基于人类作业模型（MOHO）的强化个体安置和支持（IPS）干预；一项前瞻性队列研究。
An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study.
机构信息
Queen Margaret University, Edinburgh, EH21 6UU, UK.
Faculty of Health Sciences, University of Stavanger & Oslo Metropolitan University, Oslo, Norway.
出版信息
BMC Psychiatry. 2020 Jul 8;20(1):361. doi: 10.1186/s12888-020-02745-3.
BACKGROUND
Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes.
METHODS
This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education).
RESULTS
Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ(7) = 41.38 p < .001.
CONCLUSION
An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment.
TRIAL REGISTRATION
NCT04083404 Registered 05 September 2019 (retrospectively registered).
背景
就业有益于身心健康，但患有严重精神疾病（SMI）的人往往被排除在就业之外。标准的个体安置和支持（IPS）在支持约 55%的 SMI 患者就业或接受教育方面非常有效。目前的研究考虑对 IPS 进行增强，以改善需要更复杂干预措施的人的结果。临床医生需要更好地了解谁将从这些增强的 IPS 干预中受益。本研究提供了一种新的增强 IPS 干预措施和一种预测谁可能获得成功结果的方法。
方法
这项前瞻性队列研究包括参加增强 IPS 服务且长期失业的 SMI 患者。对常规临床实践中收集的数据进行了二次数据分析。采用单变量分析结合以往的研究和临床咨询，选择变量纳入初始模型，然后采用向后逐步法构建最终的多逻辑回归模型，以成功或不成功的目标实现（就业或教育）为结果。
结果
增强 IPS 组的 63%参与者成功实现了就业或教育。从双变量分析中确定了与结果（就业或教育）相关的七个心理社会变量之间存在显著关系。适应常规以最小化困难、与工作相关的目标以及生活在较少贫困地区被发现是预测最终多逻辑回归模型中就业或教育的重要因素（R=0.16[Hosmer-Lemeshow]，0.19[Cox-Snell]，0.26[Nagelkerke]）。模型 χ(7)=41.38 p<.001。
结论
增强 IPS 服务实现就业或教育的成功率为 63%，高于可比研究，为更复杂人群提供了 IPS-Lite 和 IPS-standard 的替代方案。动机和习惯性心理社会变量有助于预测谁可能从增强 IPS 干预中受益，支持长期失业的人。
试验注册
NCT04083404 于 2019 年 9 月 5 日（回顾性注册）注册。
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