首页资讯在线记录康复叙事在改善非精神病性精神疾病患者生活质量方面的有效性和成本

在线记录康复叙事在改善非精神病性精神疾病患者生活质量方面的有效性和成本

来源：泰然健康网时间：2025年06月10日 09:47

在线记录康复叙事在改善非精神病性精神疾病患者生活质量方面的有效性和成本效益：一项实用随机对照试验。

Mike Slade, Stefan Rennick-Egglestone, Rachel A Elliott, Chris Newby, Clare Robinson, Sean P Gavan, Luke Paterson, Yasmin Ali, Caroline Yeo, Tony Glover, Kristian Pollock, Felicity Callard, Stefan Priebe, Graham Thornicroft, Julie Repper, Jeroen Keppens, Melanie Smuk, Donna Franklin, Rianna Walcott, Julian Harrison, Roger Smith, Dan Robotham, Simon Bradstreet, Steve Gillard, Pim Cuijpers, Marianne Farkas, Dror Ben Zeev, Larry Davidson, Yasuhiro Kotera, James Roe, Fiona Ng, Joy Llewellyn-Beardsley

摘要

描述心理健康问题康复亲身经历的叙事广为流传。新出现的证据表明，参与心理健康康复叙事可以让有心理健康问题的人受益，但迄今为止还没有进行过随机对照试验。我们开发了 "在线叙事经历（NEON）干预"，这是一个网络应用程序，提供自我指导和推荐系统，可访问记录的心理健康康复叙事集（n=659）。我们以常规护理为对照条件，开展了一项务实的平行组随机试验，调查访问 NEON 干预是否有益于经历非精神病性精神健康问题的成年人。主要终点是通过曼彻斯特短期评估（MANSA）评估第 52 周的生活质量。次要结果为第 52 周时的心理困扰、希望、自我效能和生活意义。在 2020 年 3 月 9 日至 2021 年 3 月 26 日期间，我们在英格兰各地招募了 1023 名参与者（根据功率分析，目标人数为 994 人），其中 827 人（80.8%）为英国白人，811 人（79.3%）为女性，586 人（57.3%）为在职者，272 人（26.6%）为失业者。他们的平均年龄为 38.4±13.6 岁。情绪和/或焦虑症（626 人，61.2%）和压力相关障碍（152 人，14.9%）是最常见的心理健康问题。在第 52 周时，我们的意向治疗分析发现，干预组和对照组之间的 MANSA 评分经基线调整后的差异为 0.13（95% CI：0.01-0.26，p=0.041），相当于每位参与者平均变化了 1.56 分，这表明干预提高了生活质量。我们还发现，经基线调整后，干预组与对照组在 "生活意义问卷 "的 "意义的存在 "分量表上的得分相差 0.22（95% CI：0.05-0.40，p=0.014）分，相当于每位参与者平均变化了 1.1 个量表点。我们发现，与常规护理相比，每位参与者的质量调整生命年（QALY）增量为 0.0142 英镑（95% 可信区间：0.0059 至 0.0226 英镑），成本增量为 178 英镑（95% 可信区间：-154 至 455 英镑），每 QALY 的增量成本效益比为 12,526 英镑。这一数字低于英格兰国家卫生服务机构采用的每QALY20,000英镑的阈值，表明该干预措施对卫生服务资源的利用具有成本效益。在包括基线时使用过专科心理健康服务的参与者在内的亚组分析中，与常规护理相比，干预既降低了成本（-98 英镑，95% 可信区间：-606 英镑至 309 英镑），又提高了每名参与者的 QALYs（0.0165，95% 可信区间：0.0057 至 0.0273）。我们的结论是，NEON 干预疗法是一项针对非精神病性精神健康问题患者的有效且具有成本效益的新干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial.

Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the "presence of meaning" subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: -£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (-£98, 95% credible interval: -£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problems.