| Methods | Allocation: randomised. Blindness: single. Duration: 14 months. Raters: independent. |
|
| Participants | Diagnosis: any severe psychiatric disorder. N = 130. History: in need of psychiatric hospital admission. Sex: 55% M, 45% F. Age: 18-62 yrs, mean ~31 yrs. Exclusions: dual diagnosis. |
|
| Interventions | 1. Home care: CLP’s home based care, multidisciplinary team, 24hr service, drug treatment, coping skills taught, family support given, use of community agencies - for 14 months & then withdrawn. N = 65 2. Standard care: hospitalisation, aim of returning to community as soon as possible, normal staffing levels, standard outpatient follow-up. N = 65 |
|
| Outcomes | Death. Harm. Hospital admission: unable to keep to initial protocol.* Leaving the study early (patients). Community burden. Unable to use - Readmission: no data for home care group. Days in hospital: includes index admission. Leaving the study early (relatives): not clear if all relatives followed up or just relatives living with the patient. Mental state: SCRS (no mean or SD). Global State: CAF (devised by authors, as yet not peer reviewed). Family burden: FBS (devised by authors, as yet not peer reviewed). Life satisfaction: LSS (no mean or SD). Self Esteem: SES (no mean or SD). Economic cost: no SD. |
|
| Notes | ||
| Risk of bias | ||
| Bias | Authors’ judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomised: not described. |
| Allocation concealment (selection bias) | Unclear risk | Not described. |
| Blinding (performance bias and detection bias) All outcomes |
Unclear risk | Not described. |
| Incomplete outcome data (attrition bias) All outcomes |
Unclear risk | Loss to follow up described for patients, not for relatives. |
| Selective reporting (reporting bias) | Low risk | All outcomes reported. |
| Other bias | Low risk | Grant funded research. |
Abbreviations 1. Diagnostic systems
DSM III: Diagnostic Statistical Manual, version 3
ICD - 8: International Classification of Diseases - 8th Review
PSE: Present State Examination
2. Scales/Forms used to collect data
BPRS: Brief Psychiatric Rating Scale
CSQ-8: Client Satisfaction Questionnaire
CAF: Community Adjustment Form
CAN: Camberwell Assessment of needs
DLS: Daily Living Score
EQ-5D: EuroQuol 5 dimension quality of life measure
FBS: Family Burden Scale
FEF: Family Evaluation Form
HSRS: Health and Sickness Rating Scale
HONOS: Health of the Nation Outcomes Scales
IMPS: Inpatient Multidimensional Psychiatric Scale
LSP: Life Skills Profile
LSS: Life Satisfaction Scale
MANSA: Manchester Short Assessment of quality of life
MSPP: Multidmensional Scale for Rating Psychiatric Patients
PANSS: Positive and Negative Syndrome Scale
PEF: Psychiatric Evaluation Form
PHNR: Public Health Nursing Report
SAS: Social Adjustment Scale
SCRS: Short Clinical Rating Scale
SES: Self Esteem Scale
SORR: Significant Other Rating Report
RSQ: Relative’s Satisfaction Questionnaire
Other
ACT: Assertive Community Treatment
CI: confidence interval
M: Male
F: Female
N: Number
CLP: Community Living Programme
CPN: Community Psychiatric Nurse
DLP: Daily Living Programme
OPD: Outpatient department relatives-sub - sub group of relatives actually living with the patient.
RR: relative risk
SD: Standard deviation
MD: mean difference