Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T00:30:00.591Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of an Assertive Community Treatment program for people with severe schizophrenia in mainland China – a 12-month randomized controlled trial

Published online by Cambridge University Press:  02 July 2018

Xingwei Luo ,
Samuel F. Law ,
Xiang Wang Open the ORCID record for Xiang Wang [Opens in a new window] ,
Jingzheng Shi ,
Wu Zeng ,
Xiaoqian Ma ,
Wendy Chow ,
Shiyan Liu ,
Wei Zhao  and
Xiaoli Liu
...Show all authors
Xingwei Luo
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Samuel F. Law
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Xiang Wang*
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Jingzheng Shi
Affiliation:
Xiangya School of Public Health, Central South University, Changsha, Hunan410078, China
Wu Zeng
Affiliation:
Brandeis University, Waltham MA, 02454, USA
Xiaoqian Ma
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Wendy Chow
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Shiyan Liu
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Wei Zhao
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Xiaoli Liu
Affiliation:
Xiangya School of Public Health, Central South University, Changsha, Hunan410078, China
Shuqiao Yao
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Michael R. Phillips
Affiliation:
Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China Departments of Psychiatry and Global Health, Emory University, Atlanta, GA, USA
*
Author for correspondence: Xiang Wang, E-mail: [email protected] or [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China.

Methods

Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers.

Results

Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life.

Conclusion

Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted.

