背景:大多数患有严重精神疾病(SMI)的人强烈喜欢独立生活而不是生活在机构中。独立支持住房(ISH)为SMI患者提供住房修复。然而,大多数需要住房康复的人都住在机构住房环境中(住房康复照常:HAU)。我们调查了从长远来看,哪种住房康复设置对哪个变量有效,以支持服务用户对两种住房康复设置形成知情偏好。
方法: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在改善参与者社会包容性方面的有效性,生活质量,情感社会支持,能力,症状严重程度,功能,服务利用率和成本。参与者在基线和6次之后进行评估,十二,还有24个月.计算混合效应模型来测试组间和组内效应。
结果:该研究包括83名ISH(n=31)和HAU(n=52)康复机构的参与者,平均年龄为36.2岁。大多数参与者是男性(64%),患有原发性精神病或精神分裂症(35%)或情感诊断(24%)。在研究期间,ISH参与者显著改善了他们的生活质量(β=0.54;95%CI:0.26-0.82),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),精神病住院率下降(p=0.04)。HAU参与者改善了他们的生活质量(β=0.40;95%CI:0.12至0.69)。ISH的住房和康复支持费用几乎是HAU的一半。
结论:ISH已被证明比HAU便宜得多,并且与一些改善相关,如减少精神病住院和提高生活质量。因此,我们的研究结果强烈主张以偏好为导向提供住房康复服务,并终止SMI患者的制度化。
背景:该研究于2018年12月4日在ClinicalTrials.gov(NCT03815604)注册。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: The study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).