Authors (including presenting author) :
Chu MHW(1), Lau B(1), Leung J(2), Chan SC(2), Tang B(1), Lau C(1), Newby C (3), Chiu R(1), Lo W.T.L(2), Schrank B(4), Slade M(3)
Affiliation :
(1)Occupational Therapy Department, Kwai Chung Hospital, Hong Kong, (2)Department of Psychiatry, Kwai Chung Hospital, Hong Kong, (3)School of Health Sciences, Institute of Mental Health, University of Nottingham, United Kingdom, (4)Karl Landsteiner University of Health Sciences, Department of Psychiatry, Krems,, Austria
Introduction :
Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive Psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomised controlled trial in the United Kingdom of impact on well-being and symptomatology.
Objectives :
The aim of this study was to test the effectiveness of Positive Psychotherapy for Psychosis, PPP (Chinese version) on the well-being of people with psychosis in Hong Kong.
Methodology :
The study was a randomized controlled trial with two-arm parallel groups, i.e. intervention group and control group. (Ethics Approval Ref. no.: KWC REC no.: 99-10) The trial was registered (ANZCTR: ACTRN12620000464965). Persons-in-recovery receiving mental health service in the Occupational Therapy Department, Kwai Chung Hospital in Hong Kong were recruited into the study. The recruited participants were randomly allocated into either intervention group or control group after baseline measurement by block randomization. All participants continued to receive standard care. Additionally, intervention group participants attended the 13 PPP sessions with a closed group size of 6-8 participants held over 7 consecutive weeks (i.e. 2 sessions per week) by trained therapists and co-therapists. Therapists followed the Chinese PPP manual. Wellbeing was measured as a primary outcome. Other secondary outcomes, e.g symptomatology, quality of life, and etc. were also measured. Researcher and assessors were blinded. Sample size estimation with 20% attrition taken into consideration allowed the detection of a medium effect size (0.5). Intention-to-treat analysis was adopted by using the last observation carried forward (LOCF) for all those lost to follow-up.
Result & Outcome :
A total of 154 participants (78 intervention, 76 control) were recruited. There was no significant change between baseline and follow-up in any outcome for the control group. By contrast, there were positive improvements within the intervention group in the primary outcome of well-being and in the secondary outcomes of hope including both Agency subscale and Pathway subscale, self-efficacy, social disability and symptomatology. Intervention group participants showed better outcomes on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p< 0.001, t=3.74, Mean difference 2.05, 95%CI (0.97, 3.13)) and on secondary outcomes of hope (Agency subscale: p=0.03, t=2.24, Mean difference 1.72, 95%CI (0.21, 3.23)) and self-efficacy (p< 0.001, t=3.60, Mean difference 3.02, 95%CI (1.36, 4.68). In the exploratory analysis, number of sessions attended was explored in all outcomes. Only SF-12 physical health score had a significant effect at post intervention and not pre intervention, suggesting that for every session attended the score went up by 0.95 (Beta=0.95, S.E.= 0.33, d.f.= 70, p= 0.01). Interaction effects were explored for sociodemographic characteristic effect with intervention/control for all trial outcomes. The only interaction effects were seen for gender and for the CDSS-C outcome, which found a significant smaller intervention effect for female participants (Beta= -2.91, S.E.= 1.12, d.f.= 150, p= 0.01) The results of this randomised controlled trial indicated a promising efficacy and acceptability of implementing a positive psychotherapy group in clinical practice in Hong Kong. The positive outcomes for people with psychosis indicate the need for clinicians in Hong Kong to develop more skills in supporting well-being.
