Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.
Addiction. 2019 Apr;114(4):730-740. doi: 10.1111/add.14500. Epub 2018 Dec 18.
Patients with co-occurring substance use and other mental disorders are vulnerable to crime victimization, yet no evidence-based preventive interventions exist. Our aim was to test the efficacy of a new intervention, Self-wise, Other-wise, Streetwise training (SOS training), to prevent victimization in these dual-diagnosis patients as an add-on to care as usual.
Multi-site single-blind parallel randomized controlled trial.
Three sites within one psychiatric service in Amsterdam, the Netherlands.
Adult in-patients and out-patients with dual diagnosis (n = 250), who were predominantly male (70.4%), aged on average 42.1 years, and diagnosed with 3.7 DSM-IV disorders.
Care as usual, consisting of pharmacotherapy combined with individual psychotherapy, group psychotherapy and/or supportive counselling (n = 125) was compared with care as usual plus SOS training: a 6-week, 12-session manualized group training focused on enhancing emotion regulation skills, conflict resolution skills and street skills (n = 125).
Victimization was assessed with the Safety Monitor, the Dutch equivalent of the International Crime Victims Survey, in a face-to-face assessment. The primary outcome measure was treatment response (yes/no), with 'yes' defined as reporting at least a 50% reduction in the number of past-year victimization incidents at the 14-month follow-up compared with baseline. Analyses were performed according to the intention-to-treat principle.
The proportion of participants achieving treatment response for total victimization was 54.0% in the control group and 67.6% in the experimental group, a significant difference [odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.02-3.11, P = 0.042]. Treatment response for violent victimization was achieved by 68.7% of the control group and 79.3% of the experimental group (OR = 1.75, 95% CI = 0.91-3.34, P = 0.092). With a Bayes factor of 2.26, this result was inconclusive.
Among dual-diagnosis patients, care as usual plus Self-wise, Other-wise, Streetwise training was more effective in preventing victimization than care as usual alone.
同时患有物质使用障碍和其他精神障碍的患者容易成为犯罪受害者，但目前尚不存在基于证据的预防干预措施。我们的目的是测试一种新的干预措施——Self-wise、Other-wise、Streetwise 培训（SOS 培训）的疗效，该干预措施作为常规护理的附加措施，旨在预防这些双重诊断患者的受害。
多地点单盲平行随机对照试验。
荷兰阿姆斯特丹一家精神病服务机构的三个地点。
患有双重诊断的成年住院和门诊患者（n=250），他们主要为男性（70.4%），平均年龄 42.1 岁，被诊断患有 3.7 种 DSM-IV 障碍。
常规护理包括药物治疗联合个体心理治疗、团体心理治疗和/或支持性咨询（n=125），与常规护理加 SOS 培训进行比较：为期 6 周、12 节的手册化小组培训，重点是增强情绪调节技能、冲突解决技能和街头技能（n=125）。
通过面对面评估使用 Safety Monitor（荷兰版国际犯罪受害者调查）评估受害情况。主要结局指标为治疗反应（是/否），定义为与基线相比，14 个月随访时过去一年受害事件数量减少至少 50%。分析按照意向治疗原则进行。
对照组和实验组中，总受害的治疗反应比例分别为 54.0%和 67.6%，差异具有统计学意义[比值比（OR）=1.78，95%置信区间（CI）=1.02-3.11，P=0.042]。对照组和实验组中，暴力受害的治疗反应比例分别为 68.7%和 79.3%（OR=1.75，95% CI=0.91-3.34，P=0.092）。贝叶斯因子为 2.26，结果不确定。
在双重诊断患者中，常规护理加 Self-wise、Other-wise、Streetwise 培训比单独常规护理更能有效预防受害。
