Mental Disorders
Conditions
Keywords
Serious mental illness, Psychiatric disability, Mental health peer-led, Mental illness education, Illness self-management
Brief summary
This randomized controlled trial tests the efficacy of a mental health peer-led educational intervention called BRIDGES (Building Recovery of Individual Dreams and Goals through Education and Support). The BRIDGES program is a 10-week, manualized education course designed to provide basic information about the etiology and treatment of mental illness, self-help skills, and recovery principles in order to empower participants to return to valued social roles within their communities. BRIDGES is a peer-led program and all instructors are adults with mental illnesses. For study purposes, the 10-week course was modified to 8-weeks, meeting 2 1/2 hours once a week. Hypothesis #1: Compared to wait-list controls, intervention participants will report increased feelings of psychological empowerment. Hypothesis #2: Compared to wait-list controls, intervention participants will report increased feelings of hopefulness. Hypothesis #3: Compared to wait-list controls, intervention participants will report enhanced coping ability. Hypothesis #4: Compared to wait-list controls, intervention participants will report enhanced recovery. Hypothesis #5: Compared to wait-list controls, intervention participants will report greater ability to advocate for themselves with health care providers. Hypothesis #6: Compared to wait-list controls, those in the BRIDGES education course will report increased knowledge of the causes and treatment of mental illness and recovery principles.
Detailed description
Eligibility criteria included having a diagnosis of serious mental illness and experiencing severe functional impairment in one or more life roles. All study participants completed telephone interviews at three points in time: study entry (pre-intervention); 8-weeks later (immediate post-intervention); and 6-months after intervention (approximately 8 months after study entry). Blinded interviewers administered valid and reliable outcome assessments that measured changes in subjects' knowledge about mental illness; emotional well-being; empowerment; hopefulness; self-advocacy; and recovery. All study participants were compensated for their time at each interview. All BRIDGES instructors were people in recovery from serious mental illnesses who were certified and experienced BRIDGES teachers. Fidelity to the BRIDGES curriculum was assessed on an ongoing basis throughout the study.
Interventions
BEHAVIORALBRIDGES Peer-Led Education
The BRIDGES program is a 10-week, manualized education course designed to provide basic education about the etiology and treatment of mental illness, self-help skills, and recovery principles in order to empower participants to return to valued social roles within their communities. BRIDGES is a peer-led program and all instructors are adults with mental illnesses. For this intervention study, the BRIDGES curriculum was modified from a week course to an 8-week course, meeting for 2 1/2 hours once a week.
Sponsors
Substance Abuse and Mental Health Services Administration (SAMHSA)
University of Illinois at Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Clinical diagnosis of mental illness * Disability due to mental illness * Age 18 years or older * Willingness to receive the intervention
Exclusion criteria
* Inability to understand spoken English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recovery From Mental Illness | Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3) | Recovery from mental illness is measured by the Recovery Assessment Scale (RAS) (Giffort et al., 1995). Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-response format ranging from strongly disagree to strongly agree. The minimum value for the RAS is 41 and the maximum is 205, with higher scores indicating a better outcome. Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and no being dominated by one's residual psychiatric symptoms. |
| Personal Empowerment | Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3) | Personal psychological empowerment is measured via the Boston University Empowerment Scale (Rogers et al.,1997). This 28-item instrument designed to measure subjective feelings of empowerment via self-report in which respondents answer questions on a four-point scale ranging from Strongly Agree to Strongly Disagree. The minimum score is 28 and the maximum is 112, with higher scores indicating a better outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hopefulness | Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3) | Hopefulness is measured by the State Hope Scale (Snyder et al., 1991). Hopefulness as a cross-situational long-term trait is assessed via patient self-report using a 12-item scale assessed on a 4-point Likert response scale with options ranging from definitely false to definitely true and summed to produce a total score and sub-scale scores. The minimum value for this scale is 12 and the maximum value is 48. Higher scores indicate a better income. |
| Patient Self-advocacy | Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3) | The ability to advocate for oneself with medical care providers is assessed via self-report using The Patient Self-Advocacy Scale (Brashers et al., 1999), an 18-item scale with a 5-point Likert response set ranging from strongly disagree to strongly agree. Dimensions include in patient knowledge, assertiveness, and potential for mindful non-adherence to treatment. Scoring involves computing the mean scale score, so therefore values range from a minimum of 1 to a maximum of 5, with higher scores indicating a better outcome. Reported below are findings for the assertiveness sub-scale. |
| Coping Style | Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3) | Coping is measured via patient self-report using The Brief COPE Inventory (Carver, 1997), a 28-item instrument with 4-point Likert responses ranging from 1-I haven't been doing this at all to 4-I have been doing this a lot. This measure includes two subscales that assess participants' adaptive coping skills (e.g., planning and using emotional support to deal with problems) and maladaptive coping skills (e.g., self-blame and denial). Scoring involves computing the means for each subscale, with a minimum value of 1 and a maximum value of 4. Higher adaptive coping scores indicate a greater use of positive coping styles; higher maladaptive coping scores indicate a greater use of negative coping styles (in other words, lower maladative coping scores indicate a better outcome). |
Countries
United States
Participant flow
Recruitment details
Recruitment was conducted collaboratively with the statewide consumer coalition, Tennessee Mental Health Consumer's Association (TMHCA), and the statewide National Alliance for Mental Illness (NAMI), NAMI Tennessee. Recruitment took place from March 2007 through March 2009 at local mental health agencies, and at residential and peer-run programs.
