Clinical and cost-effectiveness of nurse-led cognitive behavioral group therapy for recovery of self-esteem among individuals with mental disorders: A single-group pre-post study

AIM

To investigate whether the addition of a nurse-led cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) program to usual care for individuals with mental disorders can improve clinical outcomes and reduce direct medical costs.

METHODS

This study employed single-group pre-post design, and recruited 51 community-dwelling individuals with mental disorders. Participants received 12 weekly CBGTRS sessions by a nurse in addition to usual care. The primary outcome measure was the level of self-esteem, with other clinical outcomes and direct medical costs. The clinical outcomes were measured at pre-intervention (T0), intervention midpoint (T1), immediate post-intervention (T2), and 3 months post-intervention (T3). Direct medical costs were calculated for 3 months pre-intervention (A0), 3 months post-intervention (A1), between 4-6 months post-intervention (A2), and between 7-9 months post-intervention (A3).

RESULTS

Self-esteem scores were significantly improved from T0 to T2 and T3 (p = .009 and .006, respectively); within-group effect sizes were .49 (small) for T0-T2, and .51 (medium) for T0-T3. Other secondary clinical outcomes for mood, cognitive bias, global functioning, and quality of life were also improved by T3 (all p < .05). The mean total direct medical costs were significantly reduced from A0 (49,569.51 JPY) to A2 and A3 (21,845.76 JPY and 25,981.69 JPY, respectively) (p = .003 and .017, respectively).

CONCLUSIONS

The results suggest that nurse-led CBGTRS for mental disorders is a potentially effective approach in improving self-esteem and other clinical outcomes, and in reducing direct medical costs. Further controlled studies that address the limitations of this study are required.

Effect of cognitive behavioral group therapy for recovery of self-esteem on community-living individuals with mental illness: Non-randomized controlled trial

AIM

The aim of this study was to examine over a 12-month post-intervention period whether the participation of community-living individuals with mental illness in cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) resulted in improved outcomes.

METHODS

This was a non-randomized controlled trial. The participants were persons with mental illness who resided in communities in the Chugoku region of Japan. In total, 41 were assigned to an experimental group (CBGTRS intervention, 12 group sessions), and 21 to a control group. Outcome indices (self-esteem, moods, cognition, subjective well-being, psychiatric symptoms) were measured for the experimental group prior to intervention (T0), immediately post-intervention (T1), and at 3 (T2) and 12 (T3) months post-intervention. The control group was measured at the same intervals.

RESULTS

For the experimental group, self-esteem scores at T1, T2, and T3 were significantly higher than at T0. Moods and cognition scores remained significantly low until T2. Scores for Inadequate Mental Mastery in the subjective well-being index had not decreased by T3. Confidence in Coping remained significantly high until T2. Psychiatric symptoms scores at T0, T1, T2, and T3 were significantly lower than at T0. The means and standard errors for self-esteem and Inadequate Mental Mastery increased until T3, and those for Tension-Anxiety, Depression-Dejection, and Confusion decreased until T2.

CONCLUSION

From within-group trends and between-group differences in self-esteem, we conclude that CBGTRS may have a relatively long-term effect on self-esteem recovery. T2 is the turning point for moods and cognition; thus, follow-up is needed 3 months following the initial program.

The effects measurement of hand massage by the autonomic activity and psychological indicators

This study examined the effects of hand massage on autonomic activity, anxiety, relaxation and sense of affinity by performing it to healthy people before applying the technic in actual clinical practice. Findings were showed below: 1) the significant increase in the pNN50 and the significant decrease in the heart rate meant the intervention of massage increased the autonomic nervous activity, improved the parasympathetic nerve activity and reduced the sympathetic nerve activity. This means the subjects were considered to be in a state of relaxation. 2) Salivary α amylase has been reported as a possible indicator for sympathetic nerve activity. In this study, there was no significant difference in the salivary α amylase despite a decrease after massage. 3) State anxiety score is temporal situational reactions while being in the state of anxiety and this score decreased significantly after massage. 4) The level of willingness to communicate with other person and the sense of affinity toward the massage-performer had a positive change of 70 percent. From this, it can be considered that a comfortable physical contact between a patient and a nursing profession, who are in a supported-supportive relationship, leads to an effect of shortening the gap in their psychological distance.

