Barakat Ansam, Blankers Matthijs, Cornelis Jurgen E, Lommerse Nick M, Beekman Aartjan T F, Dekker Jack J M
Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.
Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands.
Int J Ment Health Syst. 2021 Jan 6;15(1):1. doi: 10.1186/s13033-020-00426-y.
BACKGROUND: This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. METHODS: Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. RESULTS: Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = - 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = - 0.01, SE = 0.12, t (103.95) = - 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = - 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). CONCLUSIONS: Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.
背景：本研究评估了与常规护理（CAU）相比，为经历精神危机的患者提供强化家庭治疗（IHT）对自我效能感是否有更大影响。自我效能感是一个与IHT目标之一密切相关的心理学概念。此外，还研究了不同精神障碍患者对自我效能感的差异影响以及自我效能感与症状恢复或生活质量之间的关联。 方法：数据来源于一项Zelen双同意随机对照试验（RCT），该试验评估了IHT与CAU相比对经历精神危机患者的影响。在基线、随访6周和26周时收集数据。使用心理健康信心量表测量自我效能感。分别使用5维度欧洲生活质量量表和简明精神病评定量表（BPRS）测量生活质量和症状恢复情况。我们使用线性混合模型来估计与自我效能感的关联。 结果：使用了142名参与者的数据。总体而言，在自我效能感方面未发现IHT与CAU之间存在差异（B = -0.08，标准误 = 0.15，p = 0.57），并且在26周期间自我效能感没有变化（B = -0.01，标准误 = 0.12，t(103.95) = -0.06，p = 0.95）。然而，发现不同精神障碍患者随时间对自我效能感有差异影响（F(8, 219.33) = 3.75，p < 0.001）。此外，自我效能感与症状恢复（BPRS总分B = -0.10，标准误 = 0.02，p < 0.00）和生活质量（B = 0.14，标准误 = 0.01，p < 0.001）密切相关。 结论：虽然自我效能感与症状恢复和生活质量相关，但与CAU相比，IHT对自我效能感没有补充作用。这一结果引发了一个问题，即危机护理是否以及如何进行调整以提高自我效能感，同时要考虑到抑郁障碍、双相情感障碍、人格障碍、精神分裂症谱系障碍及其他精神障碍中自我效能感的发展情况。对这些研究结果应谨慎看待。本研究缺乏足够的效力来检测自我效能感的微小变化，并且一些精神障碍的样本量较小。试验注册 本试验已在Trialregister.nl注册，注册号为NL6020。
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