Background
Methods
Study design
Study population and sampling procedure
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being diagnosed with a mental illness of the categories F20-F29 (schizophrenia, schizotypal and delusional disorders), F30-F39 (affective disorders), F40-F48 (neurotic, stress-related and somatoform disorders), F50-F59 (behavioural syndromes associated with physiological disturbances and physical factors), F60-F69 (disorders of adult personality and behaviour) and F91- F94 (conduct and emotional disorders, disorders of social functioning with onset usually occurring in childhood and adolescence) of the ICD-10 during the last 12 months.
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having either had a psychiatric inpatient admission or an ambulatory prescription of antipsychotic, anxiolytic or antidepressant drugs during the last 12 months.
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being between 18 and 80 years old
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not being eligible for receiving benefits from statutory long-term care insurance [25]
NWpG-IC intervention
Outcomes and assessment
Sample size calculation
Statistical analysis
Results
Study population and study flow
Total | TAU | IC |
p-valuea
| ||||
---|---|---|---|---|---|---|---|
Sociodemographic
| |||||||
age in years; m (sd) | 46.47 | 11.61 | 47.15 | 11.01 | 45.82 | 12.14 | 0.195 |
employed; n (%) | 175 | 35.1% | 58 | 23.5% | 117 | 46.4% | <0.001 |
living alone; n (%) | 235 | 46.0% | 127 | 50.6% | 108 | 41.5% | 0.040 |
female; n (%) | 353 | 69.1% | 167 | 66.5% | 186 | 71.5% | 0.221 |
health insurance company affiliation, TK; n (%) | 214 | 41.9% | 32 | 12.7% | 182 | 70.0% | <0.001 |
social welfare reception; n (%) | 26 | 5.1% | 20 | 8.0% | 6 | 2.3% | 0.004 |
Treatment
| |||||||
duration of illness in years; m (sd) | 12.47 | 11.63 | 14.24 | 11.85 | 10.77 | 11.18 | 0.001 |
number of hospitalisations; m (sd) | 2.78 | 3.89 | 3.83 | 4.92 | 1.77 | 2.1 | <0.001 |
primary diagnosis | 0.017 | ||||||
– F20-F29; n (%) | 67 | 13.1% | 43 | 17.1% | 24 | 9.2% | |
– F30-F39; n (%) | 317 | 62.0% | 140 | 55.8% | 177 | 68.1% | |
– F40-F48; n (%) | 98 | 19.2% | 53 | 21.1% | 45 | 17.3% | |
multiple mental diagnoses; n (%) | 248 | 48.5% | 135 | 53.8% | 113 | 43.5% | 0.020 |
prescription of antipsychotics; n (%) | 379 | 74.2% | 199 | 79.3% | 180 | 69.2% | 0.009 |
legal guardian; n (%) | 31 | 6.1% | 23 | 9.2% | 8 | 3.1% | 0.004 |
assisted living; n (%) | 36 | 7.1% | 31 | 12.4% | 5 | 1.9% | <0.001 |
Outcome measures
| |||||||
EPAS – total; m (sd) | 3.42 | 0.60 | 3.42 | 0.62 | 3.42 | 0.59 | 0.959 |
– daily living; m (sd) | 3.62 | 0.70 | 3.58 | 0.71 | 3.67 | 0.68 | 0.165 |
– social relationships and sexuality; m (sd) | 3.21 | 0.72 | 3.20 | 0.75 | 3.23 | 0.70 | 0.640 |
– psychiatric treatment; m (sd) | 3.66 | 0.66 | 3.72 | 0.67 | 3.61 | 0.64 | 0.045 |
– hope and self-efficacy; m (sd) | 3.19 | 0.80 | 3.18 | 0.81 | 3.20 | 0.79 | 0.753 |
– self-esteem; m (sd) | 3.41 | 0.80 | 3.41 | 0.83 | 3.40 | 0.77 | 0.899 |
