A randomized controlled trial of illness management and recovery with an active control group.

Abstract

The purpose of the study was to rigorously test Illness Management and Recovery (IMR) against an active control group in a sample that included veterans. A total of 118 participants with schizophrenia spectrum disorders, 56 of whom were veterans, were recruited from a Department of Veterans Affairs medical center and a community mental health center in the same city and were randomly assigned to an IMR group (N=60) or a weekly problem-solving group intervention (N=58). Groups met weekly for nine months. Blinded assessments were conducted at baseline, nine months, and 18 months on measures of symptoms, functioning, illness self-management, medication adherence, subjective recovery experiences, and service utilization. No significant differences were found between IMR and problem-solving groups. Participants in both groups improved significantly over time in symptom severity, illness management, and quality of life and had fewer emergency department visits. Participation rates in both interventions were low. Only 28% of consumers assigned to IMR and 17% of those assigned to the problem-solving group participated in more than half the scheduled groups, and 23% and 34%, respectively, attended no sessions. This is the first randomized controlled trial of IMR to report negative findings. Given the inclusion of an active control group and the low participation rates, further research is needed to understand factors affecting IMR effectiveness. Increased attention may need to be paid to facilitate more active participation in IMR, such as individual follow-up with consumers and the integration of IMR with ongoing treatment.