Keywords

Assertive Community Treatment (ACT)community mental health servicesfamily psychoeducationrandomized controlled trial (RCT)schizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 969 - 979
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allness, DJ and Knoedler, WH (2003) ACT Clients: Whom Is ACT for? In: A Manual for ACT Start-up: Based on the PACT Model of Community Treatment for Persons with Severe and Persistent Mental Illnesses. Arlington, Virginia: NAMI Press.Google Scholar
Andreasen, NC, Flaum, M, Swayze, VWII, Tyrrell, G and Arndt, S (1990) Positive and negative symptoms in schizophreniaA critical reappraisal. Archives of General Psychiatry 47, 615–621.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P and Nordentof, M (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762–771.Google Scholar
Bond, GR and Drake, RE (2015) The critical ingredients of assertive community treatment. World Psychiatry 14, 240–242.Google Scholar
Bond, GR, Drake, RE, Muesser, KT and Latimer, E (2001) Assertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Disease Management and Health Outcomes 9, 142–159.Google Scholar
Botha, UA, Koen, L, Galal, U, Jordaan, E and Niehaus, DJ (2014) The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up. BMC Psychiatry 14, 56.Google Scholar
Botha, UA, Koen, L, Joska, JA, Hering, LM and Oosthuizen, PP (2010) Assessing the efficacy of a modified assertive community-based treatment programme in a developing country. BMC Psychiatry 10, 73.Google Scholar
Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA., Himelhoch, S, Fang, B, Peterson, E, Aquino, PR, Keller, W and Schizophrenia Patient Outcomes Research Team (PORT) (2010) The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin 36, 71–93.Google Scholar
Burns, T (2010) The rise and fall of assertive community treatment? International Review of Psychiatry 22, 130–137.Google Scholar
Chan, SW, Yip, B, Tso, S, Cheng, BS and Tam, W (2009) Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Education and Counselling 75, 67–76.Google Scholar
Chen, H, Phillips, M, Cheng, H, Chen, Q, Chen, X, Fralick, D, Zhang, Y, Liu, M, Huang, J and Bueber, M (2012) Mental health law of the People's Republic of China (English translation with annotations): translated and annotated version of China's new Mental Health Law. Shanghai Archives of Psychiatry 24, 305–321.Google Scholar
Chien, WT and Wong, KF (2007) A family psychoeducation group program for Chinese people with schizophrenia in Hong Kong. Psychiatric Services 58, 1003–1006.Google Scholar
Chow, W, Law, S, Andermann, L, Yang, JA, Leszcz, M, Wong, J and Sadavoy, J (2010) Multi-family psycho-education group for assertive community treatment clients and families of culturally diverse background: a pilot study. Community Mental Health Journal 46, 364–371.Google Scholar
Dieterich, M, Irving, CB, Bergman, H, Khokhar, MA, Park, B and Marshall, M (2017) Intensive case management for severemental illness. Cochrane Database of Systematic Reviews (1), Art. No.: CD007906.Google Scholar
Dixon, L (2000) Assertive community treatment: twenty-five years of gold. Psychiatric Services 51, 759–765.Google Scholar
Dixon, LB, Dickerson, F, Bellack, AS, Bennett, M, Dickinson, D, Goldberg, RW, Lehman, A, Tenhula, WN, Calmes, C, Pasillas, RM, Peer, J and Kreyenbuhl, J and Schizophrenia Patient Outcomes Research Team (PORT) (2010) Schizophrenia patient outcomes research team (PORT): the 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin 36, 48–70Google Scholar
Erhart, SM, Marder, SR and Carpenter, WT (2006) Treatment of schizophrenia negative symptoms future: prospects. Schizophrenia Bulletin 32, 234–237.Google Scholar
Good, BJ and Good, MJ (2012) Significance of the 686 Program for China and for global mental health. Shanghai Archives of Psychiatry 24, 175–177.Google Scholar
Guan, LL, Liu, J, Wu, XM, Chen, DF, Wang, X, Ma, N, Wang, Y, Good, B, Ma, H, Yu, X and Good, MJ (2015) Unlocking patients with mental disorders who were in restraints at home: a national follow-up study of China's new public mental health initiatives. PLoS ONE 10, e0121425.Google Scholar
Guy, W (1976) Clinical global impressions. In: ECDEU Assessment Manual for Psychopharmacology, Rockville, MD, U.S. Department of Health, Education, and Welfare, 218–222.Google Scholar
Issakidis, C, Sanderson, K, Teesson, M, Johnston, S and Buhrich, N (1999) Intensive case management in Australia: a randomized controlled trial. Acta Psychiatrica Scandinavica 99, 360–367.Google Scholar
Ito, H, Setoya, Y and Suzuki, Y (2012) Lessons learned in developing community mental health care in East and South East Asia. World Psychiatry 11, 186–190.Google Scholar
Ito, J, Oshima, I, Nishio, M, Sono, T, Suzuki, Y, Horiuchi, K, Niekawa, N, Ogawa, M, Setoya, Y, Hisanaga, F, Kouda, M and Tsukada, K (2011) The effect of assertive community treatment in Japan. Acta Psychiatrica Scandinavica 123, 398–401.Google Scholar
Kay, SR, Fiszbein, A and Opler, LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Kim, TW, Jeong, JH, Kim, YH, Kim, Y, Seo, HJ and Hong, SC (2015) Fifteen-month follow up of an assertive community treatment program for chronic patients with mental illness. BMC Health Services Research 15, 388.Google Scholar
