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A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial
Franco Mascayano1, Ruben Alvarado1, Howard F Andrews1
1Department of Epidemiology, Mailman School of Public Health, Columbia University (Mascayano, Fader, Pratt, Valencia, Yang, Restrepo Henao, Martínez-Alés, Susser), and Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute (Mascayano, Susser), New York City; Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaiso, Valparaiso, Chile (Alvarado); Faculty of Medicine, Universidad de Chile, Santiago (Alvarado, Jorquera, Rojas, Schilling, Tapia); Departments of Psychiatry and Biostatistics, Columbia University Medical Center, New York City (Andrews, Shriver); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Baumgartner); Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile (Burrone); Instituto de Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro (Cintra, Lovisi, Rodrigues Sarução); Silberman School of Social Work, Hunter College, City University of New York, New York City (Conover); Pan American Health Organization/World Health Organization, Brasilia, Brazil (Dahl); Department of Biostatistics, Columbia University, New York City (Gorroochurn); School of Public Health, Boston University, Boston (Galea); Psychiatric Institute, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro (Mitkiewicz de Souza, Cavalcanti); School of Medicine, Yale University, New Haven, Connecticut (Restrepo-Toro, Rosenheck); Community Access, New York City (Stastny); Faculty of Medicine, Universidad Central de Chile Santiago, Santiago, Chile (Tapia); Department of Social and Behavioral Sciences, New York University, New York City (Yang); University of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Psychiatry, Hospital Universitario de la Princesa, Madrid (Romero Pardo); Department of Psychiatry, Hospital Día Benito Menni, Granollers, Spain (Gomez Alemany).
Objective:
This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months.
Methods:
A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used.
Results:
At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found.
Conclusions:
Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.
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