Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial.

Bert-Jan Roosenschoon,Cornelis L Mulder,Astrid M Kamperman,Jaap Van Weeghel,Emmie W Van Esveld,Mathijs L Deen

doi:10.3389/fpsyt.2021.723435

Bert-Jan Roosenschoon, Cornelis L Mulder + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2021.723435

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Abstract

There have been inconsistent findings in the literature with respect to the efficacy of Illness Management and Recovery (IMR) in the psychosocial treatment of people with schizophrenia or other severe mental illnesses. This study aimed to comprehensively investigate the effectiveness of IMR, including the impact of completion and fidelity. In this randomized controlled trial (RCT), 187 outpatients received either IMR plus care as usual (CAU) or only CAU. Multilevel modeling was implemented to investigate group differences over an 18-month period, comprising 12 months of treatment and six months of follow-up. The primary outcome was overall illness management, which was assessed using the client version of the IMR scale. Secondary outcomes included measures regarding illness management, clinical, personal, and functional recovery, and hospitalizations. The interviewers were blinded to group allocation. This clinical trial was registered with the Netherlands Trial Register (NL4931, NTR5033). Patients who received IMR showed statistically significant improvement in self-reported overall illness management (the primary outcome). Moreover, they showed an improvement in self-esteem, which is a component of personal recovery. There were no effects within the other questionnaires. There were also no statistically significant between-group differences in terms of hospitalizations. Patients in both groups showed statistically significant improvement in clinician-rated overall illness management, social support, clinical and functional recovery, and self-stigma over time. IMR completion was associated with stronger effects. High IMR fidelity was associated with self-esteem. This study confirms the efficacy of IMR in overall illness self-management. To our knowledge, this is the first RCT on IMR to explore the impact of fidelity on treatment efficacy. Future studies should further establish efficacy in personal recovery. To improve efficacy, it appears important to promote IMR completion and fidelity.

Highlights

Patients with schizophrenia and other severe mental illnesses (SMIs) face major challenges in achieving personal goals and fully participating in society
As compared with the control group, the Illness Management and Recovery (IMR) group showed a statistically significant improvement in the primary outcome measure (Table 2)
Our results support the effectiveness of IMR in overall illness self-management

Summary

Introduction

Patients with schizophrenia and other severe mental illnesses (SMIs) face major challenges in achieving personal goals and fully participating in society. This is due to their recurring symptomatology, cognitive impairment, loss of social support, and societal barriers such as stigma [1, 2]. Treatment with psychopharmacological drugs facilitates reductions in symptom severity and relapse, there is a need for effective psychosocial interventions to support participants in illness selfmanagement The aim of these interventions is to develop fulfilling and valued workplace roles and social connections, to obtain housing, and to facilitate self-determination and well-being [1, 3,4,5,6]. These programs seek to improve the course of illness [1, 7, 8]

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