School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, 2308, Australia.
Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia.
Psychiatr Q. 2021 Dec;92(4):1611-1634. doi: 10.1007/s11126-021-09934-7. Epub 2021 Jun 14.
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.
鲜有研究考察过在住院和亚急性心理健康环境中提供以康复为导向的项目与出院后获益之间的关系。本研究旨在评估一项为期 6 周的亚急性住院干预计划对 27 名患有严重精神疾病（平均年龄 33.22 岁，70.4%为精神病诊断）的服务使用者的中期结果。使用自我报告、协作和临床措施在入院时、出院时以及出院后 3 个月和 6 个月收集康复数据。三个临床医生评定的措施（评估治疗性参与、功能和生活技能）显示出从入院到 6 个月随访的线性改善（平均 z 变化范围为 0.72 到 1.35），自我报告的社会联系措施（心理健康康复之星，Mental Health Recovery Star，MHR）也是如此（平均 z 变化：1.05）。自我决定和自我报告的 MHR 症状管理和功能评分也出现了曲线改善；然而，希望（Herth Hope Index）和 MHR 自我信念评分仅略有变化。基于自我报告和临床医生评定的措施的变化分数往往不相关。对客户层面结果的探索揭示了三个康复轨迹亚组：短暂（21.7%）、逐渐（34.8%）或持续（43.5%）改善；后者组的成员往往患病时间更长。研究结果令人鼓舞，因为它们表明以康复为重点的亚急性住院计划可以促进临床康复和个人康复的各个方面。然而，它们也表明，客户和临床医生之间的康复观点存在差异，需要进一步研究来了解产生和维持康复希望的心理因素。
