title: Effectiveness of a rehabilitative program that integrates hospital and community services for patients with schizophrenia in one community in Shanghai.
abstract: BACKGROUND
  One possible reason for the less than satisfactory long-term outcomes for schizophrenia is the lack of coordination between inpatient and community-based services.
  
  
  OBJECTIVE
  Assess the effectiveness of a rehabilitation model for schizophrenia that integrates hospital and community services.
  
  
  METHODS
  Ninety patients with schizophrenia participating in an integrated rehabilitation program at 10 community centers in Changning, Shanghai (intervention group) and 52 community-based patients with schizophrenia randomly selected from all patients in Changning participating in routine outpatient care (control group) were assessed at enrollment using the Positive and Negative Syndrome Scale (PANSS) and the Morningside Rehabilitation Status Scale (MRSS) and then re-assessed 1 year later by clinicians who were blind to the group assignment of the patients. The patients' registered guardians (the vast majority were co-resident family members) were assessed at the same times using the Family Burden Scale (FBS), the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS).
  
  
  RESULTS
  At enrollment the clinical status of patients in the two groups (assessed with PANSS) was similar but the social functioning measures assessed by MRSS were significantly worse in the intervention group than in the control group. After one year the improvement of both clinical symptoms and social functioning measures were significantly greater in the intervention group than in the control group. In the year of follow-up, 3 individuals (3.3%) in the intervention group and 6 individuals (11.5%) in the control group were re-hospitalized (Fisher Exact Test, p=0.074). The feelings of burden, depression, anxiety and reported social support among guardians of patients in the intervention group were not significantly different from those for guardians of patients in the control group either at the time of enrollment or after the 1-year intervention. However, guardians in the intervention group showed a significant decrease in depressive and anxiety symptoms over the one-year follow-up.
  
  
  CONCLUSIONS
  Rehabilitative approaches that integrate hospital and community services can improve clinical and social outcomes for patients with schizophrenia. Further development of these programs is needed to increase the proportion of patients who achieve regular employment (i.e., 'community re-integration') and to provide family members with better psychosocial support.
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Tao
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Lanjun
authors.initials: L
authors.lastname: Song
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Niu
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xuehai
authors.initials: X
authors.lastname: Li
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Qiongting
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Cui
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: Changning District Mental Health Center, Shanghai, China.
authors.forename: Zhenghui
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Changning District Hospital, Shanghai, China.
authors.forename: Wenli
authors.initials: W
authors.lastname: Fang