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Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT

  • Wolfgang GaebelEmail author
  • Harald Zäske
  • Klaus Hesse
  • Stefan Klingberg
  • Christian Ohmann
  • Jürgen Grebe
  • Henrike Kolbe
  • Andrea Icks
  • Frank Schneider
  • Volker Backes
  • Claus Wolff-Menzler
  • Birgit Guse
  • Jürgen Gallinat
  • Thomas Bock
  • Maria-Christiane Jockers-Scherübl
  • Timo Krüger
  • Frank Jessen
  • Andreas Bechdolf
  • Tilo Kircher
  • Carsten Konrad
  • Peter Falkai
  • Annette Schaub
  • Matthias Rudolph
  • Volker Köllner
  • Gerhard Schmid-Ott
  • Michael Linden
  • Barbara Lieberei
  • Monika Stuhlinger
  • Sebastian Sommerfeld
  • Albrecht Schumacher
  • Sabine Krenge
  • Stephanie Gereke
  • Norbert Mönter
  • Alicia Navarro-Urena
  • Günter Frosch
  • Franz-Josef Kuhlbusch
  • Helen Cleveland
  • Mathias Riesbeck
Original Paper
  • 1 Downloads

Abstract

There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment (‘STEM’). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3–F31.5, F32–F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients’ treatment benefit. However, factors contributing to improvement need to be explored.

The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.

Keywords

Stigma Stigma coping intervention Cluster-RCT Depression Schizophrenia 

Notes

Acknowledgements

The study has been funded by a research grant of the Federal Ministry of Education and Research (BMBF; research Grant 01GX1011).

We want to thank all study participants and all collaborators of the STEM work group who contributed to this study.

STEM work group (all facilities are located in Germany): Gaebel W, Cleveland, H, Conradt B, Feiertag N, Heise F, Janssen B, Riesbeck M, Sauter S, Siegert A, Zäske H; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, LVR-Klinikum, Düsseldorf. Klingberg S, Hesse K, Richter J, Nentwich B; Department of Psychiatry and Psychotherapy, University of Tübingen. Ohmann C, Grebe J, See B, Verde P; Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf. Icks, A; Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich Heine University, Düsseldorf. Schneider F, Backes V; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen. Wolff-Menzler C, Guse B; Department of Psychiatry, University Medical Center Göttingen, Göttingen. Bock T, Frey J; Department of Psychiatry and Psychotherapy of the University Medical Center Hamburg-Eppendorf. Jockers-Scherübl MC, Krüger T; Charité, Universitätsmedizin Berlin, Berlin, Germany Hennigsdorf: Oberhavel Kliniken GmbH, Klinik Hennigsdorf. Jessen F, Bechdolf A, v. Pützfeld V, Zarafonitis S. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne. Kircher T, Konrad C. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg. Falkai P, Schaub A. Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich. Rudolph M; Mittelrhein-Klinik for Psychosmatics and Rehabilitation, Bad Salzig. Köllner, V; Department of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel. Schmidt-Ott G, Stock Gissendanner S; Department of Psychosomatics, Berolina Clinic Löhne. Linden, M, Lieberei B; Department of Behavioral Medicine, Rehabilitation Center Seehof, Berlin. Stuhlinger M; Psychiatric-psychotherapeutic Rehabilitation Center grund.stein, Tübingen. Sommerfeld S, Schumacher A, Krenge S; AHG Klinik, Waren. Gereke S, Mönter N, Navarro-Urena A; Psychiatric Practices, Berlin. Frosch G, Kuhlbusch FJ; Psychiatric Practices, Düsseldorf.

Compliance with ethical standards

Conflicts of interest

J. Gallinat has received research funding from the German Federal Ministry of Education and Research, German Science Foundation, and speaker fees from Lundbeck, Janssen-Cilag, Lilly and Otsuka. All other authors state that they have no conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Wolfgang Gaebel
    • 1
    • 2
    Email author
  • Harald Zäske
    • 1
  • Klaus Hesse
    • 3
  • Stefan Klingberg
    • 3
  • Christian Ohmann
    • 4
  • Jürgen Grebe
    • 4
  • Henrike Kolbe
    • 4
  • Andrea Icks
    • 5
    • 6
  • Frank Schneider
    • 7
    • 8
  • Volker Backes
    • 7
  • Claus Wolff-Menzler
    • 9
  • Birgit Guse
    • 9
  • Jürgen Gallinat
    • 10
  • Thomas Bock
    • 10
  • Maria-Christiane Jockers-Scherübl
    • 11
    • 12
  • Timo Krüger
    • 11
    • 12
  • Frank Jessen
    • 13
  • Andreas Bechdolf
    • 13
  • Tilo Kircher
    • 14
  • Carsten Konrad
    • 14
  • Peter Falkai
    • 15
  • Annette Schaub
    • 15
  • Matthias Rudolph
    • 16
  • Volker Köllner
    • 17
    • 18
  • Gerhard Schmid-Ott
    • 19
  • Michael Linden
    • 18
  • Barbara Lieberei
    • 18
  • Monika Stuhlinger
    • 20
  • Sebastian Sommerfeld
    • 21
  • Albrecht Schumacher
    • 21
  • Sabine Krenge
    • 21
  • Stephanie Gereke
    • 22
  • Norbert Mönter
    • 22
  • Alicia Navarro-Urena
    • 22
  • Günter Frosch
    • 23
  • Franz-Josef Kuhlbusch
    • 23
  • Helen Cleveland
    • 1
  • Mathias Riesbeck
    • 1
    • 2
  1. 1.Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich Heine UniversityDüsseldorfGermany
  2. 2.WHO Collaborating Center for Quality Assurance and Empowerment of Mental HealthLVR-Klinikum DüsseldorfDüsseldorfGermany
  3. 3.Department of Psychiatry and PsychotherapyUniversity of TübingenTübingenGermany
  4. 4.Coordination Center for Clinical Trials, Medical FacultyHeinrich Heine UniversityDüsseldorfGermany
  5. 5.Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical FacultyHeinrich Heine UniversityDüsseldorfGermany
  6. 6.German Diabetes CenterDüsseldorfGermany
  7. 7.Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH AachenAachenGermany
  8. 8.University Hospital, Heinrich Heine UniversityDüsseldorfGermany
  9. 9.Department of PsychiatryUniversity Medical Center GöttingenGöttingenGermany
  10. 10.Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  11. 11.Charité Universitätsmedizin BerlinBerlinGermany
  12. 12.Oberhavel Kliniken GmbHKlinik HennigsdorfHennigsdorfGermany
  13. 13.Department of Psychiatry and PsychotherapyUniversity of CologneCologneGermany
  14. 14.Department of Psychiatry and PsychotherapyUniversity of MarburgMarburgGermany
  15. 15.Department of Psychiatry and Psychotherapy, University HospitalLMU MunichMunichGermany
  16. 16.Mittelrhein-Klinik for Psychosmatics and RehabilitationBad SalzigGermany
  17. 17.Department of Psychosomatic MedicineMediclin Bliestal ClinicBlieskastelGermany
  18. 18.Department of Behavioral MedicineRehabilitation Center SeehofTeltowGermany
  19. 19.Department of PsychosomaticsBerolina ClinicLöhneGermany
  20. 20.Psychiatric-Psychotherapeutic Rehabilitation Center grund.steinTübingenGermany
  21. 21.AHG KlinikWarenGermany
  22. 22.Psychiatric Practices BerlinBerlinGermany
  23. 23.Psychiatric Practices DüsseldorfDüsseldorfGermany

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