Lay Barbara, Drack Thekla, Bleiker Marco, Lengler Silke, Blank Christina, Rössler Wulf
Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
Front Psychiatry. 2015 Nov 18;6:161. doi: 10.3389/fpsyt.2015.00161. eCollection 2015.
To evaluate the effects of a preventive monitoring program targeted to reduce compulsory rehospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment, and self-reported mental health functioning at 12 months.
The program consists of individualized psychoeducation, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s) during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients.
Study participants reported lower levels of perceived coercion, negative pressures, and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations, and social role functioning (significant time effects). However, improvements were not confined to the intervention group, but seen also in the treatment-as-usual group (no significant group or interaction effects). Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others.
Our findings suggest that changes in the subjective perspective were fueled primarily by participation in this study rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between "objective" measures (compulsory readmissions) and patients' perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.
评估一项旨在减少重症精神障碍患者强制再住院率和感知到的强制感的预防性监测项目的效果。我们分析了患者在12个月时在感知到的强制感、赋权和自我报告的心理健康功能方面的结果。
该项目包括个性化心理教育、危机卡片，以及在从精神病医院出院后进行为期24个月的预防性监测。共有238名在过去24个月内有过强制入院经历的精神科住院患者纳入试验。182名患者在基线后12个月完成了T1评估。
研究参与者报告称，感知到的强制感、负面压力和过程排斥水平较低，乐观程度较高，因症状、人际关系和社会角色功能导致的痛苦程度较低（有显著的时间效应）。然而，改善并不局限于干预组，在常规治疗组也有体现（无显著的组间或交互效应）。认知的改变与年龄较大、病程较短、女性、非精神病性障碍以及非因对他人造成伤害风险而强制住院有关。
我们的研究结果表明，主观视角的变化主要是由参与本研究推动的，而非接受了特定干预。该研究有助于更好地理解“客观”指标（强制再入院）与患者认知之间的相互作用，并强调了对有非自愿精神病住院史的个体采用促进赋权的治疗方法的必要性。
