Sanches Sarita A, Swildens Wilma E, Schaefer Barbara, Moerbeek Mirjam, Feenstra Talitha L, van Asselt Antoinette D I, Danner Unna N, van Weeghel Jaap, van Busschbach Jooske T
Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.
Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.
Front Psychiatry. 2020 Sep 23;11:571640. doi: 10.3389/fpsyt.2020.571640. eCollection 2020.
People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities.
To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands.
In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients' views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning.
During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms.
While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.
患有严重精神疾病（SMI）的人在通过工作或其他日常活动参与社会方面存在困难。
在荷兰，确定波士顿大学精神康复方法（BPR）提高SMI患者社会参与水平的有效性。
在一项涉及188名SMI患者的随机对照试验中，我们将BPR组（n = 98）与积极对照条件组（ACC，n = 90）进行了比较（试验注册号ISRCTN88987322）。采用多层次模型研究两个为期六个月的时间段内的干预效果。主要结局指标是社会参与水平，用过去六个月是否参与有偿或无偿工作、有偿或无偿工作的总时长以及当前社会参与水平来表示。次要结局指标包括患者对康复目标达成情况的看法、生活质量（QOL）、个人康复、自我效能感和心理社会功能。
在研究期间，两组患者的社会参与、生活质量和心理社会功能均有所改善。然而，在任何结局指标上，BPR都不比ACC更有效。既往工作经历和较低的精神症状强度预示着更好的社会参与。
虽然ACC在提高SMI患者的社会参与方面与BPR一样有效，但与没有针对社会参与提供特定支持的观察性研究相比，我们样本中更高比例的参与者找到了（有偿）工作或其他有意义的活动。这表明，无论使用何种具体方法，有针对性的康复努力都是有益的。
