Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Psychiatry. 2024 Oct 24;24(1):729. doi: 10.1186/s12888-024-06181-5.
Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams.
Our explorative, prospective, pre-post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment.
After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team's fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start.
ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.
在许多高收入国家，积极社区治疗 (ACT) 团队已成为严重精神疾病患者精神卫生服务的一部分。一些国家的研究调查了 ACT 的结果，也需要了解挪威 ACT 团队的结果。我们的目的是研究 ACT 的临床结果，以及这些结果与患者和治疗的特征有何关联，以及它们是否因 ACT 团队而异。
我们的探索性、前瞻性、前后对照多中心研究纳入了 142 名在挪威城乡地区建立的前 12 个 ACT 团队接受了两年 ACT 治疗的患者。没有对照组。主要结果是临床医生评定的精神症状变化。次要结果是临床医生评定的功能和参与变化以及与 ACT 前 2 年相比社区居住时间的变化。我们使用积极社区治疗测量工具评估了 ACT 模型的保真度。我们进行了线性混合效应模型分析以分析结果及其与患者和治疗特征的关联。
两年后，精神症状明显减轻，效果较小。阴性症状、焦虑和抑郁、躁动和躁狂有显著减轻，而阳性症状无显著变化。功能、参与度和社区居住时间均显著增加，效果较小。年龄、参与难度、酒精使用问题、频繁使用住院服务、总疗程数和团队对 ACT 模型的保真度与不同症状群有关。功能改善较少与团队保真度和疗程数有关。参与度的变化与任何预测因素均无关。社区居住时间的增加与年轻患者和治疗开始时接受社区治疗令的患者有关。
两年的 ACT 治疗导致精神症状、功能、参与度和社区居住时间的显著积极结果，效果较小。结果与一些潜在的预测因素有关，并且出现了一些团队层面的差异。两年后出现积极的显著结果表明，ACT 团队的长期治疗可能会取得更大的改善。
