Leff H Stephen, Chow Clifton M, Pepin Renee, Conley Jeremy, Allen I Elaine, Seaman Christopher A
Human Services Research Institute, 2336 Massachusetts Ave., Cambridge, MA 02140, USA.
Psychiatr Serv. 2009 Apr;60(4):473-82. doi: 10.1176/ps.2009.60.4.473.
Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction.
Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared.
All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively).
The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions.
众多研究评估了社区住房模式对重度精神疾病患者治疗效果的影响。作者对30项研究中描述的44种独特住房选择进行了荟萃分析，将其分为住宿护理与治疗、住宿连续体、永久性支持住房和非模式住房。所考察的结果包括住房稳定性、症状、住院情况和满意度。
将结果分数转换为适合数据的效应量指标。合并效应量以估计住房模式的随机效应，然后进行比较。
所有模式在住房稳定性方面均显著优于非模式住房。这种效应在永久性支持住房中最为明显（效应量 = 0.63，p < 0.05）。各住房模式之间没有显著差异。在减轻精神症状方面，只有住宿护理与治疗与非模式住房存在差异（效应量 = 0.65，p < 0.05）。在减少住院方面，住宿护理与治疗和永久性支持住房均与非模式住房存在差异（p < 0.05）。永久性支持住房在满意度方面的效应量最高（0.73），与非模式住房以及住宿护理与治疗存在差异（分别为p < 0.001和p < 0.05）。
荟萃分析提供了定量证据，表明与非模式住房相比，住房模式有助于实现稳定住房和其他良好结果。研究结果还支持了不同住房模式对不同亚组产生不同结果的理论。数据不足以充分回答旨在帮助项目规划者和提供者更好满足消费者需求的问题。通过采用通用测量方法并遵循科学惯例的研究来回答这些问题很重要。