Participants by arm
| Arm | Count |
|---|---|
| BRIDGES Intervention BRIDGES Peer-Led Education: The BRIDGES program is a 10-week, manualized education course designed to provide basic education about the etiology and treatment of mental illness, self-help skills, and recovery principles in order to empower participants to return to valued social roles within their communities. BRIDGES is a peer-led program and all instructors are adults with mental illnesses. For this intervention study, the BRIDGES curriculum was modified from a 10-week course to an 8-week course, meeting for 2 1/2 hours once a week. | 212 |
| Comparison Wait-list Group Participants assigned to the comparison group were in a delayed treatment condition in which they continued in public services as usual, but were offered the chance to attend the BRIDGES program after their final research interview. | 216 |
| Total | 428 |
Baseline characteristics
| Characteristic | Total | Comparison Wait-list Group | BRIDGES Intervention |
|---|---|---|---|
| Age, Continuous | 42.8 Years STANDARD_DEVIATION 10.9 | 43.0 Years STANDARD_DEVIATION 11.8 | 42.7 Years STANDARD_DEVIATION 9.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 146 Participants | 71 Participants | 75 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 282 Participants | 145 Participants | 137 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 25 Participants | 15 Participants | 10 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 146 Participants | 71 Participants | 75 Participants |
| Race (NIH/OMB) More than one race | 7 Participants | 4 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 20 Participants | 9 Participants | 11 Participants |
| Race (NIH/OMB) White | 229 Participants | 117 Participants | 112 Participants |
| Region of Enrollment United States | 428 participants | 216 participants | 212 participants |
| Sex: Female, Male Female | 238 Participants | 124 Participants | 114 Participants |
| Sex: Female, Male Male | 190 Participants | 92 Participants | 98 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 212 | 0 / 216 |
| other Total, other adverse events | 1 / 212 | 2 / 216 |
| serious Total, serious adverse events | 0 / 212 | 0 / 216 |
Outcome results
Primary
Personal Empowerment
Personal psychological empowerment is measured via the Boston University Empowerment Scale (Rogers et al.,1997). This 28-item instrument designed to measure subjective feelings of empowerment via self-report in which respondents answer questions on a four-point scale ranging from Strongly Agree to Strongly Disagree. The minimum score is 28 and the maximum is 112, with higher scores indicating a better outcome.
