Psychiatric symptoms moderate the effects of mental illness self-management in a randomized controlled trial.

Depression has been shown to moderate the effects of physical illness self-management (ISM) programs. We attempted to replicate these findings for a mental ISM intervention. Outpatients with serious mental illness (N = 428) from eight Tennessee communities were randomly assigned to receive a peer-led self-management intervention called Building Recovery of Individual Dreams and Goals Through Education and Support or services as usual. Psychiatric symptoms were assessed with the Brief Symptom Inventory; the outcome of personal empowerment was measured by the Empowerment Scale. Intent-to-treat analysis using mixed-effects random regression found significant interaction effects between study condition and three moderating symptom profiles. Empowerment was greater for the intervention participants with high levels of depressive symptoms, anxiety symptoms, and general symptom distress than for the experimental participants with low symptom levels and the control subjects with high or low levels of symptoms. These results shed light on how mental ISM programs operate and ways these can be improved.

Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education.

This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait list (control condition). Interviews were conducted at enrollment, at the end of the intervention, and 6-months post-intervention. Random regression results indicate that, compared to controls, BRIDGES participants experienced significant increases in overall empowerment, empowerment-self-esteem, and self-advocacy-assertiveness, and maintained these improved outcomes over time. Peer-led education interventions may provide participants with the information, skills and support they need to become more actively involved in the treatment decision-making process.

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee.

OBJECTIVE: Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 160 participants in the Building Recovery of Individual Dreams and Goals (BRIDGES) education program. BRIDGES is a peer-led 8-week course taught by trained instructors who publicly disclose the fact that they are in recovery from mental illness. METHOD: Structured interviews assessing recovery outcomes were conducted with participants in the month prior to their receipt of BRIDGES, and immediately after receipt of the intervention. Paired t-tests were conducted to examine changes in psychiatric symptoms, hopefulness, social support, self-advocacy, empowerment, adaptive coping, and recovery pre-receipt and post-receipt of BRIDGES. RESULTS: Post-receipt of BRIDGES, participants reported significantly fewer psychiatric symptoms, decreased use of maladaptive coping behaviors, and increased feelings of hopefulness, self-advocacy, empowerment, and recovery. CONCLUSIONS: These promising early results from our ongoing study of BRIDGES suggest that peer-led education interventions are a valuable resource. Additional research is needed to better understand the effectiveness of these interventions, including potential long-term post-program participation benefits.

Randomized controlled trial of peer-led recovery education using Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES).

OBJECTIVE: The purpose of this study was to test the efficacy of a peer-led, mental illness education intervention called Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). METHOD: Subjects were recruited from outpatient community mental health settings in eight Tennessee communities. Using a single-blind, randomized controlled trial design, 428 individuals with serious mental illness (SMI) were interviewed at baseline and assigned to BRIDGES or to a services as usual wait list control condition. Two-and-one-half hour classes were taught once a week for 8 weeks by peers who were certified BRIDGES instructors. Subjects were followed-up at immediate post-intervention and 6-months later. The primary outcome was self-perceived recovery, measured by the Recovery Assessment Scale (RAS). A secondary outcome was hopefulness as assessed by the State Hope Scale (SHS). An exploratory hypothesis examined the impact of depressive symptoms on both recovery outcomes. RESULTS: Eighty six percent of participants were followed up. On average, participants attended five sessions. Intent-to-treat analysis using mixed-effects random regression found that, compared to controls, intervention participants reported: 1) significantly greater improvement in total RAS scores as well as subscales measuring personal confidence and tolerable symptoms; and 2) significantly greater improvement in hopefulness as assessed by the agency subscale of the SHS. While study subjects with high levels of depressive symptoms had significantly poorer outcomes, outcomes were superior for BRIDGES participants regardless of depressive symptoms. CONCLUSIONS: Peer-led mental illness education improves participants' self-perceived recovery and hopefulness over time, even controlling for severity of depressive symptoms.