TY - JOUR
T1 - The effectiveness of an additive informal social network intervention for forensic psychiatric outpatients
T2 - results of a randomized controlled trial
AU - Swinkels, Lise T. A.
AU - van der Pol, Thimo M.
AU - Twisk, Jos
AU - ter Harmsel, Janna F.
AU - Dekker, Jack J. M.
AU - Popma, Arne
N1 - Funding Information: The authors thank the formal and informal care organizations – Inforsa Forensic Mental Healthcare and De Regenboog Groep – for facilitating this study. This research project would not have been possible without the financial support by De Stichting tot Steun VCVGZ. We sincerely thank all participants, volunteer coaches, and mental healthcare professionals for cooperating in this study. We also thank to Jerry May Zeilstra and Daan van Leeuwen for their collaboration and project coordination at De Regenboog Groep. We thank Jaap Peen for facilitating the data collection from medical records. Finally, our special thanks go to Laura Catsburg, Martijn Folkersma, Léonie Sijbring, Annemiek Vogelaar, Eline Middelhoven, Bo Hornkamp, Christiaan Doll, Lotte Nijhuis, Nienke Smit, Michelle Kemper, Lisette Stegeman, Nine van Eerde, Wiesje van Overbeek, Ashira Oude Lenferink, Lisa Kisters, Roos Brakeboer, Vera Heugen, Esry Josepha, Melanie Haeck, Christine van der Beek, Cylia Hendriks, Joris Hagenbeek, Margreet Flipse, Lisa Kok, and Isabella Knuijt for their involvement in data collection. Publisher Copyright: Copyright © 2023 Swinkels, van der Pol, Twisk, ter Harmsel, Dekker and Popma.
PY - 2023
Y1 - 2023
N2 - Objectives: A supportive social network is associated with better mental health and wellbeing, and less criminal behavior. Therefore, this study examined the effectiveness of an additive informal social network intervention to treatment as usual (TAU) among forensic psychiatric outpatients. Materials and methods: An randomized controlled trial (RCT) was conducted in forensic psychiatric care, allocating eligible outpatients (N = 102) to TAU with an additive informal social network intervention or TAU alone. Participants receiving the additive intervention were matched to a trained community volunteer over 12 months. TAU consisted of forensic care (e.g., cognitive behavioral therapy and/or forensic flexible assertive community treatment). Follow-up assessments were conducted at 3, 6, 9, 12, and 18 months after baseline. The primary outcome was the between-group effect on mental wellbeing at 12 months. Between-group effects on secondary outcomes (e.g., general psychiatric functioning, hospitalization, criminal behavior) were explored. Results: Intention-to-treat analyses showed non-significant between-group effects on mental wellbeing on average over time and at 12 months. However, significant between-group effects were found on hospitalization duration and criminal behavior. Specifically, TAU participants were hospitalized 2.1 times more days within 12 months and 4.1 more days within 18 months than participants in the additive intervention. Furthermore, TAU participants reported 2.9 times more criminal behaviors on average over time. There were no significant effects on other outcomes. Exploratory analyses revealed that sex, comorbidity, and substance use disorders moderated effects. Conclusion: This is the first RCT examining the effectiveness of an additive informal social network intervention in forensic psychiatric outpatients. Although no improvements were found on mental wellbeing, the additive intervention was effective in reducing hospitalization and criminal behavior. The findings suggest that forensic outpatient treatment can be optimized by collaborating with informal care initiatives aimed at improving social networks within the community. Future research is warranted to determine which specific patients might benefit from the intervention and if effects can be improved by extending the intervention duration and enhancing patient compliance. Clinical Trial Registration: [https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7163], identifier [NTR7163].
AB - Objectives: A supportive social network is associated with better mental health and wellbeing, and less criminal behavior. Therefore, this study examined the effectiveness of an additive informal social network intervention to treatment as usual (TAU) among forensic psychiatric outpatients. Materials and methods: An randomized controlled trial (RCT) was conducted in forensic psychiatric care, allocating eligible outpatients (N = 102) to TAU with an additive informal social network intervention or TAU alone. Participants receiving the additive intervention were matched to a trained community volunteer over 12 months. TAU consisted of forensic care (e.g., cognitive behavioral therapy and/or forensic flexible assertive community treatment). Follow-up assessments were conducted at 3, 6, 9, 12, and 18 months after baseline. The primary outcome was the between-group effect on mental wellbeing at 12 months. Between-group effects on secondary outcomes (e.g., general psychiatric functioning, hospitalization, criminal behavior) were explored. Results: Intention-to-treat analyses showed non-significant between-group effects on mental wellbeing on average over time and at 12 months. However, significant between-group effects were found on hospitalization duration and criminal behavior. Specifically, TAU participants were hospitalized 2.1 times more days within 12 months and 4.1 more days within 18 months than participants in the additive intervention. Furthermore, TAU participants reported 2.9 times more criminal behaviors on average over time. There were no significant effects on other outcomes. Exploratory analyses revealed that sex, comorbidity, and substance use disorders moderated effects. Conclusion: This is the first RCT examining the effectiveness of an additive informal social network intervention in forensic psychiatric outpatients. Although no improvements were found on mental wellbeing, the additive intervention was effective in reducing hospitalization and criminal behavior. The findings suggest that forensic outpatient treatment can be optimized by collaborating with informal care initiatives aimed at improving social networks within the community. Future research is warranted to determine which specific patients might benefit from the intervention and if effects can be improved by extending the intervention duration and enhancing patient compliance. Clinical Trial Registration: [https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7163], identifier [NTR7163].
KW - criminal recidivism
KW - forensic psychiatry
KW - informal social network intervention
KW - mental wellbeing
KW - psychiatric functioning
KW - randomized controlled trial
KW - social support
KW - volunteer mentoring and befriending
UR - http://www.scopus.com/inward/record.url?scp=85161225251&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fpsyt.2023.1129492
DO - https://doi.org/10.3389/fpsyt.2023.1129492
M3 - Article
C2 - 37293397
SN - 1664-0640
VL - 14
JO - Frontiers in psychiatry
JF - Frontiers in psychiatry
M1 - 1129492
ER -