Identifying social participation subgroups of individuals with severe mental illnesses:a latent class analysis

Purpose To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). Methods A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. Results Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. Conclusions Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

Prevention and Intervention Programs Targeting Sexual Abuse in Individuals with Mild Intellectual Disability:A Systematic Review

Introduction: Compared to their non-disabled peers, individuals with mild intellectual disability (MID) are at higher risk of becoming a victim of sexual abuse and more vulnerable to its disruptive effects. This review provides an overview of content and effectiveness of prevention and intervention programs targeting sexual abuse in individuals with MID. Methods: PRISMA guidelines were followed and quality and effectiveness of the programs were evaluated taking into account the rating of the Quality Assessment Tool for Quantitative Studies (QATQS). Results: Twelve studies were included. In prevention programs role-play prevailed, whereas the content of intervention programs varied. All studies received a "weak" QATQS rating. By consequence, effectiveness of the program was downgraded to "unclear" in ten, and "ineffective" in two studies. Conclusion: Further development of programs and higher quality of research is needed to investigate whether they are effective in preventing sexual abuse or reducing its consequences in individuals with MID

The Body Experience Questionnaire for adults with mild intellectual disability or borderline intellectual functioning (BEQ-mb):Development and initial evaluation

Background: Body experience is an important facet of psychosocial functioning and health. However, to date no test exists to measure body experience in adults with mild intellectual disability and borderline intellectual functioning (MID-BIF). We therefore adapted the Body Experience Questionnaire (BEQ) to this group, resulting in the BEQ-mb, and evaluated its usability, comprehensibility, and reliability. Method: The BEQ-mb was developed in five stages: concept development, focus group, verbal reports, pilot testing, and evaluation. Results: The BEQ-mb is applicable in, and comprehensible by, adults with MID-BIF. Internal consistency is good for the total scale and the body awareness and body satisfaction subscales, but low for the body attitude subscale. Test-retest reliability is excellent for the total scale and the subscales. Conclusion: The BEQ-mb unlocks new opportunities for clinical examination and research on body experience. Future research is needed to investigate its structural validity

The effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial

Abstract: BACKGROUND: In primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training. METHODS AND DESIGN: A randomized controlled trial is designed. One hundred patients are randomized to either the group training or the waiting list. Physicians in general practices and outpatients clinics of general hospitals refer patients. Referral leads to inclusion if patients are between 18 and 65 years old, understand Dutch, have no handicaps impeding participation and the principal DSM-IV-TR classification is undifferentiated somatoform disorder or chronic pain disorder. In contrast to other treatment effect studies, the co-morbidity of a personality disorder does not lead to exclusion. By this, we optimize the comparability between the study population and patients in daily practice enlarging the generalization possibilities. Also in contrast to other effect studies, we chose quality of life (SF-36) instead of physical symptoms as the primary outcome measure. The SF-6D is used to estimate Quality Adjusted Life Years (QALYs). Costs are measured with the Trimbos/iMTA Questionnaire for Costs associated with Psychiatric Illness. Measurements are scheduled at baseline, after the training or waiting list, three and twelve months after the training. The differences between measurements are analyzed according to the intention-to-treat principle. The cost-effectiveness is expressed as costs per QALY, using multiple sensitivity analyses on the basis of a probabilistic model of the trial. DISCUSSION: If we show that our group training is (cost-)effective, more patients could be served, their quality of life could be improved while costs might be reduced. As the training is investigated in a heterogeneous patient group i

Employment in Personality Disorders and the Effectiveness of Individual Placement and Support:Outcomes from a Secondary Data Analysis

Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80–4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD

Clinical characteristics of individuals with intellectual disability who have experienced sexual abuse. An overview of the literature

Background: Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics. Objective: The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse. Method: PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of “intellectual disability” and “sexual abuse”. Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies. Results: The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics. Conclusions: Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear

Use of the Triangle of Care Card and its influence on the cooperation with caregivers and clients

ACHTERGRONDEr is consensus over het belang van het betrekken van naasten in de zorg voor mensen met ernstige psychiatrische problematiek. Vanuit de naasten, hulpverlening en cliënten is er de vraag hoe dit op een goede manier vorm te geven.DOELVaststellen of de Triadekaart, een gespreksinstrument ontwikkeld om de rol van naasten in het contact te versterken, leidt tot betere samenwerking.METHODEQuasi-experimenteel onderzoek bij 12 woonzorgteams en 3 FACT-teams die met de Triadekaart gingen werken en 8 vergelijkbare woonzorgteams en 2 FACT-teams. Met dossieronderzoek en enquêtes verzamelden we informatie over gebruik van de kaart en de samenwerking bij invoering en een jaar daarna.RESULTATENDe Triadekaart bleek spaarzaam te worden ingezet. Bij gebruik ervan, werd een breder scala aan onderwerpen besproken waaronder de behoeften van naasten zelf. Ook kregen cliënten een grotere rol bij de verdeling van taken. In teams waar aandacht was geweest voor de Triadekaart kwam bij meer cliënten het netwerk in beeld en sprak men elkaar ook vaker face-to-face.CONCLUSIEAandacht voor de Triadekaart leidt tot beter bereik van naasten en, indien ingezet, tot inhoudsvoller contact. Daadwerkelijke implementatie van de Triadekaart blijkt echter problematisch en de beoogde positieve invloed op samenwerking en zorg daarmee nog gering.BACKGROUND: Although there is consensus on the importance of involving informal caregivers of people with severe mental illness, interventions are needed to support this.AIM: To explore whether the use of the 'Triangle of Care Card', an instrument developed to help strengthen the role of care-givers in their contact with workers, increases quality of cooperation and care.METHOD: Three outpatient mental health teams and twelve teams for supported housing started working with the card. Information from files and questionnaires were used to monitor change and compare this with the changes during the same year in ten other teams.RESULTS: Use of the Triangle of Care Card was sparse. When it was used, a broader range of subjects were discussed, including the needs of caregivers. Also, clients were more involved. In teams where the card was introduced, the clients' networks became more apparent and there was an increase in face-to-face meetings with members of this network.CONCLUSION: Introduction of the Triangle of Care Card leads to change in the involvement of caregivers. However, implementation is problematic and therefore the increase in quality of the cooperation with caregivers and quality of care is yet small.</p