Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack).
Psychiatr Serv. 2019 Jan 1;70(1):19-25. doi: 10.1176/appi.ps.201800162. Epub 2018 Oct 24.
Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions.
Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes.
Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up.
Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.
许多患有严重精神疾病的成年人都承受着巨大的医疗负担和较差的疾病自我管理能力。在这项研究中，作者研究了一种基于小组的疾病自我管理干预措施——“活得好”，该措施由两名共同提供服务的人员来共同实施，其中一位人员自身具有共病的心理健康和医疗条件的经历。
将 242 名患有严重精神疾病的成年人随机分配到“活得好”组或积极对照组。参与者在基线、治疗后和随访时完成生活质量、健康态度、自我管理行为和症状评估。通过病历审查评估急诊室使用情况。混合效应模型检验了结果的组间×时间交互作用。
与对照组相比，“活得好”组在治疗后心理健康相关生活质量（t=2.15，p=.032）、自我管理自我效能感（t=4.10，p<.001）、患者激活（t=2.08，p=.038）、内部健康控制源（t=2.01，p=.045）、行为和认知症状管理（t=2.77，p=.006）和整体精神症状（t=-2.02，p=.044）方面的改善更大；在随访时，在身体活动相关自我管理（t=2.55，p=.011）和关系质量（t=-2.45，p=.015）方面的改善更大。对于急诊室使用情况，没有发现效果。对照组在治疗后身体相关生活质量方面的改善更大（t=-2.23，p=.026）。在自我管理自我效能感（t=2.86，p=.004）和行为和认知症状管理（t=2.08，p=.038）方面，治疗后仍存在显著的组间差异。
与积极对照组相比，同伴共同实施的疾病自我管理小组在改善患有严重精神疾病的成年人的生活质量和自我管理自我效能感方面更为有效。