Time frame: Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3)
Population: The Overall Number of Participants Analyzed reflects the number of participants at Time 1
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BRIDGES Intervention | Personal Empowerment | Baseline (Time 1) | 78.82 score on a scale | Standard Deviation 9.29 |
| BRIDGES Intervention | Personal Empowerment | Post-intervention 1 (Time 2) | 82.31 score on a scale | Standard Deviation 9.12 |
| BRIDGES Intervention | Personal Empowerment | Post-intervention 2 (Time 3) | 81.19 score on a scale | Standard Deviation 9.21 |
| Comparison Wait-list Group | Personal Empowerment | Baseline (Time 1) | 78.58 score on a scale | Standard Deviation 10.04 |
| Comparison Wait-list Group | Personal Empowerment | Post-intervention 1 (Time 2) | 79.91 score on a scale | Standard Deviation 9.88 |
| Comparison Wait-list Group | Personal Empowerment | Post-intervention 2 (Time 3) | 79.57 score on a scale | Standard Deviation 10.31 |
Comparison: We tested 3 moderating variables: BSI depressive symptom, anxiety, and general symptom distress. In these three models, we hypothesized that the intervention participants with high levels of each type of symptoms would experience greater gains in empowerment over time than participants with low levels of symptoms, as well as control participants with both high and low symptom level.~This model includes depressive symptoms as the moderator (High depressive symptoms X time X study condition)p-value: 0.01Mixed Effects Random Regression
Comparison: We tested 3 moderating variables: depressive symptom, anxiety, and general symptom distress. In these three models, we hypothesized that the intervention participants with high levels of each type of symptoms would experience greater gains in empowerment over time than participants with low levels of symptoms, as well as control participants with both high and low symptom level.~This model includes anxiety as the moderator (high anxiety X time X study condition)p-value: 0.01Mixed Effects Random Regression
Comparison: We tested 3 moderating variables: BSI depressive symptom, anxiety, and general symptom distress. In these three models, we hypothesized that the intervention participants with high levels of each type of symptoms would experience greater gains in empowerment over time than participants with low levels of symptoms, as well as control participants with both high and low symptom level.~This model includes general symptom distress as the moderator (high symptom distress X time X study condition)p-value: 0.022Mixed Effects Random Regression
Primary
Recovery From Mental Illness
Recovery from mental illness is measured by the Recovery Assessment Scale (RAS) (Giffort et al., 1995). Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-response format ranging from strongly disagree to strongly agree. The minimum value for the RAS is 41 and the maximum is 205, with higher scores indicating a better outcome. Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and no being dominated by one's residual psychiatric symptoms.
Time frame: Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3)
Population: The Overall Number of Participants Analyzed reflects the number of participants at Time 1
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BRIDGES Intervention | Recovery From Mental Illness | Baseline | 91.90 score on a scale | Standard Deviation 13.65 |
| BRIDGES Intervention | Recovery From Mental Illness | Post-intervention 1 (Time 2) | 94.84 score on a scale | Standard Deviation 12.83 |
| BRIDGES Intervention | Recovery From Mental Illness | Post-intervention 2 (Time 3) | 96.13 score on a scale | Standard Deviation 12.76 |
| Comparison Wait-list Group | Recovery From Mental Illness | Baseline | 90.72 score on a scale | Standard Deviation 13.33 |
| Comparison Wait-list Group | Recovery From Mental Illness | Post-intervention 1 (Time 2) | 91.01 score on a scale | Standard Deviation 14.35 |
| Comparison Wait-list Group | Recovery From Mental Illness | Post-intervention 2 (Time 3) | 91.97 score on a scale | Standard Deviation 14.58 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in self-perceived Recovery and that this effect would be maintained overtime; and that intervention participants would report greater increases in hopefulness than controls, also maintained longitudinally~This first model reports on Recovery over time.p-value: 0.013Mixed Effects Random Regression
Secondary
Coping Style
Coping is measured via patient self-report using The Brief COPE Inventory (Carver, 1997), a 28-item instrument with 4-point Likert responses ranging from 1-I haven't been doing this at all to 4-I have been doing this a lot. This measure includes two subscales that assess participants' adaptive coping skills (e.g., planning and using emotional support to deal with problems) and maladaptive coping skills (e.g., self-blame and denial). Scoring involves computing the means for each subscale, with a minimum value of 1 and a maximum value of 4. Higher adaptive coping scores indicate a greater use of positive coping styles; higher maladaptive coping scores indicate a greater use of negative coping styles (in other words, lower maladative coping scores indicate a better outcome).
