Li Juan Fang

Outcomes of a Randomized Study of a Peer-Taught Family-to-Family Education Program for Mental Illness

OBJECTIVE The Family-to-Family Education Program (FTF) is a 12-week course offered by the National Alliance on Mental Illness (NAMI) for family members of adults with mental illness. This study evaluated the courses effectiveness. METHODS A total of 318 consenting participants in five Maryland counties were randomly assigned to take FTF immediately or to wait at least three months for the next available class with free use of any other NAMI supports or community or professional supports. Participants were interviewed at study enrollment and three months later (at course termination) regarding problem- and emotion-focused coping, subjective illness burden, and distress. A linear mixed-effects multilevel regression model tested for significant changes over time between intervention conditions. RESULTS FTF participants had significantly greater improvements in problem-focused coping as measured by empowerment and illness knowledge. Exploratory analyses revealed that FTF participants had significantly enhanced emotion-focused coping as measured by increased acceptance of their family members illness, as well as reduced distress and improved problem solving. Subjective illness burden did not differ between groups. CONCLUSIONS This study provides evidence that FTF is effective for enhancing coping and empowerment of families of persons with mental illness, although not for reducing subjective burden. Other benefits for problem solving and reducing distress are suggested but require replication.

“MOVE!”: Outcomes of a Weight Loss Program Modified for Veterans With Serious Mental Illness

OBJECTIVES Veterans with serious mental illness are at increased risk of obesity, sedentary lifestyle, and a host of related chronic diseases. Although evidence suggests that lifestyle interventions can help mental health consumers achieve modest weight loss, several studies have failed to show a benefit and most have concluded that significant challenges remain in delivering effective interventions. In 2006, the Veterans Health Administration introduced MOVE!, a weight management program that includes behaviorally based dietary and physical activity self-management support. This article describes modifications used to manualize MOVE! for veterans with serious mental illness and reports findings from a randomized controlled trial of the new intervention. METHODS Between January 2007 and June 2009, overweight or obese veterans with serious mental illness were randomly assigned to a six-month trial of MOVE! (N=53), which includes both individual and group sessions, or to a control condition that offered basic information about diet and exercise every month (N=56). Weight and metabolic, attitudinal, behavioral, and functional variables were measured at baseline and six months, and weight was also measured monthly. RESULTS Thirty participants in MOVE! and 41 participants in the control group completed the six-month assessment, and only seven lost 5% of their baseline weight; there was no effect of group assignment on weight loss. There were no significant group × time differences in any metabolic, dietary, physical activity, attitudinal, or functional measure. CONCLUSIONS Despite the negative findings of this study, research is crucial to identify lifestyle interventions and related supports and services to help veterans with mental illness reduce overweight and obesity.

Sustained outcomes of a peer-taught family education program on mental illness.

Objective:  This study examines 6‐month follow‐up data from participants in a randomized trial of a peer‐driven 12‐session family support and education program, called family‐to‐family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained.

Factors influencing implementation of smoking cessation treatment within community mental health centers

Objective: Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidence-based “5 As” (ask, advise, assess, assist, arrange) in six community mental health centers in greater Baltimore. Methods: Data collected as part of a larger study examining the effectiveness of delivery of the 5 As at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5 As. Second, we used multilevel models to examine variance between patients (n = 228), patient factors, and variance between their psychiatrists (n = 28) in the delivery of the 5 As (and first 3 As). Results: The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5 As and 3 As. Patient “readiness to change” predicted delivery of the full 5 As, while smoking severity predicted delivery of the first 3 As. Conclusions: There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidence-based smoking cessation treatment in the mental health care setting.

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.

Outcomes of a Psychoeducational Intervention to Reduce Internalized Stigma Among Psychosocial Rehabilitation Clients

OBJECTIVE This community-based randomized controlled trial was carried out to test the Ending Self-Stigma (ESS) psychoeducational intervention, which is designed to help adults with serious mental illnesses reduce internalization of mental illness stigma and its effects. METHODS A total of 268 adults from five different mental health programs in Maryland took part. After baseline interview, consenting participants were randomly assigned to the nine-week ESS intervention or a minimally enhanced treatment-as-usual control condition. Participants were assessed by using symptom, psychosocial functioning, and self-stigma measures at baseline, postintervention, and six-month follow-up. Demographic characteristics were assessed at baseline. RESULTS Compared with participants in the control condition, ESS group participants showed significant decreases on the stereotype agreement and self-concurrence subscales of the Self Stigma of Mental Illness Scale, significant improvement on the alienation and stigma resistance subscales of the Internalized Stigma Mental Illness measure, and a significant increase in recovery orientation from baseline to postintervention. None of these differences were sustained at six-month follow-up. CONCLUSIONS Results indicate that ESS was useful in helping to reduce key aspects of internalized stigma among individuals with mental illnesses and that advances in the delivery, targeting, and content of the intervention in the field may be warranted to increase its potency.