– empowerment at work (n = 250); m (sd) | 3.43 | 0.81 | 3.43 | 0.83 | 3.42 | 0.80 | 0.900 |
– parenting of minor children (n = 96); m (sd) | 3.68 | 0.73 | 3.85 | 0.70 | 3.56 | 0.72 | 0.054 |
HONOS - total; m (sd) | 10.66 | 5.30 | 10.53 | 5.12 | 10.79 | 5.48 | 0.576 |
number of needs; m (sd) | 4.70 | 2.63 | 5.07 | 2.70 | 4.34 | 2.51 | 0.002 |
proportion of met needs; m (sd) | 59.5% | 68.2% | 62.9% | 69.6% | 56.2% | 67.2% | 0.017 |
QOL-BREF; m (sd) | 48.86 | 22.04 | 48.63 | 22.64 | 49.08 | 21.49 | 0.818 |
satisfaction score; m (sd) | 24.22 | 4.43 | 24.51 | 4.53 | 23.94 | 4.33 | 0.154 |
OR | 95%-CI | |||
---|---|---|---|---|
age, years [+ 1] | 1.017 | 0.995 | - | 1.041 |
employment statusa
| 1.684 | 1.052 | - | 2.695 |
childrena
| 1.027 | 0.618 | - | 1.704 |
living alonea
| 0.966 | 0.571 | - | 1.637 |
femalea
| 1.346 | 0.855 | - | 2.119 |
higher secondary school qualificationa
| 0.752 | 0.432 | - | 1.311 |
in partnershipa
| 0.853 | 0.506 | - | 1.439 |
reception of Hartz IV benefita
| 0.858 | 0.458 | - | 1.605 |
reception of social welfarea
| 0.522 | 0.163 | - | 1.672 |
duration of illness [+ 1] | 0.997 | 0.977 | - | 1.017 |
number of psychiatric inpatient admissions [+ 1] | 1.131 | 1.045 | - | 1.225 |
reception of sickness benefit (last 6 months) a
| 2.950 | 1.838 | - | 4.717 |
any diagnosis F20-F29a
| 1.410 | 0.627 | - | 3.175 |
any diagnosis F30-F39a
| 1.321 | 0.701 | - | 2.488 |
multiple psychiatric diagnosesa
| 0.747 | 0.474 | - | 1.176 |
prescription of antipsychoticsa
| 0.787 | 0.479 | - | 1.294 |
motivation for outpatient care (instead of inpatient care) a
| 1.845 | 1.149 | - | 2.967 |
mental guardiana
| 1.263 | 0.429 | - | 3.717 |
assisted livinga
| 0.371 | 0.123 | - | 1.122 |
frequent contact with familya
| 1.481 | 0.808 | - | 2.717 |
body mass index [+1 kg/m2] | 1.016 | 0.982 | - | 1.052 |
smokera
| 0.793 | 0.511 | - | 1.230 |
HONOS total score [+ 1] | 0.959 | 0.906 | - | 1.015 |
CAN needs [+ 1] | 1.145 | 1.030 | - | 1.274 |
CAN proportion of unmet needs [+ 100%] | 0.486 | 0.232 | - | 1.017 |
QOL-BREF total Score [+ 1] | 1.006 | 0.991 | - | 1.021 |
QOL-dimension 1 Score [+ 1] | 0.983 | 0.961 | - | 1.006 |
QOL-dimension 2 Score [+ 1] | 1.010 | 0.989 | - | 1.031 |
QOL-dimension 4 Score [+ 1] | 0.991 | 0.972 | - | 1.010 |
CSQ-8 satisfaction score [+ 1] | 1.045 | 0.992 | - | 1.101 |
total costs (last 6 months) [+ 1 €] | 1.000 | 1.000 | - | 1.000 |
Primary outcome effect
b | se |
p
| 95%-CI | n | ||||
---|---|---|---|---|---|---|---|---|
EPAS - total | Intercept | 3.27 | 0.06 |
<0.001
| 3.15 | - | 3.39 | 511 |
IC | −0.10 | 0.07 | 0.406 | −0.20 | - | 0.07 | ||
Time | 0.07 | 0.01 |
<0.001
| 0.05 | - | 0.09 | ||
IC x Time | 0.02 | 0.01 | 0.258 | 0.00 | - | 0.04 | ||
PS | 0.23 | 0.12 | 0.054 | 0.00 | - | 0.47 | ||
EPAS - daily living | Intercept | 3.33 | 0.07 |
<0.001
| 3.20 | - | 3.47 | 511 |
IC | 0.00 | 0.08 | 0.934 | −0.20 | - | 0.14 | ||
Time | 0.06 | 0.01 |
<0.001
| 0.04 | - | 0.09 | ||
IC x Time | 0.00 | 0.02 | 0.91 | 0.00 | - | 0.03 | ||