Time frame: Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3)
Population: The Overall Number of Participants Analyzed reflects the number of participants at Time 1. Results are provided for the Maladaptive Coping Subcale.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BRIDGES Intervention | Coping Style | Baseline (Time 1) | 2.14 units on a scale | Standard Deviation 0.53 |
| BRIDGES Intervention | Coping Style | Post-intervention 1 (Time 2) | 2.01 units on a scale | Standard Deviation 0.51 |
| BRIDGES Intervention | Coping Style | Post-intervention 2 (Time 3) | 2.04 units on a scale | Standard Deviation 0.48 |
| Comparison Wait-list Group | Coping Style | Baseline (Time 1) | 2.14 units on a scale | Standard Deviation 0.54 |
| Comparison Wait-list Group | Coping Style | Post-intervention 1 (Time 2) | 2.13 units on a scale | Standard Deviation 0.53 |
| Comparison Wait-list Group | Coping Style | Post-intervention 2 (Time 3) | 2.06 units on a scale | Standard Deviation 0.52 |
p-value: 0.017Mixed Effects Random Regression
Secondary
Hopefulness
Hopefulness is measured by the State Hope Scale (Snyder et al., 1991). Hopefulness as a cross-situational long-term trait is assessed via patient self-report using a 12-item scale assessed on a 4-point Likert response scale with options ranging from definitely false to definitely true and summed to produce a total score and sub-scale scores. The minimum value for this scale is 12 and the maximum value is 48. Higher scores indicate a better income.
Time frame: Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3)
Population: The Overall Number of Participants Analyzed reflects the number of participants at Time 1
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BRIDGES Intervention | Hopefulness | Baseline | 22.64 score on a scale | Standard Deviation 4.31 |
| BRIDGES Intervention | Hopefulness | Post-intervention 1 (Time 2) | 23.12 score on a scale | Standard Deviation 3.73 |
| BRIDGES Intervention | Hopefulness | Post-intervention 2 (Time 3) | 23.24 score on a scale | Standard Deviation 3.92 |
| Comparison Wait-list Group | Hopefulness | Baseline | 22.68 score on a scale | Standard Deviation 4.77 |
| Comparison Wait-list Group | Hopefulness | Post-intervention 1 (Time 2) | 22.77 score on a scale | Standard Deviation 4.8 |
| Comparison Wait-list Group | Hopefulness | Post-intervention 2 (Time 3) | 22.66 score on a scale | Standard Deviation 4.73 |
Comparison: This mixed effects random regression analysis tested whether intervention participants would report larger increases than controls in Hopefulness that would be maintained longitudinallyp-value: <0.01Mixed Effects Random Regression
Secondary
Patient Self-advocacy
The ability to advocate for oneself with medical care providers is assessed via self-report using The Patient Self-Advocacy Scale (Brashers et al., 1999), an 18-item scale with a 5-point Likert response set ranging from strongly disagree to strongly agree. Dimensions include in patient knowledge, assertiveness, and potential for mindful non-adherence to treatment. Scoring involves computing the mean scale score, so therefore values range from a minimum of 1 to a maximum of 5, with higher scores indicating a better outcome. Reported below are findings for the assertiveness sub-scale.
Time frame: Study entry (Pre-intervention/T1), 8-weeks later (Post-Intervention 1/T2), & 6-months after T2 (Post-Intervention 2/T3)
Population: The Overall Number of Participants Analyzed reflects the number of participants at Time 1
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BRIDGES Intervention | Patient Self-advocacy | Baseline | 3.68 average score on a scale | Standard Deviation 0.71 |
| BRIDGES Intervention | Patient Self-advocacy | Post-intervention 1 (Time 2) | 3.82 average score on a scale | Standard Deviation 0.72 |
| BRIDGES Intervention | Patient Self-advocacy | Post-intervention 2 (Time 3) | 3.82 average score on a scale | Standard Deviation 0.73 |
| Comparison Wait-list Group | Patient Self-advocacy | Baseline | 3.72 average score on a scale | Standard Deviation 0.71 |
| Comparison Wait-list Group | Patient Self-advocacy | Post-intervention 1 (Time 2) | 3.73 average score on a scale | Standard Deviation 0.76 |
| Comparison Wait-list Group | Patient Self-advocacy | Post-intervention 2 (Time 3) | 3.79 average score on a scale | Standard Deviation 0.75 |
Comparison: This analysis Mixed Effects Random Regression Modeling to test whether self-advocacy scores changed overtime by study condition status. Reported below are findings for the self-advocacy assertiveness sub scale.p-value: <0.01Mixed Effects Random Regression