TY - JOUR
T1 - A Recovery-Oriented Intervention for People With Psychosis
T2 - A Pilot Randomized Controlled Trial
AU - Mascayano, Franco
AU - Alvarado, Ruben
AU - Andrews, Howard F.
AU - Baumgartner, Joy N.
AU - Burrone, Maria Soledad
AU - Cintra, Jacqueline
AU - Conover, Sarah
AU - Dahl, Catarina M.
AU - Fader, Kim M.
AU - Gorroochurn, Prakash
AU - Galea, Sandro
AU - Jorquera, Maria J.
AU - Lovisi, Giovanni M.
AU - de Souza, Flavia Mitkiewicz
AU - Pratt, Charissa
AU - Restrepo-Toro, Maria E.
AU - Rojas, Graciela
AU - Rodrigues Sarução, Keli
AU - Rosenheck, Robert
AU - Schilling, Sara
AU - Shriver, Tom
AU - Stastny, Peter
AU - Tapia, Eric
AU - Cavalcanti, Maria Tavares
AU - Valencia, Eliecer
AU - Yang, Lawrence H.
AU - Restrepo Henao, Alexandra
AU - Martínez-Alés, Gonzalo
AU - Romero Pardo, Victor
AU - Gomez Alemany, Teresa
AU - Susser, Ezra
N1 - Publisher Copyright:
© 2022 American Psychiatric Association. All rights reserved.
PY - 2022/11
Y1 - 2022/11
N2 - Objective: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention–task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. Methods: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N560; Rio de Janeiro, N550). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment–Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. Results: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. Conclusions: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.
AB - Objective: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention–task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. Methods: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N560; Rio de Janeiro, N550). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment–Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. Results: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. Conclusions: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.
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U2 - 10.1176/appi.ps.202000843
DO - 10.1176/appi.ps.202000843
M3 - Article
C2 - 35678081
AN - SCOPUS:85141004427
SN - 1075-2730
VL - 73
SP - 1225
EP - 1231
JO - Psychiatric Services
JF - Psychiatric Services
IS - 11
ER -