Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT
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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.
KeywordsStigma Stigma coping intervention Cluster-RCT Depression Schizophrenia
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.
- 3.Gaebel W, Rössler W, Sartorius N (eds) (2017) The stigma of mental illness–end of the story? Springer, Heidelberg Google Scholar
- 4.Gaebel W, Zäske H, Baumann AE, Klosterkötter J, Maier W, Decker P, Möller HJ (2008) Evaluation of the German WPA “Program against stigma and discrimination because of schizophrenia—Open the doors”: results from representative telephone surveys before and after 3 years of antistigma interventions. Schizophr Res 98:184–193CrossRefGoogle Scholar
- 23.Mehta N, Clement S, Marcus E, Stona AC, Bezborodovs N, Evans-Lacko S, Palacios J, Docherty M, Barley E, Rose D, Koschorke M, Shidhaye R, Henderson C, Thornicroft G (2015) Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 207:377–384CrossRefGoogle Scholar
- 26.Bäuml J, Pitschel-Walz G, Berger H, Gunia H (2009) Manual psychoeducation for schizophrenia [arbeitsbuch psychoedukation bei schizophrenie (APES)], 2nd edn. Schattauer, StuttgartGoogle Scholar
- 27.Pitschel-Walz G, Bäuml J, Kissling W (2003) Psychoeducation for depression: manual for groups with patients and relatives [psychoedukation bei depressionen: manual zur leitung von patienten- und angehörigengruppen], 1st edn. Urban und Fischer, MünchenGoogle Scholar
- 28.Hesse K, Klingberg S, Zäske H, Conrad B, Heise F, Gaebel W, Wölwer W, Richter J, Wernet T (2018) Coping with sigmatization and promoting empowerment (STEM) manual and worksheets for download [Stigmatisierung überwinden und empowerment fördern (STEM). Manual und Arbeitsblätter zum download]. http://psychose-psychotherapie.de/index.php/therapiemanuale. Accessed 9 Sept 2019
- 31.Kay SR, Opler LA, Fiszbein A (1986) The positive and negative syndrome scale (PANSS) rating manual. Soc Behav Sci Doc 17:28–29Google Scholar
- 32.Guy W, Bethesda MD (1976) Clinical Global Impressions (CGI) Scale. In: Guy W (ed) ECDEU assessment manual for psychopharmacology, revised. US Dept. Health, Education, and Welfare, Washington, pp 218–222Google Scholar
- 33.Frances A, Pincus HA, First MB (1994) The Global Assessment of Functioning Scale (GAF). Diagnostic and Statistical Manual of Mental Disorder–IV. American Psychiatric Association, Washington, p 32Google Scholar
- 39.Hardt J (2008) The symptom checklist-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument. GMS Psychosoc MedGoogle Scholar
- 40.Roick C, Kilian R, Matschinger H, Bernert S, Mory C, Angermeyer MC (2001) German adaptation of the client sociodemographic and service receipt inventory—an instrument for the cost of mental health care. Psychiatr Prax 28(Suppl 2):90Google Scholar
- 42.Amaresha AC, Kalmady SV, Joseph B, Agarwal SM, Narayanaswamy JC, Venkatasubramanian G, Muralidhar D, Subbakrishna DK (2018) Short term effects of brief need based psychoeducation on knowledge, self-stigma, and burden among siblings of persons with schizophrenia: a prospective controlled trial. Asian J Psychiatr 32:59–66CrossRefGoogle Scholar