Generalizability in the Family-to-Family Education Program Randomized Waitlist-Control Trial

OBJECTIVE Randomized controlled trials (RCTs) may have limited generalizability for the community when a high proportion of individuals refuse randomization or otherwise do not participate-a not uncommon phenomenon. A randomized waitlist-control trial of the Family-to-Family (FTF) education program, a 12-week course offered by the National Alliance on Mental Illness for family members of adults with mental illness, was previously reported. This study assessed whether the RCT-derived estimates of effectiveness of FTF were generalizable to individuals who participated in FTF but declined participation in the RCT. METHODS Propensity score matching was used to create five quintiles, each containing scores for individuals in FTF or waitlist conditions and for decliners; scores were matched on multiple baseline characteristics (N=442) within each quintile. Effectiveness estimates, with standard errors, were derived for the decliner population on the basis of effectiveness estimates derived from participants in the RCT; estimates were weighted to the baseline distribution of quintiles for the decliners. RESULTS For each outcome, estimates of the effect sizes observed in the RCT were very similar to the effect sizes observed for the decliner population; confidence intervals also had a high degree of overlap. CONCLUSIONS This study suggests that the benefits of FTF observed in the RCT are generalizable to the group of individuals who declined RCT participation, providing further evidence of FTFs effectiveness. Propensity score matching was a useful statistical tool for addressing selection bias resulting from high rates of nonconsent in randomized waitlist-control trials.

A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications

Adherence to recommendations for monitoring of metabolic side effects of antipsychotic medications has been historically low. This randomized controlled trial tested whether a computerized, patient-centered intervention that educated Veterans with serious mental illness about these side effects and encouraged them to advocate for receipt of monitoring would increase rates of monitoring compared to enhanced treatment as usual. The mean proportion of days adherent to monitoring guidelines over the 1-year study was similarly high and did not differ between the intervention (range 0.81–0.98) and comparison (range 0.76–0.96) groups. Many individuals in both groups had persistent abnormal metabolic parameter values despite high rates of monitoring, contact with medical providers, and receipt of cardiometabolic medications. Participants exposed to the intervention were interested in receiving personalized information about their cardiometabolic status, demonstrating the preliminary feasibility of brief interventions for enhancing involvement of individuals with serious mental illness in health care decision making.

Use of a “Microecologic Technique” to Study Crime Around Substance Abuse Treatment Centers

Whether substance abuse treatment centers affect neighborhood crime is hotly debated. Empirical evidence on this issue is lacking because of the difficulty of distinguishing the crime effect of treatment centers in high-crime areas, the inability to make before-and-after comparisons for clinics founded before computerized crime data, and the need for appropriate control sites. The authors present an innovative method (without an actual data analysis) to overcome these challenges. Clinic addresses and crime data are geocoded by street address. Crimes are counted within concentric-circular, 25-meter “buffers” around the clinics. Regression analyses are used to calculate the “crime slope” (β) among the buffers. A negative β indicates more crimes closer to the site. A similar process is used to evaluate crimes around control sites: convenience stores, hospitals, and residential points. This innovative technique provides valid empirical evidence on crime around substance abuse treatment centers.

Stigma: a Unique Source of Distress for Family Members of Individuals with Mental Illness

To distinguish the impact of mental illness stigma from that of other negative caregiving experiences, this study examined the unique relationships between stigma and caregiver/family functioning. Adult relatives (n = 437) of individuals with mental illness completed questionnaires regarding caregiving experiences, distress, empowerment, and family functioning, as part of a larger study. Regression analyses examined the relationship between stigma and caregiver/family variables, while controlling for other negative caregiving experiences. Stigma was uniquely associated with caregiver distress, empowerment, and family functioning. Mental illness stigma is a potent source of distress for families and an important target of family services.