title: Social skills programmes for schizophrenia.
abstract: BACKGROUND
  Social skills programmes (SSP) are treatment strategies aimed at enhancing the social performance and reducing the distress and difficulty experienced by people with a diagnosis of schizophrenia and can be incorporated as part of the rehabilitation package for people with schizophrenia.
  
  
  OBJECTIVE
  The primary objective is to investigate the effects of social skills training programmes, compared to standard care, for people with schizophrenia.
  
  
  METHODS
  We searched the Cochrane Schizophrenia Group's Trials Register (November 2006 and December 2011) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. We inspected references of all identified studies for further trials.A further search for studies has been conducted by the Cochrane Schizophrenia Group in 2015, 37 citations have been found and are currently being assessed by review authors.
  
  
  METHODS
  We included all relevant randomised controlled trials for social skills programmes versus standard care involving people with serious mental illnesses.
  
  
  METHODS
  We extracted data independently. For dichotomous data we calculated risk ratios (RRs) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD) and 95% CIs.
  
  
  RESULTS
  We included 13 randomised trials (975 participants). These evaluated social skills programmes versus standard care, or discussion group. We found evidence in favour of social skills programmes compared to standard care on all measures of social functioning. We also found that rates of relapse and rehospitalisation were lower for social skills compared to standard care (relapse: 2 RCTs, n = 263, RR 0.52 CI 0.34 to 0.79, very low quality evidence), (rehospitalisation: 1 RCT, n = 143, RR 0.53 CI 0.30 to 0.93, very low quality evidence) and participants' mental state results (1 RCT, n = 91, MD -4.01 CI -7.52 to -0.50, very low quality evidence) were better in the group receiving social skill programmes. Global state was measured in one trial by numbers not experiencing a clinical improvement, results favoured social skills (1 RCT, n = 67, RR 0.29 CI 0.12 to 0.68, very low quality evidence). Quality of life was also improved in the social skills programme compared to standard care (1 RCT, n = 112, MD -7.60 CI -12.18 to -3.02, very low quality evidence). However, when social skills programmes were compared to a discussion group control, we found no significant differences in the participants social functioning, relapse rates, mental state or quality of life, again the quality of evidence for these outcomes was very low.
  
  
  CONCLUSIONS
  Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.
authors.affiliation: Department of General Surgery, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK, LS9 7TF.
authors.forename: Muhammad Qutayba
authors.initials: MQ
authors.lastname: Almerie
authors.forename: Muhammad
authors.initials: M
authors.lastname: Okba Al Marhi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Jawoosh
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alsabbagh
authors.forename: Hosam E
authors.initials: HE
authors.lastname: Matar
authors.forename: Nicola
authors.initials: N
authors.lastname: Maayan
authors.forename: Hanna
authors.initials: H
authors.lastname: Bergman
mesh_terms: D000328:Adult; D001242:Assertiveness; D003142:Communication; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000534:rehabilitation*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D066107:Social Skills; D013315:Stress, Psychological / Q000534:rehabilitation*