Liem, SK and Lee, CC (2013) Effectiveness of assertive community treatment in Hong Kong among patients with frequent hospital admissions. Psychiatric Services 64, 1170–1172.Google Scholar
Liu, J, Ma, H, He, YL, Xie, B, Xu, YF, Tang, HY, Li, M, Hao, W, Wang, XD, Zhang, MY, Ng, CH, Goding, M, Fraser, J, Herrman, H, Chiu, HF, Chan, SS, Chiu, E and Yu, X (2011) Mental health system in China: history, recent service reform and future challenges. World Psychiatry 10, 210–216.Google Scholar
Low, L, Tan, YY, Lim, BL, Poon, WC and Lee, C (2013) Effectiveness of assertive community management in Singapore. Annals of the Academy of Medicine, Singapore 42, 125–132.Google Scholar
Mansfield, AK, Keitner, GI and Dealy, J (2015) The family assessment device: an update. Family Process 54, 82–93.Google Scholar
Mausbach, BT, Harvey, PD, Goldman, SR, Jeste, DV and Patterson, TL (2007) Development of a brief scale of everyday functioning in persons with serious mental illness. Schizophrenia Bulletin 33, 1364–1372.Google Scholar
Monroe-DeVita, M, Teague, GB and Moser, LL (2011) The TMACT: a new tool for measuring fidelity to assertive community treatment. Journal of American Psychiatric Nurses Association 17, 17–29.Google Scholar
Murray, CJ and Lopez, AD (1996) Evidence-based health policy – lessons from the global burden of disease study. Science 274, 740–743.Google Scholar
Phillips, MR (2004) Mental health in China: challenges and options for the 21st century. Chinese Journal of Neurology and Psychiatry 30, 1–10.Google Scholar
Phillips, MR (2013). Can China's new mental health law substantially reduce the burden of illness attributable to mental disorders? The Lancet 381, 1964–1966.Google Scholar
Phillips, MR, Chen, HH, Diesfeld, K, Xie, B, Cheng, HG, Mellsop, G and Liu, XH (2013) China's new mental health law: reframing involuntary treatment. American Journal of Psychiatry 170, 588–591.Google Scholar
Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, Li, X, Zhang, Y and Wang, Z (2009) Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. The Lancet 373, 2041–2053.Google Scholar
Salyers, MP, McGuire, AB, Rollins, AL, Bond, GR, Mueser, KT and Macy, VR (2010) Integrating assertive community treatment and illness management and recovery for consumers with severe mental illness. Community Mental Health Journal 46, 319–329.Google Scholar
Salyers, MP and Tsemberis, S (2007) ACT and recovery: integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal 43, 619–641.Google Scholar
Sono, T, Oshima, I and Ito, J (2008) Family needs and related factors in caring for a family member with mental illness: adopting assertive community treatment in Japan where family caregivers play a large role in community care. Psychiatry and Clinical Neuroscience 62, 584–590.Google Scholar
The WHOQOL Group (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine 28, 551–558.Google Scholar
Tianmei, S, Liang, S, Yun'ai, S, Chenghua, T, Jun, Y, Jia, C, Xueni, L, Qi, L, Yantao, M, Weihua, Z and Hongyan, Z (2011) The Chinese version of the personal and social performance scale (PSP): validity and reliability. Psychiatry Research 185, 275–279.Google Scholar
Tse, S, Ran, MS, Huang, Y and Zhu, S (2013) Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in China. Psychiatric Services 64, 613–616.Google Scholar
Wang, CY, Xiang, YT, Weng, YZ, Bo, QJ, Chiu, HF, Chan, SS, Lee, EH and Ungvari, GS (2010) Cigarette smoking in patients with schizophrenia in China: prospective, multicentre study. Australian and New Zealand Journal of Psychiatry 44, 456–462.Google Scholar
Wang, X, Zhang, W, Ma, N, Guan, L, Law, SF, Yu, X and Ma, H (2016) Adherence to antipsychotic medication by community-based patients with schizophrenia in China: a cross-sectional study. Psychiatric Services 67, 431–437.Google Scholar
Winter, JP and Calsyn, RJ (2000) The Dartmouth assertive community treatment scale (DACTS). A generalizability study. Evaluation Review 24, 319–338.Google Scholar
World Health Organization (1988) WHO psychiatric Disability Assessment Schedule (WHO/DAS): With A Guide to its use. Geneva: WHO.Google Scholar
Xiang, YT, Yu, X, Sartorius, N, Ungvari, GS and Chiu, HF (2012) Mental health in China: challenges and progress. The Lancet 380, 1715–1716.Google Scholar
Xiong, W and Phillips, MR (2016) Translated and annotated version of the 2015–2020 national mental health work plan of the People's Republic of China. Shanghai Archives of Psychiatry 28, 4–17.Google Scholar
Xu, JF, Yu, FH and Wang, J (2013) Analyzing the hospitalization expense and management status of severe mental illness. Chinese Health Economics 32, 53–56.Google Scholar
Zhang, J, Wieczorek, WF, Jiang, C, Zhou, L, Jia, S, Sun, Y, Jin, S and Conwell, Y (2002) Studying suicide with psychological autopsy: social and cultural feasibilities of the methodology in China. Suicide and Life-Threat Behavior 32, 370–379.Google Scholar
Zhao, W, Law, S, Luo, X, Chow, W, Zhang, J, Zhu, Y, Liu, S, Ma, X, Yao, S and Wang, X (2015) First adaptation of a family-based ACT model in mainland China: a pilot project. Psychiatric Services 66, 438–441.Google Scholar
Supplementary material: File

Luo et al. supplementary material

Luo et al. supplementary material 1

Download Luo et al. supplementary material(File)
File 52.3 KB