Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
Institut national de psychiatrie légale Philippe-Pinel, Montréal, Québec, Canada.
Can J Psychiatry. 2020 Jul;65(7):473-483. doi: 10.1177/0706743719885477. Epub 2019 Nov 25.
This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness.
The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale-11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis.
For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% ( = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% ( = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness.
Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.
本研究调查了冲动性与无家可归的精神病患者康复的六个维度之间的关系。
该样本由 418 名参与“优先住房”随机对照试验的参与者组成，这是一个以康复为导向的项目，为无家可归的精神病患者提供获得永久性住房的机会。采用可靠变化指数法，对从基线到 24 个月（即有临床意义的改善）的结果进行统计和临床意义的估计，这些结果与康复维度有关：精神症状（临床）、身体健康和物质使用问题（身体）、居住稳定性（功能）、逮捕（犯罪学）、社区融合（社会）和希望与个人信心（存在主义）。我们测试了冲动性的影响，冲动性采用 Barratt 冲动量表-11 进行评估，调整了年龄、性别和干预分配，因为两个干预组都包含在分析中，以评估对每个特定结果的有临床意义的改善的影响。
冲动性总分每增加一个标准差，体验有临床意义的改善的几率就会降低 29%（ = 0.71，95%CI，0.55 至 0.91），表现在临床维度上；降低 53%（ = 0.47，95%CI，0.32 至 0.68），表现在存在主义维度上。然而，与身体、功能、犯罪学和社会维度相关的结果变化不受冲动性影响。
研究结果强调了在面向康复的干预措施中解决冲动性问题的重要性。可能需要进一步研究，以改善针对冲动个体独特需求的干预措施，以支持临床和存在主义的康复。
