Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial

Springer Science and Business Media LLC - Tập 18 Số 1
Ansam Barakat1, Matthijs Blankers1, Jurgen Cornelis2,1, Nick M. Lommerse1, Aartjan Beekman3, Jack Dekker1
1Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
2Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
3Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands

Tóm tắt

Abstract Background Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. Methods Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants’ characteristics moderate the effect of IHT on the total BPRS score. Results Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03–0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. Conclusions On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. Trial registration This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).

Từ khóa


Tài liệu tham khảo

American Psychiatric Association. Practice guidelines for the Psychiatric evaluation of adults, Third Edition. The American Psychiatric Association Practice Guidelines for the Psychiatric evaluation of adults. American Psychiatric Association; 2015.

Sharfstein SS. Goals of inpatient treatment for psychiatric disorders. Annu Rev Med. 2009;60:393–403.

Fenton WS, Hoch JS, Herrell JM, Mosher L, Dixon L. Cost and cost-effectiveness of hospital vs residential crisis care for patients who have serious mental Illness. Arch Gen Psychiatry. 2002;59(4):357–64.

Rüsch N, Müller M, Lay B, et al. Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental Illness. Eur Arch Psychiatry Clin Neurosci. 2014;264:35–43.

Loch AA. Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization. Psychol Res Behav Manage. 2014;7:137–45.

Murphy SM, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev. 2015;2015(12). CD001087.

Lloyd-Evans B, Johnson S. Community alternatives to inpatient admissions in psychiatry. World Psychiatry. 2019;18(1):31–2. https://doi.org/10.1002/wps.20587. PMID: 30600640; PMCID: PMC6313241.

Johnson S, Thornicroft G. The development of crisis resolution and home treatment teams. In: Thornicroft G, Bindman JP, Needle J, Johnson S, editors. Crisis Resolution and Home Treatment in Mental Health. Cambridge: Cambridge University Press; 2008. pp. 9–22.

Karlsson B, Borg M, Kim HS. From good intentions to real life: introducing crisis resolution teams in Norway. Nurs Inq. 2008;15(3):206–15.

National Health Service. In: Health, Do, editors. The NHS plan: a plan for investment, a plan for reform. London: the stationary Office; 2000.

Sjølie H, Karlsson B, Kim HS. Crisis resolution and home treatment: structure, process, and outcomea literature review. J Psychiatr Ment Health Nurs. 2010;17(10):881.

Prinsen E, Wel Bv, Mulder N. Handboek intensive home treatment. Utrecht: De Tijdstroom; 2016.

Cornelis JE, Barakat A, Blankers M, Peen J, Lommerse LM, Eikelenboom M, et al. The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution: a two-centre Zelen double consent randomised controlled trial. Lancet Psychiatry. 2022;9(8):625–35.

Johnson S, Nolan F, Pilling S, Sandor A, Hoult J, McKenzie N, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ (Clinical Research ed). 2005;331(7517):599.

Stulz N, Wyder L, Maeck L, Hilpert M, Lerzer H, Zander E, et al. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry. 2020;216(6):323–30.

Stulz N, Kawohl W, Jäger M, Mötteli S, Schnyder U, Hepp U. From research to practice: implementing an experimental home treatment model into routine mental health care. Eur Psychiatry: J Association Eur Psychiatrists. 2020;63(1):e94.

Smyth MG, Hoult J. The home treatment enigma. BMJ (Clinical Research ed). 2000;320(7230):305–8.

Lalevic G, Suhail A, Doyle H. Home-based crisis team in North Cork service description and patient-related outcomes. Ir J Psychol Med. 2019;36(1):29–33.

Lloyd-Evans B, Christoforou M, Osborn D, Ambler G, Marston L, Lamb D, et al. Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs. Southampton (UK): NIHR Journals Library; 2019.

Kraemer HC, Frank E, Kupfer DJ. Moderators of treatment outcomes: clinical, research, and policy importance. JAMA. 2006;296(10):1286–9.

Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59(10):877–83.

Cornelis J, Barakat A, Dekker J, Schut T, Berk S, Nusselder H et al. Intensive home treatment for patients in acute psychiatric crisis situations: a multicentre randomized controlled trial. BMC Psychiatry. 2018;18(1).

Nugter MA, Engelsbel F, Bahler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) implementation: a prospective Real Life Study. Community Ment Health J. 2016;52(8):898–907.

Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979;300(22):1242–5.

Ruggeri M, Koeter M, Schene A, Bonetto C, Vazquez-Barquero JL, Becker T, et al. Factor solution of the BPRS-expanded version in Schizophrenic outpatients living in five European countries. Schizophr Res. 2005;75(1):107–17.

Barakat A, Blankers M, Cornelis JE, van der Post L, Lommerse NM, Beekman ATF, et al. Police encounters, agitation, diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment patients during a Psychiatric Crisis. Front Psychiatry. 2021;12:602912.

Brimblecombe N, O’Sullivan G, Parkinson B. Home treatment as an alternative to inpatient admission: characteristics of those treated and factors predicting hospitalization. J Psychiatr Ment Health Nurs. 2003;10(6):683–7.

Cotton MA, Johnson S, Bindman J, Sandor A, White IR, Thornicroft G, et al. An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams. BMC Psychiatry. 2007;7:52.

Guo S, Biegel DE, Johnsen JA, Dyches H. Assessing the impact of community-based mobile crisis services on preventing hospitalization. Psychiatric Serv (Washington DC). 2001;52(2):223–8.

Hasselberg N, Grawe RW, Johnson S, Saltyte-Benth J, Ruud T. Psychiatric admissions from crisis resolution teams in Norway: a prospective multicentre study. BMC Psychiatry. 2013;13:117.

Mötteli S, Jäger M, Hepp U, Wyder L, Vetter S, Seifritz E, et al. Home Treatment for Acute Mental Healthcare. Who Benefits Most? Community Ment Health J; 2020.

De Beurs E, Zitman F. The brief symptom inventory (BSI), the reliability and validity of a handy alternative to the SCL-90 [de brief symptom inventory (BSI). De betrouwbaarheid en validiteit van een handdzaam alternatief voor de SCL-90 (in Dutch)]. Maandblad Geestelijke Gezondheid 2006(61):120–41.

Mulder CL, Staring ABP, Loos J, Buwalda VJA, Kuijpers D, Sytema S, et al. De Health of the Nation Outcome scales (HoNOS) als instrument voor ‘routine outcome assessment’. Tijdschr Psychiatr. 2004;46(5):273–84.

Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. Audit. The Alcohol Use Disorders Identification Test (AUDIT): guidelines for use in primary care. 2001.

Schippers GM, Broekman TG, Angela B, Koeter MWJ, Van Den Brink W. Measurements in the addictions for triage and evaluation (MATE): an instrument based on the World Health Organization family of international classifications. Addiction. 2010;105(5):862–71.

Luedtke A, Sadikova E, Kessler RC. Sample size requirements for Multivariate models to predict between-patient differences in best treatments of major depressive disorder. Clin Psychol Sci. 2019;7(3):445–61.

Huang HCH, Taylor M, Carmichael A. The outcomes of home treatment for schizophrenia. BJPsych Bull. 2018;42(6):238–42.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 18 Số 1

Thông tin tác giả