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A Randomized Controlled Trial of Illness Management and Recovery With an Active Control Group
Michelle P. Salyers, Ph.D.; Alan B. McGuire, Ph.D.; Marina Kukla, Ph.D.; Sadaaki Fukui, Ph.D.; Paul H. Lysaker, Ph.D.; Kim T. Mueser, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300354
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Dr. Salyers, Dr. McGuire, and Dr. Kukla are with the Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis (e-mail: mpsalyer@iupui.edu). Dr. McGuire and Dr. Kukla are also with the Department of Health Services Research and Development, Roudebush Veterans Affairs Medical Center, Indianapolis, where Dr. Lysaker is with the Department of Psychiatry. Dr. Lysaker is also with the Indiana University School of Medicine, Indianapolis. Dr. Fukui is with the School of Social Welfare, University of Kansas, Lawrence. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  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.

Methods  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.

Results  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.

Conclusions  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.

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Table 1Characteristics of participants randomly assigned to Illness Management and Recovery (IMR) or a problem-solving control group (PS)
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Table 2Scores at three time points and group and time effects for 118 participants randomly assigned to Illness Management and Recovery or a problem-solving control groupa
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a Descriptive statistics are simple statistics for means without any covariates adjusted. Group and time effects were tested for the mean differences adjusting for the covariates (baseline scores and site) and accounting for the missing data.

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b Reported test values are F tests for interview-based measures and chi square tests for measures of service utilization.

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c Positive and Negative Syndrome Scale. Possible total scores range from 30 to 210, with higher scores indicating more severe symptoms.

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d Possible scores range from 0 to 6, with higher scores indicating better quality of life.

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e Possible scores range from 1 to 5, with higher scores indicating better self-management.

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f Possible scores range from 0 to 100, with higher scores indicating higher activation.

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g Measured with the Morisky Scale. Possible scores range from 0 to 4, with higher scores indicating poorer adherence.

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h Possible scores range from 1 to 4, with higher scores indicating better perceived recovery.

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