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Articles   |    
E–Mental Health Self-Management for Psychotic Disorders: State of the Art and Future Perspectives
Lian van der Krieke, M.Sc., M.A.; Lex Wunderink, M.D., Ph.D.; Ando C. Emerencia, M.Sc.; Peter de Jonge, Ph.D.; Sjoerd Sytema, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300050
View Author and Article Information

Ms. van der Krieke, Dr. de Jonge, and Dr. Sytema are with the University Center for Psychiatry, University Medical Center Groningen, University of Groningen, the Netherlands (e-mail: j.a.j.van.der.krieke@umcg.nl). Dr. Wunderink is with Friesland Mental Health Care Services, Leeuwarden, the Netherlands. Mr. Emerencia is with the Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, the Netherlands.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The aim of this review was to investigate to what extent information technology may support self-management among service users with psychotic disorders. The investigation aimed to answer the following questions: What types of e–mental health self-management interventions have been developed and evaluated? What is the current evidence on clinical outcome and cost-effectiveness of the identified interventions? To what extent are e–mental health self-management interventions oriented toward the service user?

Methods  A systematic review of references through July 2012 derived from MEDLINE, PsycINFO, AMED, CINAHL, and the Library, Information Science and Technology database was performed. Studies of e–mental health self-management interventions for persons with psychotic disorders were selected independently by three reviewers.

Results  Twenty-eight studies met the inclusion criteria. E–mental health self-management interventions included psychoeducation, medication management, communication and shared decision making, management of daily functioning, lifestyle management, peer support, and real-time self-monitoring by daily measurements (experience sampling monitoring). Summary effect sizes were large for medication management (.92) and small for psychoeducation (.37) and communication and shared decision making (.21). For all other studies, individual effect sizes were calculated. The only economic analysis conducted reported more short-term costs for the e–mental health intervention.

Conclusions  People with psychotic disorders were able and willing to use e–mental health services. Results suggest that e–mental health services are at least as effective as usual care or nontechnological approaches. Larger effects were found for medication management e–mental health services. No studies reported a negative effect. Results must be interpreted cautiously, because they are based on a small number of studies.

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Table 1Clinical trials of e–mental health interventions for people with psychotic illness
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aAll participants were adults with a diagnosis of schizophrenia or a related psychotic disorder, unless specified otherwise.

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bRecruitment by systematic identification refers to a strategy in which participants were identified in a systematic way, with strict inclusion and exclusion criteria, within one or more departments of a health care service. Recruitment by population-based invitation refers to a strategy in which members of broadly defined populations received an open invitation. Recruitment by convenience sampling refers to a nonprobability method in which participants were selected because they were easy to recruit.

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cRCT, randomized controlled trial

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dTIPS, telephone intervention for problem solving; SMS, short-message system; ITAREPS, Information Technology-Aided Program of Relapse Prevention in Schizophrenia

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eIn case of multiple control groups, the first group was included in the analysis.

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fPANSS, Positive and Negative Syndrome Scale; CGI, Clinical Global Impression Scale; KISS, Knowledge and Information About Schizophrenia Schedule; BPRS, Brief Psychiatric Rating Scale; ITAQ, Insight and Treatment Attitudes Questionnaire; GAF, Global Assessment of Functioning; RAS, Recovery Assessment Scale; MOS, Medical Outcomes Study social support; HSCL, Hopkins Symptom Checklist; PSS-Fin, Patient Satisfaction Scale (Finnish version); MANSA, Manchester Short Assessment of Quality of Life; CANSAS-P, self-rated version of the Camberwell Assessment of Need Short Appraisal Schedule; RIAS, Roter Interaction Analysis System

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gDifferences refer to statistically significant differences.

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hDropout percentages are based on the number of enrolled service users. In case of recruitment by systematic identification and recruitment by population-based invitation, dropout percentages for the total N based on the number of invited service users are included in parentheses. “Not reported” means that studies did not present figures about eligibility and enrollment.

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iThe maximum possible score was 28, and quality scores were grouped into the following four levels: excellent, 26–28; good, 20–25; fair, 15–19; poor, <15.

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jSchizophrenia spectrum disorder (22%) or affective disorder (78%)

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kRelated publications: Koivunen et al., 2007 (63), 2010 (64); Anttila et al. (65), 2008; Välimäki et al. (66), 2008; Hätönen et al. (67), 2010; Pitkänen et al. (68), 2011

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lIncludes 13 pilot study participants

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mRelated publication: Hansson et al. (70), 2008

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nParticipants were over 14 years old; in addition, the study included 24 support persons.

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oN is mental health appointments; 458 (16%) were appointments for service users with a psychotic disorder (mean age of 43 years).

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pPercentage of appointments with male service users

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qParticipants were over 13 years old; in addition, the study included 20 clinicians.

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rIn addition, the study included 20 case managers.

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Table 2Feasibility and acceptability studies of e–mental health interventions for people with psychotic illnessa
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aAll participants had a diagnosis of schizophrenia or a related psychotic disorder, unless specified otherwise. NA, not applicable because research is ongoing; NR, not reported; PDA, personal digital assistant

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bRecruitment by systematic identification refers to a strategy in which participants were identified in a systematic way, with strict inclusion and exclusion criteria, within one or more departments of a health care service. Recruitment by population-based invitation refers to a strategy in which members of broadly defined populations received an open invitation. Recruitment by convenience sampling refers to a nonprobability method in which participants were selected because they were easy to recruit.

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cBased on the number of enrolled service users. In case of recruitment by systematic identification dropout percentages for the total N based on the number of invited service users are mentioned between brackets.

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dDropout rate based on 5 invited

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eMeasured by the University of California, San Diego, Performance-Based Skills Assessment

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fThe number invited was unknown.

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gThe user group included professionals as well as 4 service users.

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hOnly 4 service users were willing to participate, whereas researchers hoped for more.

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iDropout rate based on 50 invited

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Table 3Types of service user involvement in studies of e–mental health interventions for people with psychotic illnessa
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aReported items are checked (✓); items that were either not reported or reported in the study as not being included are marked with a dash. NA, not applicable

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