200 Chapter 7 compared topatients intheusual caregroup, showedsimilar resultsas the intention-to-treat analyses. Noteworthy, the sample sizes of the compliance groups compared in the per-protocol analyses were small, compromising the statistical power. The last important limitation we would like to address is the potential bias in the measurement of outcomes. Many studies examining the effects of interventions used subjective outcome measures, including self-report questionnaires, to determine treatment outcomes (chapter 2). However, the validity of these outcome measures depends on the circumstances of patients as well as the methods of data collection (Del Boca & Noll, 2000). For example, response accuracy could be limited in patient populations with severe (psychiatric and social) problems due to affect bias, decreased self-insight, and recent life events (Atkinson, Zibin, & Chuang, 1997). In our research, we also noticed it was challenging to measure subjective treatment outcomes among forensic psychiatric patients with complex problems. Although the study dropout was relatively low and the follow-up response rate in our study described in chapter 5 was satisfactory (i.e., 21% of the patients dropped out during the study and about 80% of the measurements were partially or fully completed), in our experiences, patients were often struggling to complete measurements, self-report questionnaires in particular. As mentioned above, this is not surprising given the fact that most of the patients in our study were diagnosed with multiple and enduring psychiatric disorders and had socio-environmental problems. In these circumstances, it might be difficult to reflect on emotions, thoughts, and behaviors. Moreover, participation in a large amount of self-report questionnaires, which consisted of many questions with Likert-scale response options, may have exhausted patients, affecting their response (chapter 3). Directions for future research This dissertation contributed to the evidence on the effectiveness of social network interventions in addition to usual care in (forensic) psychiatric patients. In addition, our research showed that enhancement of supportive social networks in forensic psychiatric patients is a complex and challenging task (Biegel et al., 1994, 1995). The overall treatment effects of social network interventions were found to be modest or even absent, and it is clear that there is no “one-size-fits-all” intervention (Cassidy et al., 2019; Heaney & Israel, 2008; Priebe et al., 2020; Purgato et al., 2021; Siette et al., 2017). Moreover, our findings are based on a first RCT examining an informal social network intervention in forensic psychiatric patients. Therefore, future research is needed to (1) better understand its effectiveness – “who should provide what to whom (and when)” (Heaney & Israel, 2008),
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