexed: 01/04/2023]
Abstract
Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol-using patients treated by Crisis Resolution Teams (CRTs), an intensive community-based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London-based Crisis Resolution Teams, with death-by-any-cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk-assessment, AUDIT, or ICD-10 diagnosis) with death-or-recontact at (i) 30-days and (ii) 1-year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1-year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death-or-recontact at 30-days (AOR 1.17, 95%CI 0.73, 1.88) or 1-year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death-or-recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.
Collapse
Affiliation(s)
- John E Robins
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Innovation, Health, and Science, RAND Europe, Cambridge, UK.,Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine and NIHR Maudsley Biomedical Research Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre (BRC), King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IOPPN) King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|