"Why I stay in community psychiatric rehabilitation": a semi-structured survey in persons with schizophrenia

Storytelling as narrative health promotion in community psychiatry: a quasi-experimental study

BACKGROUND

Community-based psychiatric rehabilitation (CBPR) helps patients reintegrate into society while enabling them to live autonomously in supportive environments. CBPR uses multi-modal approach to address patients' needs in health, education, livelihood, empowerment and social functioning. In addition to pharmacotherapy, other interventions such as metacognitive training, lifestyle interventions, psychoeducation, arts therapy may be used to improve functioning and quality of life. Storytelling as a new intervention was implemented in a community-based rehabilitation setting with patients with mental health issues to test its feasibility and potential to improve life satisfaction.

METHODS

Stories presenting difficult lives and complicated relationships were narrated and discussed in eight storytelling sessions for members of a civil organization involved in psychiatric rehabilitation in four months. Acceptability was tested by following participation rate and feedback with scales after each session. Demographic as well as mental health data including sense of coherence, distress, self-efficacy, and life satisfaction were investigated by standard scales before the first and after the last session.

RESULTS

Participation ranged from 31 to 49% compared to all persons present at the setting. Participants (mean age: 53.41 ± 12.23 years, 63% females) found the stories highly interesting (mean: 8.93 ± 1.62) and comprehensible (8.67 ± 1.9) on a 1-10 scale though the means of individual sessions somewhat varied. Significant positive correlation was found between the stories being interesting and comprehensible (Spearman's rho = 0.656) but significant negative correlation was found between story length and comprehension (Spearman's rho=-0.183). Based on the responses from participants who completed the questionnaires before and after the intervention, life satisfaction significantly increased. Psychological variables such as self-efficacy, sense of coherence, pathological distress showed improving tendency without reaching significance. Pre-intervention data showed significant positive correlation between self-efficacy and sense of coherence (Pearson's r = 0.659). Psychological distress was negatively related to both self-efficacy (Pearson's r=-0.728) and sense of coherence (Pearson's r=-0.825).

CONCLUSIONS

Storytelling as a means for promoting health proved to be feasible in a group of rehabilitated patients with mental disorders. Their life satisfaction significantly improved in four months. Carefully selected stories narrated and discussed in group settings may result in the gradual shift of participants' perspectives leading to improved life satisfaction.

Interventions supporting meaningful connections for people with serious mental illness: a concept-framed systematic narrative review

PURPOSE

Meaningful connections, encompassing relationships providing emotional support, understanding, acceptance, and a sense of belonging, are vital for social inclusion and well-being of Individuals with serious mental illness (SMI). The mixed methods review critically explored multifaceted approaches supporting people with SMI to foster meaningful (non-intimate) social relationships or connections.

METHODS

Searches of eight electronic databases returned 4882 records. Duplicate removal, title abstract, then full-text, screening and hand searching resulted in 23 records for inclusion. Studies were integrated using the CIVIC Framework emphasising the importance of Closeness, Identity, Valued relationships, Involvement, feeling Cared for and accepted.

RESULTS

The review identified emotional and physical challenges, societal stigma, and other environmental factors to hinder making meaningful connections. Studies highlighted the necessity for interventions being adaptable, personalised, and encompassing of structured activities, peer and professional supports, and technology-assisted platforms.

CONCLUSION

The complexity of social interactions for those with SMI call for comprehensive, holistic strategies to nurture social relationships within their communities.

The experience of loneliness among people with psychosis: Qualitative meta-synthesis

BACKGROUND

Loneliness can be a significant challenge for people living with psychosis. We currently lack evidence about how to help with this. Understanding the origins, experience, and impact of loneliness in this group is helpful in developing strategies to reduce it. We therefore aimed to conduct a meta-synthesis of the qualitative literature exploring the nature of loneliness, and the factors contributing to the development and maintenance of loneliness, among people living with psychosis.

METHODS

We searched four electronic databases (MEDLINE, Embase, PsycINFO and Web of Science) for studies meeting pre-defined eligibility criteria. We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and appraised the quality of each eligible study using the Critical Appraisal Skills Programme (CASP) checklist. We conducted thematic synthesis to combine the included qualitative findings to generate key overarching themes.

RESULTS

We included 41 articles and our analysis generated six meta-themes: (1) loneliness in the form of disconnection, (2) a rejecting and stigmatising external world, (3) loneliness and acute psychotic episodes and symptoms, (4) thwarted longing for connection, (5) paradoxes of loneliness and psychosis, and (6) well-being embedded in the social world. Our findings suggest a vicious cycle in which loneliness, psychosis and social withdrawal can be mutually reinforcing. Reciprocity of and continuity in relationships were valued by those with psychosis, while self-stigma and experiences of rejection appeared to exacerbate loneliness and impede recovery.

CONCLUSION

Our meta-synthesis offers insights into how people living with psychosis are affected by loneliness. Tailored interventions are needed, which should focus on supporting people in overcoming internal barriers to connection and low self-esteem, challenging stigma and self-stigma, and linking people to social support according to needs and preferences.

Long-Term Impact of Community Psychiatric Care on Quality of Life amongst People Living with Schizophrenia: A Systematic Review

The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

Association between social support and the severity of positive symptoms in rural community-dwelling patients with schizophrenia during the COVID-19 pandemic

BACKGROUND

This study examined the association between social support and the severity of positive symptoms in rural community-dwelling schizophrenia patients during the COVID-19 pandemic.

METHOD

The cross-sectional study included 665 rural community-dwelling schizophrenia patients investigated during the COVID-19 pandemic. Social support was measured using the Social Support Rating Scale, and positive symptoms were assessed using the Positive Scale extracted from the Positive and Negative Syndrome Scale. Multiple linear regression was adopted to examine the association of social support with positive symptoms.

RESULT

The scores for total social support, subjective support, objective support and the use of social support were 28.3 ± 5.9, 16.4 ± 5.2, 6.5 ± 1.4 and 5.4 ± 2.8, respectively. Total social support (β = -0.08, 95%CI: -0.13 to -0.02, P < 0.01) and subjective social support (β = -0.10, 95%CI: -0.16 to -0.04, P < 0.01) were significantly and negatively associated with the Positive Scale score after adjustment for confounders. Objective social support (β = 0.11, 95%CI: -0.10 to 0.32, P = 0.31) and the use of social support (β = -0.03, 95%CI: -0.14 to 0.07, P = 0.53) were not significantly associated with the Positive Scale score.

CONCLUSION

The study confirmed the importance of social support, especially subjective support, provided to rural community-dwelling schizophrenia patients during the COVID-19 pandemic. This support should be addressed and strengthened for such patients in emergent events.