Factors influencing patients' recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial.
The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme.



RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18-64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU).



Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU.



According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks.



This study was supported by a private foundation.



ISRCTN58280620.
Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland. michaelpascal.hengartner@zhaw.ch.
Michael P
MP
Hengartner
Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland.
Silvia
S
Passalacqua
Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (Ipw), Winterthur, Switzerland.
Gisela
G
Heim
Integrated Psychiatric Clinic of Winterthur and Zurich Unterland (Ipw), Winterthur, Switzerland.
Andreas
A
Andreae
Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.|Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paolo, Sao Paulo, Brazil.
Wulf
W
Rössler
Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037, Zurich, Switzerland.
Agnes
A
von Wyl
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D013557:Switzerland; D055815:Young Adult
Case management; Discharge intervention; Randomized controlled trial; Recovery; Social support