Effects of Individual Placement and Support Supplemented with Cognitive Remediation and Work-Focused Social Skills Training for People with Severe Mental Illness: A Randomized Clinical Trial

Thomas Nordahl Christensen*, Iben Gammelgård Wallstrøm, Elsebeth Stenager, Anders Bo Bojesen, Christian Gluud, Merete Nordentoft, Lene Falgaard Eplov

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Importance: Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). Objectives: To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. Design, Setting, and Participants: This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. Interventions: Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. Main Outcomes and Measures: The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. Results: Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3%] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5%]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95% CI, 0.01-0.295]; P =.016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95% CI, -0.017 to 0.276]; P =.004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95% CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95% CI, 0.187-0.478]). Conclusions and Relevance: Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. Trial Registration: ClinicalTrials.gov identifier: NCT01722344.

OriginalsprogEngelsk
TidsskriftJAMA Psychiatry
Vol/bind76
Udgave nummer12
Sider (fra-til)1232-1240
ISSN2168-622X
DOI
StatusUdgivet - dec. 2019

Fingeraftryk

Randomized Controlled Trials
Education
Denmark
Community Mental Health Services
Self-Help Groups
Self Efficacy
Individuality
Research Personnel
Outcome Assessment (Health Care)
Cognitive Remediation
Social Skills
Population

Citer dette

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title = "Effects of Individual Placement and Support Supplemented with Cognitive Remediation and Work-Focused Social Skills Training for People with Severe Mental Illness: A Randomized Clinical Trial",
abstract = "Importance: Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). Objectives: To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. Design, Setting, and Participants: This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. Interventions: Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. Main Outcomes and Measures: The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. Results: Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3{\%}] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5{\%}]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95{\%} CI, 0.01-0.295]; P =.016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95{\%} CI, -0.017 to 0.276]; P =.004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95{\%} CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95{\%} CI, 0.187-0.478]). Conclusions and Relevance: Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. Trial Registration: ClinicalTrials.gov identifier: NCT01722344.",
author = "Christensen, {Thomas Nordahl} and Wallstr{\o}m, {Iben Gammelg{\aa}rd} and Elsebeth Stenager and Bojesen, {Anders Bo} and Christian Gluud and Merete Nordentoft and Eplov, {Lene Falgaard}",
year = "2019",
month = "12",
doi = "10.1001/jamapsychiatry.2019.2291",
language = "English",
volume = "76",
pages = "1232--1240",
journal = "Archives of General Psychiatry",
issn = "0003-990X",
publisher = "The JAMA Network",
number = "12",

}

Effects of Individual Placement and Support Supplemented with Cognitive Remediation and Work-Focused Social Skills Training for People with Severe Mental Illness : A Randomized Clinical Trial. / Christensen, Thomas Nordahl; Wallstrøm, Iben Gammelgård; Stenager, Elsebeth; Bojesen, Anders Bo; Gluud, Christian; Nordentoft, Merete; Eplov, Lene Falgaard.

I: JAMA Psychiatry, Bind 76, Nr. 12, 12.2019, s. 1232-1240.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Effects of Individual Placement and Support Supplemented with Cognitive Remediation and Work-Focused Social Skills Training for People with Severe Mental Illness

T2 - A Randomized Clinical Trial

AU - Christensen, Thomas Nordahl

AU - Wallstrøm, Iben Gammelgård

AU - Stenager, Elsebeth

AU - Bojesen, Anders Bo

AU - Gluud, Christian

AU - Nordentoft, Merete

AU - Eplov, Lene Falgaard

PY - 2019/12

Y1 - 2019/12

N2 - Importance: Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). Objectives: To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. Design, Setting, and Participants: This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. Interventions: Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. Main Outcomes and Measures: The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. Results: Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3%] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5%]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95% CI, 0.01-0.295]; P =.016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95% CI, -0.017 to 0.276]; P =.004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95% CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95% CI, 0.187-0.478]). Conclusions and Relevance: Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. Trial Registration: ClinicalTrials.gov identifier: NCT01722344.

AB - Importance: Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). Objectives: To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. Design, Setting, and Participants: This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. Interventions: Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. Main Outcomes and Measures: The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. Results: Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3%] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5%]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95% CI, 0.01-0.295]; P =.016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95% CI, -0.017 to 0.276]; P =.004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95% CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95% CI, 0.187-0.478]). Conclusions and Relevance: Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. Trial Registration: ClinicalTrials.gov identifier: NCT01722344.

U2 - 10.1001/jamapsychiatry.2019.2291

DO - 10.1001/jamapsychiatry.2019.2291

M3 - Journal article

C2 - 31483451

AN - SCOPUS:85072030852

VL - 76

SP - 1232

EP - 1240

JO - Archives of General Psychiatry

JF - Archives of General Psychiatry

SN - 0003-990X

IS - 12

ER -