PS | 0.44 | 0.13 |
<0.001
| 0.18 | - | 0.69 | ||
EPAS - social relationships and sexuality | Intercept | 3.03 | 0.07 |
<0.001
| 2.89 | - | 3.17 | 511 |
IC | 0.00 | 0.08 | 0.838 | −0.20 | - | 0.14 | ||
Time | 0.07 | 0.01 |
<0.001
| 0.05 | - | 0.09 | ||
IC x Time | 0.00 | 0.02 | 0.725 | 0.00 | - | 0.03 | ||
PS | 0.26 | 0.14 | 0.061 | 0.00 | - | 0.53 | ||
EPAS - psychiatric treatment participation | Intercept | 3.71 | 0.07 |
<0.001
| 3.58 | - | 3.85 | 511 |
IC | −0.20 | 0.07 |
0.026
| −0.30 | - | 0.00 | ||
Time | 0.04 | 0.01 |
0.005
| 0.01 | - | 0.06 | ||
IC x Time | 0.06 | 0.02 |
0.001
| 0.02 | - | 0.09 | ||
PS | 0.01 | 0.13 | 0.928 | −0.20 | - | 0.26 | ||
EPAS - hope and self-efficacy | Intercept | 3.02 | 0.08 |
<0.001
| 2.86 | - | 3.18 | 511 |
IC | 0.00 | 0.09 | 0.751 | −0.20 | - | 0.14 | ||
Time | 0.10 | 0.01 |
<0.001
| 0.07 | - | 0.13 | ||
IC x Time | 0.01 | 0.02 | 0.698 | 0.00 | - | 0.05 | ||
PS | 0.19 | 0.15 | 0.227 | −0.10 | - | 0.49 | ||
EPAS - self-esteem | Intercept | 3.23 | 0.08 |
<0.001
| 3.07 | - | 3.39 | 511 |
IC | −0.10 | 0.09 | 0.417 | −0.20 | - | 0.10 | ||
Time | 0.07 | 0.01 |
<0.001
| 0.05 | - | 0.10 | ||
IC x Time | 0.02 | 0.02 | 0.352 | 0.00 | - | 0.05 | ||
PS | 0.31 | 0.15 |
0.045
| 0.01 | - | 0.61 | ||
EPAS - empowerment at work | Intercept | 3.53 | 0.12 |
<0.001
| 3.30 | - | 3.76 | 358 |
IC | 0.12 | 0.13 | 0.328 | −0.10 | - | 0.37 | ||
Time | 0.09 | 0.03 |
<0.001
| 0.04 | - | 0.14 | ||
IC x Time | 0.01 | 0.03 | 0.826 | −0.10 | - | 0.07 | ||
PS | −0.40 | 0.19 |
0.046
| −0.80 | - | 0.00 | ||
EPAS - parenting of minor children | Intercept | 3.80 | 0.18 |
<0.001
| 3.45 | - | 4.16 | 122 |
IC | −0.20 | 0.18 | 0.299 | −0.50 | - | 0.17 | ||
Time | 0.00 | 0.04 | 0.991 | −0.10 | - | 0.07 | ||
IC x Time | 0.06 | 0.05 | 0.194 | 0.00 | - | 0.15 | ||
PS | −0.10 | 0.30 | 0.875 | −0.60 | - | 0.55 | ||
HoNOS - total | Intercept | 11.40 | 0.54 |
<.001
| 10.30 | - | 12.40 | 511 |
IC | 0.74 | 0.58 | 0.2 | −0.40 | - | 1.88 | ||
Time | −0.30 | 0.11 |
0.013
| −0.50 | - | −0.10 | ||
IC x Time | −0.30 | 0.16 | 0.108 | −0.60 | - | 0.06 | ||
PS | −1.80 | 0.97 | 0.071 | −3.70 | - | 0.15 | ||
CAN - needs | Intercept | 6.61 | 0.25 |
<.001
| 6.11 | - | 7.10 | 511 |
IC | 0.00 | 0.28 | 0.996 | −0.60 | - | 0.55 | ||
Time | −0.50 | 0.05 |
<.001
| −0.60 | - | −0.40 | ||
IC x Time | 0.09 | 0.07 | 0.217 | −0.10 | - | 0.23 | ||
PS | −3.00 | 0.44 |
<.001
| −3.80 | - | −2.10 | ||
CAN - proportion of met needs | Intercept | 0.60 | 0.03 |
<.001
| 0.55 | - | 0.66 | 511 |
IC | 0.00 | 0.04 | 0.329 | −0.10 | - | 0.03 | ||
Time | 0.05 | 0.01 |
<.001
| 0.03 | - | 0.07 | ||
IC x Time | 0.01 | 0.01 | 0.621 | 0.00 | - | 0.03 | ||
PS | −0.10 | 0.05 | 0.314 | −0.10 | - | 0.04 | ||
CSQ-8 satisfaction score | Intercept | 24.80 | 0.43 |
<.001
| 23.90 | - | 25.60 | 511 |
IC | −0.30 | 0.47 | 0.467 | −1.30 | - | 0.58 | ||
Time | 0.42 | 0.09 |
<.001
| 0.24 | - | 0.61 | ||
IC x Time | 0.27 | 0.13 |
0.039
| 0.01 | - | 0.53 | ||
PS | −1.10 | 0.76 | 0.136 | −2.60 | - | 0.36 |