Psychological therapy for inpatients receiving acute mental healthcare: a systematic review and meta-analysis of controlled trials

Charlotte Paterson, Thanos Karatzias, Adele Dickson, Sean Harper, Nadine Dougall, Paul Hutton

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Abstract

Objectives
The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomised controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesise evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes, and examine whether the presence of randomisation and rater-blinding moderated these estimates.

Method
A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, Embase, Cinahl, Cochrane, Medline and PsycINFO using a combination of the key terms ‘inpatient’, ‘psychological therapy’ and ‘acute’. No restriction was placed on diagnosis. The moderating effect of the use of single-blind RCT methodology was examined via subgroup and sensitivity analyses.

Results
Overall, psychological therapy was associated with small to moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression and anxiety. The use of single-blind randomised controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms, and was also associated with reduced benefits on readmission and depression, however these reductions were not statistically significant.

Conclusions
The provision of psychological therapy to acute psychiatric inpatients is associated with improvements, however the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format and intensity of brief psychological therapy is required to achieve sustained benefits.
Original languageEnglish
Pages (from-to)453-472
Number of pages20
JournalBritish Journal of Clinical Psychology
Volume57
Issue number4
Early online date16 Apr 2018
DOIs
Publication statusPublished - Nov 2018

Keywords

  • acute inpatients, psychological therapies, brief psychotherapy, psychotic symptoms, readmission, depression, anxiety

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