Feedback-informed treatment in emergency psychiatry; a randomised controlled trial.
BACKGROUND
Immediate patient feedback has been shown to improve outcomes for patients in mild distress but it is unclear whether psychiatric patients in severe distress benefit equally from feedback. This study investigates the efficacy of an immediate feedback instrument in the treatment of patients with acute and severe psychosocial or psychiatric problems referred in the middle of a crisis.


METHODS
A naturalistic mixed diagnosis sample of patients (N = 370) at a Psychiatric Emergency Centre was randomised to a Treatment-as-Usual (TAU) or a Feedback (FB) condition. In the FB condition, feedback on patient progress was provided on a session-by-session basis to both therapists and patients. Outcomes of the two treatment conditions were compared using repeated measures MANCOVA, Last Observation Carried Forward and multilevel analysis.


RESULTS
After 3 months, symptom improvement in FB (ES 0.60) did not significantly differ from TAU (ES 0.71) (p = 0.505). After 6 weeks, FB patients (ES 0.31) actually improved less than TAU patients (0.56) (p = 0.019).


CONCLUSIONS
Patients with psychiatric problems and severe distress seeking emergency psychiatric help did not benefit from direct feedback.


BACKGROUND
Dutch Trial Register, NTR3168 , date of registration 1-9-2009.
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. flipjanvanoenen@gmail.com.|, Baarsjesweg 224, 1058 AA, Amsterdam, The Netherlands. flipjanvanoenen@gmail.com.
Flip Jan
FJ
van Oenen
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.
Suzy
S
Schipper
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.
Rien
R
Van
Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Robert
R
Schoevers
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.
Irene
I
Visch
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.
Jaap
J
Peen
Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.|Klinische Psychologie Vrije Universiteit van Amsterdam, de Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
Jack
J
Dekker
D000328:Adult; D001676:Biofeedback, Psychology; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D012107:Research Design
Crisis intervention; Efficacy; Outcome monitoring; Patient feedback; Randomised controlled trial