Comparison of educational interventions for mental health consumers receiving psychotropic medication.
BACKGROUND
One in four people globally will be affected by mental disorders at some point in their life. Currently approximately 450 million people worldwide suffer from this condition thereby placing mental health disorders among the leading cause of illness. Although treatment with psychotropic medication for specific psychological interventions has been demonstrated to be beneficial, it is also associated with relapse due to non-adherence to the medication regime. Factors associated with non-compliance include inadequate knowledge of the condition and the side-effects of the drugs. However, there is still some debate amongst psychiatrists as to the relative benefits of informing consumers about the side-effects.


OBJECTIVE
The objective of this review was to systematically assess the literature and present the best available evidence that investigated the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder.


METHODS
A literature search was performed using the following databases Medline (1966-2000), CINAHL (1982-2002), EMBASE (1980-2002) ProQuest, Psychlit and the Cochrane Controlled Trials Register (Issue 2, 2002 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. No language restrictions were applied. Experts and investigators were contacted to elicit further information.


METHODS
All relevant randomised controlled trials that investigated the effectiveness of providing education and the methods to provide education to adult consumers with a mental illness were eligible for inclusion in the study.


METHODS
Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials was assessed jointly by two reviewers. All information was verified by a third reviewer. Odds ratio for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate a narrative overview was undertaken.


RESULTS
Twenty-one studies were included in this review. Knowledge was assessed in 15 studies. Compliance was assessed in 13 studies. Relapse was assessed in five studies and insight was assessed in six studies. Those patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared to those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion was demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge gains in the short term (up to 1 month); however, the effectiveness of multiple sessions in the long term (2 years) was inconclusive. The review provides evidence that multiple education sessions are better than single education sessions in improving knowledge relating to medications and insight into illness.


CONCLUSIONS
Evidence from the trials demonstrates that structured educational interventions delivered at frequent intervals are useful as part of the treatment program for people with a mental illness. More well-designed and reported randomised studies investigating the efficacy of education are urgently needed.
1South Western Sydney Centre for Applied Nursing Research, 2 School of Nursing, Family and Community Health, University of Western Sydney, Sydney, New South Wales, Australia.
Rhonda D
RD
Griffiths
Ritin S
RS
Fernandez
Maria S
MS
Mostacchi
Venita
V
Evans