154 Chapter 5 including mental wellbeing (primary outcome), general psychiatric functioning, number and duration of hospitalization, criminal behavior, incarceration (key secondary outcomes), and other relevant treatment outcomes, on average over time and at different timepoints from baseline assessment to 18-months follow-up, (2) explore treatment effects of patients with either no, low, or high compliance to the additive intervention on mental wellbeing, psychiatric functioning, and criminal recidivism on average over time to determine dose-response effects, and (3) explore potential moderators of treatment effects to gain insight intowhich patientsmight benefitmore fromthe additive intervention. With respect to the first aim, contrary to expectations, the current study found no significant differential effects of the additive intervention on mental wellbeing on average over time and at different timepoints, with the exemption of the 6-month follow-up. Surprisingly, at 6-months, mental wellbeing in patients receiving the additive intervention was lower compared to patients receiving TAU. However, in line with our expectations, significant benefits were found on duration of hospitalization and criminal behavior. Specifically, the findings show that patients receiving TAU were hospitalized 2.1 times more days within 12 months after baseline, compared to patients in the additive intervention, and that this effect increased over 18 months. Patients receiving TAU reported 2.9 times more criminal behaviors on average over time, with a stronger effect when groups were compared at 18 months. Furthermore, no benefits of the additive intervention on other treatment outcomes (i.e., social network, substance use, quality of life, and self-sufficiency) were found. On the contrary, besides mental wellbeing, hard drugs use at 6-month follow-up was temporary deteriorated in patients receiving the additive intervention, compared to patients receiving TAU. Next, exploration of the effects across patients with different levels of compliance to the additive intervention showed no evidence of dose-response effects. Only for duration of hospitalization, stronger differential benefits were found in patients who fully adhered to the intervention. However, caution must be applied, as the groups of patients with different compliance levels were small. Lastly, the exploratory findings from moderator analyses suggested that the treatment effects of the additive intervention may only be positive for patients with no primary substance use disorders, patients with comorbid disorders, and males. There are several possible explanations for our findings. The null findings on mental wellbeing could indicate more limited benefits of informal social network interventions in psychiatric patients with severe problems and complex needs, consistent with a recent study among patients with schizophrenia as well as with our meta-analysis of general social network interventions for psychiatric populations, both of which found no
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