title: The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders.
abstract: In this effectiveness trial we compared the long-term effects on hospitalizations of group psychoeducation (GP) versus individual psychoeducation (IP) for a heterogeneous sample of patients with BD recruited from general clinical settings.
  
  
  
  Eighty-five patients with BD were randomized to receive 10 weekly sessions of GP followed by 8 booster-sessions over the next two years, or three sessions of IP. Time to first admission over the course of GP was the primary outcome measure, with additional outcomes examining the use of psychiatric services over about 8 years.
  
  
  
  Patients allocated to GP had longer survival time compared to IP over 27 months (p<0.05). There were also group differences in survival time over 8 years, but treatment allocation alone was no longer a significant predictor of survival time (p=0.07). There was an interaction between group (GP/IP) and harmful substance use (HSU), such that GP cases with comorbid HSU had the shortest survival time, whilst GP cases without HSU survived the longest (p=0.02). Also, GP cases had a small but significant reduction in hospital use compared with IP (p=0.04).
  
  
  
  We did not have a 'pure' treatment as usual group. Wide confidence intervals for some of the odds ratios suggest that the findings need to be treated with some caution. Insufficient sample size for more detailed subgroup analyses.
  
  
  
  GP is superior to IP in delaying hospitalizations in a clinically representative population. However, GP did not prevent or delay admissions in BD patients with HSU.
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway. Electronic address: havard.kallestad@ntnu.no.
authors.forename: Håvard
authors.initials: H
authors.lastname: Kallestad
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Helgeland Hospital Trust, Mo i Rana, Norway.
authors.forename: Elin
authors.initials: E
authors.lastname: Wullum
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Academic Psychiatry, Institute of Neuroscience, University of Newcastle, Newcastle Upon Tyne, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.affiliation: Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Tore C
authors.initials: TC
authors.lastname: Stiles
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Morken
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Alcohol and substance misuse; Bipolar disorders; Hospitalization; Psychoeducation; Survival analysis