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Del Piccolo MC, Valmaggia L, Henderson C, Spencer TJ, Lewis D, Fitzell S, Edwards S, Evans C, Tognin S. Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study. Psychiatr Rehabil J 2024; 47:56-63. [PMID: 37917465 DOI: 10.1037/prj0000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE This study aimed to assess the feasibility of implementing Individual Placement and Support (IPS) with a focus on educational and employment goals, within a clinical service for the early detection of individuals at clinical high risk (CHR) of psychosis. METHOD Between June 2019 and April 2021, participants were recruited and received up to 6 (± 2) months support. Primary outcome: Enrolled participants, attended sessions, and disengagement rates were analyzed to assess feasibility. SECONDARY OUTCOMES Enrollment in mainstream education or/and employment, hours spent working or/and studying, salary, level of functioning, and self-efficacy at baseline and follow-up were compared. RESULTS Thirty-one participants were recruited, 13 of whom were remotely recruited after the first COVID-19 lockdown. Dropout rates were relatively low (16.1%), and 26 participants (83.9%) completed the program. Each participant received on average nine sessions (M = 9.65; SD = 4.92). Secondary outcomes: At follow-up, 73.1% participants were employed, working on average more hours per week, t(25) = -2.725; p = .012, and were earning significantly more money, t(25) = -3.702; p = .001, compared to baseline. Gains in educational outcomes were less clear. Global Assessment of Functioning, t = 248.50; p = .001, and Social Occupational Functioning, t(25) = -3.273; p = .003, were significantly higher at 6-month follow-up compared to baseline. No differences were found in participants' self-efficacy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings indicate that research procedures are appropriate and that IPS implementation within a CHR clinical team is feasible. Secondary outcomes also suggest that IPS may be a beneficial intervention for young people at CHR. A longer follow-up might be needed to assess its impact on educational outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Maria Chiara Del Piccolo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Claire Henderson
- South London and Maudsley National Health Service Foundation Trust
| | - Tom J Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | | | - Sharon Fitzell
- Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust
| | - Sara Edwards
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Carys Evans
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London
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Rai D, Webb D, Lewis A, Cotton L, Norris JE, Alexander R, Baldwin DS, Brugha T, Cochrane M, Del Piccolo MC, Glasson EJ, Hatch KK, Kessler D, Langdon PE, Leonard H, MacNeill SJ, Mills N, Morales MV, Morgan Z, Mukherjee R, Realpe AX, Russell A, Starkstein S, Taylor J, Turner N, Thorn J, Welch J, Wiles N. Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trial. Trials 2024; 25:37. [PMID: 38212784 PMCID: PMC10782796 DOI: 10.1186/s13063-023-07847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. METHODS STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. DISCUSSION Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population. TRIAL REGISTRATION ISRCTN, ISRCTN15984604 . Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021.
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Affiliation(s)
- Dheeraj Rai
- Population Health Sciences, University of Bristol, Bristol, UK.
- NIHR Bristol Biomedical Research Centre, Bristol, UK.
- Avon & Wiltshire Partnership Mental Health NHS Trust, Bath, UK.
| | - Doug Webb
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Amanda Lewis
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Leonora Cotton
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jade Eloise Norris
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Regi Alexander
- Hertfordshire Partnership NHS Foundation Trust, Hatfield, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Madeleine Cochrane
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Katherine K Hatch
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - David Kessler
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Peter E Langdon
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Stephanie J MacNeill
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Maximiliano Vazquez Morales
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - Raja Mukherjee
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Alba X Realpe
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Sergio Starkstein
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Jodi Taylor
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Joanna Thorn
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jack Welch
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Nicola Wiles
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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