Chapter 5 112 Methods Study Design This multicenter, parallel-group, single-blinded RCT was conducted at two mental health care institutions in the Netherlands (6). Ethical approval was obtained at the Erasmus University Medical Center (METC registration number NL38605.078.12). The inclusion criteria were as follows: age 18–65 years; diagnosis with an SMI such as schizophrenia or a persistent mood disorder with or without comorbid disorders (i.e., substance abuse and personality disorders); and receiving outpatient treatment in the greater Rotterdam area. Exclusion criteria comprised previous participation in IMR training and insufficient Dutch language skills. Participants were recruited through clinician referrals from 14 participating community mental health teams. Measures The primary outcome measure was the IMR scale (client version) (6). Both the client and clinician versions of the IMR scale allow for the overall measurement of illness self-management, and both scales are composite measures of various selfmanagement components. The 15 scale items comprise the key elements of IMR training, including progress toward goals, knowledge regarding mental illness, relapse prevention planning, involvement with significant others, coping with symptoms, medication adherence, substance abuse, and symptom distress (3, 41– 43). Moreover, we sought to determine whether individually assessing the scale components had any effect on study results and interpretation. Therefore, in addition to the clinician version of the IMR scale and measuring instruments with respect to clinical, functional, and personal recovery, we included five separate scales regarding components of illness self-management as secondary outcome measures in the current study (6). Secondary outcome measures included the IMR Scale (clinician version) (43) and five scales assessing specific aspects of illness management as follows: coping (Coping Self-Efficacy Scale) (44), social support (Multidimensional Scale of Perceived Social Support) (45), medication adherence (treatment-adherence subscale of the clinician-rated Service Engagement Scale) (46), problems with alcohol or drugs (item 24 of the Addiction Severity Index) (47), and psychiatric insight (Insight Scale) (48). Clinical recovery was analyzed using the Brief Symptom Inventory (49). Hospitalizations were assessed and operationalized as the occurrence of hospitalizations and the lengths of hospital stay.
RkJQdWJsaXNoZXIy MjY0ODMw