Center for Psychiatric Rehabilitation, Research and Development, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, CH-3098, Köniz, Switzerland.
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
BMC Psychiatry. 2024 Aug 9;24(1):554. doi: 10.1186/s12888-024-05995-7.
Most individuals with severe mental illness (SMI) strongly prefer independent living over living in an institution. Independent Supported Housing (ISH) provides housing rehabilitation for persons with SMI in their accommodations. However, most individuals who need housing rehabilitation live in institutional housing settings (housing rehabilitation as usual: HAU). We investigated which housing rehabilitation setting is effective on which variable in the long term to support service users to form an informed preference for either housing rehabilitation setting.
We conducted a two-year longitudinal observational non-inferiority study to test the effectiveness of ISH in improving participants' social inclusion, quality of life, emotional social support, capabilities, symptom severity, functioning, service utilisation and costs. Participants were assessed at baseline and after six, twelve, and 24 months. Mixed effects models were computed to test between-group and within-group effects.
The study included 83 participants in ISH (n = 31) and HAU (n = 52) housing rehabilitation settings with a mean age of 36.2 years. Most participants were male (64%) and had a primary psychotic or schizophrenic (35%) or an affective diagnosis (24%). During the study, ISH participants significantly improved their quality of life (β = 0.54; 95% CI: 0.26 to 0.82), symptoms (β = -0.32; 95% CI: -0.60 to -0.03), and capabilities (β = 4.46; 95% CI: 0.14 to 8.77) and decreased psychiatric hospitalisations (p = 0.04). HAU participants improved their quality of life (β = 0.40; 95% CI: 0.12 to 0.69). Housing and rehabilitation support costs were almost half with ISH than with HAU.
ISH has been shown to be much less expensive than HAU and was associated with several improvements like reduced psychiatric hospitalisations and improved quality of life. Therefore, our findings strongly argue for a preference-driven provision of housing rehabilitation services and to end the institutionalisation of persons with SMI.
The study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).
大多数患有严重精神疾病（SMI）的人强烈倾向于独立生活，而不是住在机构中。独立支持性住房（ISH）为 SMI 患者在其住所提供住房康复。然而，大多数需要住房康复的人住在机构住房环境中（常规住房康复：HAU）。我们研究了哪种住房康复环境对哪些变量更有效，以便长期为服务使用者提供支持，使其能够对这两种住房康复环境形成知情偏好。
我们进行了一项为期两年的纵向观察性非劣效性研究，以测试 ISH 在改善参与者的社会包容度、生活质量、情感社会支持、能力、症状严重程度、功能、服务利用和成本方面的有效性。参与者在基线和 6、12 和 24 个月时进行评估。使用混合效应模型来测试组间和组内效果。
这项研究包括在 ISH（n=31）和 HAU（n=52）住房康复环境中的 83 名参与者，平均年龄为 36.2 岁。大多数参与者为男性（64%），患有原发性精神病或精神分裂症（35%）或情感性诊断（24%）。在研究期间，ISH 参与者的生活质量（β=0.54；95%CI：0.26 至 0.82）、症状（β=-0.32；95%CI：-0.60 至 -0.03）和能力（β=4.46；95%CI：0.14 至 8.77）均显著改善，并且精神科住院治疗减少（p=0.04）。HAU 参与者的生活质量（β=0.40；95%CI：0.12 至 0.69）也有所改善。ISH 的住房和康复支持成本几乎比 HAU 低一半。
ISH 已被证明比 HAU 便宜得多，并且与减少精神科住院治疗和改善生活质量等几个改善因素相关。因此，我们的研究结果强烈支持基于偏好的住房康复服务提供，并结束对患有 SMI 的人的机构化。
该研究于 2018 年 12 月 4 日在 ClinicalTrials.gov（NCT03815604）注册。