[Factors affecting WHOQOL-26 in community-dwelling patients with schizophrenia]

OBJECTIVE

Schizophrenic patients' quality of life (QOL) has become increasingly important due to shift of mental health care from hospitals to communities. This paper describes a longitudinal study conducted to clarify relationships among the QOL, self-esteem, depressive mood, and uncooperativeness of schizophrenic patients identified in the authors' previous crosssectional study.

METHODS

Subjects were 61 schizophrenic patients attending day care at mental hospitals. They were assessed initially, and again after a 12-month follow-up. The assessment was carried out using the Rosenberg Self-Esteem Scale, WHOQOL-26 Scale, and the Brief Psychiatric Rating Scale, and included personal characteristics. Covariance structure analysis (Synchronous Effects Model) was conducted to clarify the relationships between self-esteem and the WHOQOL-26 Scale, and between psychiatric states (depressive mood and uncooperativeness) and self-esteem, while controlling for subjects' individual characteristics and use of antipsychotics as confounding factors.

RESULTS

The results indicated that self-esteem had a significantly positive effect on the WHOQOL-26 Scale while depressive mood and uncooperativeness were without significant effects.

CONCLUSIONS

The results provide evidence that the enhancement and maintenance of self-esteem may be an effective method of improving WHOQOL-26 in schizophrenic patients.

Quality of life of schizophrenic patients living in the community: the relationships with personal characteristics, objective indicators and self-esteem

The relationship of personal characteristics, objective indicators, and self-esteem to quality of life (QOL) was investigated cross-sectionally in 73 Japanese schizophrenic patients, and the question of how objective conditions affect subjective evaluation was evaluated. Depressive mood and uncooperativeness were negatively correlated with self-esteem, and self-esteem was positively correlated with QOL. Self-esteem was considered to directly affect QOL, and depressive mood and uncooperativeness to affect QOL via self-esteem. Findings suggest that, in order to improve the QOL of schizophrenia patients, interventions to help alleviate psychiatric symptoms (e.g. depressive mood, uncooperativeness) must be utilized. A change in Japanese society itself must occur so that the consequences of stigma may be reduced and patient coping skills improved.

[Quality of life and schizophrenia. A review of the literature]

The aim of this paper was to clarify the concept of quality of life (QOL) and to identify appropriate goals for future studies on the QOL of patients with schizophrenia, by historically review of the literature. First, the concept of QOL was discussed. With the recent move to attach more importance to outcomes in health services, more attention has been paid to QOL as an indicator of patients' perceived outcomes, and many studies on QOL have been published since 1990. Although definitions of QOL differ from researcher to researcher, four fundamental characteristics are identified: 1) QOL is based on the response from the patient himself/herself, 2) it is the subjective experience of the patient, 3) its index is multifactorial, and 4) scores for QOL change with time. Next, the QOL models of Bigelow, Lehman, and Skantze and Malm were reviewed as models of the QOL of patients with schizophrenia, and seven QOL scales were also discussed. Last, studies on the QOL of community residents with schizophrenia retrieved from the Medline and Japana Centra Revuo Medicina databases for 1992 to 2002 were examined. The strategy used for the search was "Quality of Life, psychiatric". As a result, patients with schizophrenia had lower total QOL scores compared to non-disabled persons and patients with depression. Factors associated with their QOL were personal characteristics, lifestyle, negative symptoms, mental symptoms, adjustment (to relations with family, friends and others), social support, self-esteem, autonomy. Results indicated that a longitudinal study is needed to clarify the relationship between these factors and QOL affected by psychological variables of the patient and develop effective psychosocial intervention necessary in the care of patients with schizophrenia.

[Grading of light perception and hand movement utilizing a novel device called the low vision evaluator]

PURPOSE

There has been no device for grading very low visual function expressed as light perception or hand movement up to the present. It is necessary to evaluate even slight effects of modern and classical therapies during the follow-up period. The goal of this study was to invent a novel device for grading such low visual function.

METHODS

Sixty-two patients with a visual acuity of counting fingers or worse due to various diseases were examined. The device, which we call the Low Vision Evaluator, has a pair of goggles equipped with two white light-emitting diodes. Nine variations of stimulus for light intensity (1, 10, 100 cd/m2 or 10, 100, 1,000 cd/m2) and duration (0.1, 0.3, 1 second) can be delivered in a random sequence. Patients were asked to push a button whenever they saw a stimulus. Response of patients to the stimuli was recorded.

RESULTS AND CONCLUSIONS

The visual function of light perception and hand movement could be reproducibly assessed by this method. The method represents a valuable new tool for evaluating low visual function.