Effectiveness of self-management training in community residents with chronic schizophrenia: a single-blind randomized controlled trial in Shanghai, China.

Abstract

AimEvaluate the effectiveness of self-management training in community-dwelling adults with schizophrenia.MethodsA total of 201 individuals with chronic schizophrenia (mean duration of illness of 17.4 years) were recruited and randomized into the self-management intervention group (n=103) and treatment-as-usual control group (n=98). The self-management training involved weekly group sessions for 6 months in which basic self-management skills were discussed and modelled followed by monthly group booster sessions for 24 months in which a community health worker reviewed patients’ self-management checklist journals. Two psychiatrists who were blind to group assignment evaluated the symptoms and social functioning of participants at baseline and 6 months and 30 months after enrollment using the Brief Psychiatric Rating Scale (BPRS), Social Disability Screening Schedule (SDSS), and Morningside Rehabilitation Status Scale (MRSS). A total of 194 individuals (99 from the intervention group and 95 from the control group) completed the 2.5-year follow-up. Intention-to-treat analysis with the last observation carried forward method was used for analysis. Results Compared to the control group, the intervention group had lower mean scores in the BPRS, SDSS and MRSS at both follow-up points. The scores in the intervention group continued to improve during the maintenance phase of the treatment from 6 months to 30 months after enrollment.ConclusionSelf-management training is an effective method to improve symptoms and social functioning among individuals with chronic schizophrenia living in the community. After six months of weekly training in self-management skills, monthly booster sessions reviewing patients’ daily checklist of illness-related symptoms events are sufficient to maintain the beneficial effects of the training. Further study of the long-term cost-effectiveness of this method is needed.