Swinkels Lise T A, van der Pol Thimo M, Twisk Jos, Ter Harmsel Janna F, Dekker Jack J M, Popma Arne
Department of Forensic Outpatient Care, Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.
Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands.
Front Psychiatry. 2023 May 24;14:1129492. doi: 10.3389/fpsyt.2023.1129492. eCollection 2023.
A supportive social network is associated with better mental health and wellbeing, and less criminal behavior. Therefore, this study examined the effectiveness of an additive informal social network intervention to treatment as usual (TAU) among forensic psychiatric outpatients.
An randomized controlled trial (RCT) was conducted in forensic psychiatric care, allocating eligible outpatients ( = 102) to TAU with an additive informal social network intervention or TAU alone. Participants receiving the additive intervention were matched to a trained community volunteer over 12 months. TAU consisted of forensic care (e.g., cognitive behavioral therapy and/or forensic flexible assertive community treatment). Follow-up assessments were conducted at 3, 6, 9, 12, and 18 months after baseline. The primary outcome was the between-group effect on mental wellbeing at 12 months. Between-group effects on secondary outcomes (e.g., general psychiatric functioning, hospitalization, criminal behavior) were explored.
Intention-to-treat analyses showed non-significant between-group effects on mental wellbeing on average over time and at 12 months. However, significant between-group effects were found on hospitalization duration and criminal behavior. Specifically, TAU participants were hospitalized 2.1 times more days within 12 months and 4.1 more days within 18 months than participants in the additive intervention. Furthermore, TAU participants reported 2.9 times more criminal behaviors on average over time. There were no significant effects on other outcomes. Exploratory analyses revealed that sex, comorbidity, and substance use disorders moderated effects.
This is the first RCT examining the effectiveness of an additive informal social network intervention in forensic psychiatric outpatients. Although no improvements were found on mental wellbeing, the additive intervention was effective in reducing hospitalization and criminal behavior. The findings suggest that forensic outpatient treatment can be optimized by collaborating with informal care initiatives aimed at improving social networks within the community. Future research is warranted to determine which specific patients might benefit from the intervention and if effects can be improved by extending the intervention duration and enhancing patient compliance. [https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7163], identifier [NTR7163].
一个支持性的社会网络与更好的心理健康和幸福感以及更少的犯罪行为相关。因此，本研究考察了在法医精神科门诊患者中，一种附加的非正式社会网络干预相对于常规治疗（TAU）的有效性。
在法医精神科护理中进行了一项随机对照试验（RCT），将符合条件的门诊患者（n = 102）分配至接受附加非正式社会网络干预的常规治疗组或仅接受常规治疗组。接受附加干预的参与者在12个月内与一名经过培训的社区志愿者配对。常规治疗包括法医护理（例如，认知行为疗法和/或法医灵活的积极社区治疗）。在基线后的3、6、9、12和18个月进行随访评估。主要结局是12个月时两组在心理健康方面的组间效应。探讨了两组在次要结局（例如，一般精神功能、住院、犯罪行为）方面的组间效应。
意向性分析显示，随着时间推移以及在12个月时，两组在心理健康方面的组间效应不显著。然而，在住院时间和犯罪行为方面发现了显著的组间效应。具体而言，常规治疗组的参与者在12个月内住院天数比附加干预组多2.1倍，在18个月内多4.1天。此外，常规治疗组的参与者报告的犯罪行为平均随时间推移多2.9倍。对其他结局没有显著影响。探索性分析表明，性别、共病和物质使用障碍会调节效应。
这是第一项考察附加非正式社会网络干预对法医精神科门诊患者有效性的随机对照试验。尽管在心理健康方面未发现改善，但附加干预在减少住院和犯罪行为方面是有效的。研究结果表明，通过与旨在改善社区内社会网络的非正式护理举措合作，可以优化法医门诊治疗。未来有必要进行研究，以确定哪些特定患者可能从干预中受益，以及延长干预持续时间和提高患者依从性是否可以改善效果。[https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7163]，标识符 [NTR7163]
