Abstract
Background: Patient-reported outcome measures (PROMs) are increasingly used to evaluate interventions for people with schizophrenia. It is unclear how widely PROMs developed using qualitative participatory research techniques are used in controlled intervention studies. This study aims to provide a narrative synthesis of the extent to which psychosocial interventions for schizophrenia lead to improvements on PROMs developed with input from mental health service users using qualitative participatory research techniques from the start. This study will use a systematic review approach.Methods: This review was pre-registered and follows PRISMA reporting guidance. Embase, Ovid Medline and APA PsycInfo databases were systematically searched (from inception to August 2023) using search terms related to schizophrenia spectrum disorders, psychosocial interventions, and controlled intervention studies. Studies were screened, and included only if they used PROMs developed using qualitative participatory research techniques. Data were extracted on the intervention type, length, and format (group or individual), control group, sample size, and primary outcome, and the efficacy of the intervention on the PROM outcomes. The Clinical Trials Assessment Measure was used to assess risk of bias. Screening, data extraction and risk of bias assessment were completed for all papers independently by two researchers. Results were summarised narratively according to prespecified topics.
Results: After screening, forty-two independent studies met the inclusion criteria. These reported a range of psychosocial interventions. The studies used thirteen PROMs, measuring mental wellbeing, recovery, quality of life, and self-stigma. PROMs were secondary outcomes in 69% of included studies. There was evidence for interventions considered to reduce self-stigma and internalised stigma. Cognitive behavioural therapy for psychosis (CBTp) was found to improve mental wellbeing and psychological recovery, and there was less clear evidence for CBTp benefits to quality of life and self-stigma. CBT-informed interventions were found to improve patient-chosen recovery outcomes. Neither Metacognitive Training nor Cognitive Remediation was found to improve quality of life, and there was evidence that Integrated Psychological Therapy may reduce quality of life. Studies were generally of moderate to high methodological quality, although 23.8% were considered at high risk of bias.
Discussion: The variety of the interventions considered coupled with the inconsistent use of PROMs limits the scope of generalisations for many of the psychosocial interventions considered. Gold-standard PROMs developed from service user perspectives are not widely used in psychosocial intervention studies, and further use will enable the generation of higher quality evidence. Involvement of service users as collaborators in mental health research should extend to the development of outcome measures.
| Date of Award | 1 Oct 2024 |
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| Original language | English |
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| Supervisor | Matteo Cella (Supervisor) & Til Wykes (Supervisor) |