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Self-management is intended to empower individuals in their recovery by providing the skills and confidence they need to take active steps in recognising and managing their own health problems. Evidence supports such interventions in a range of long-term physical health conditions, but a recent systematic synthesis is not available for people with severe mental health problems.
To evaluate the effectiveness of self-management interventions for adults with severe mental illness (SMI).
A systematic review of randomised controlled trials was conducted. A meta-analysis of symptomatic, relapse, recovery, functioning and quality of life outcomes was conducted, using RevMan.
A total of 37 trials were included with 5790 participants. From the meta-analysis, self-management interventions conferred benefits in terms of reducing symptoms and length of admission, and improving functioning and quality of life both at the end of treatment and at follow-up. Overall the effect size was small to medium. The evidence for self-management interventions on readmissions was mixed. However, self-management did have a significant effect compared with control on subjective measures of recovery such as hope and empowerment at follow-up, and self-rated recovery and self-efficacy at both time points.
There is evidence that the provision of self-management interventions alongside standard care improves outcomes for people with SMI. Self-management interventions should form part of the standard package of care provided to people with SMI and should be prioritised in guidelines: research on best methods of implementing such interventions in routine practice is needed.
Informal caregiving is an integral part of the care of people with severe
mental illness, but the support needs of those providing such care are
not often met.
To determine whether interventions provided to people caring for those
with severe mental illness improve the experience of caring and reduce
We conducted a systematic review and meta-analyses of randomised
controlled trials (RCTs) of interventions delivered by health and social
care services to informal carers (i.e. family or friends who provide
support to someone with severe mental illness).
Twenty-one RCTs with 1589 carers were included in the review. There was
evidence suggesting that the carers' experience of care was improved at
the end of the intervention by psychoeducation (standardised mean
difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16,
95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological
distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but
not immediately post-intervention. Support interventions had a beneficial
effect on psychological distress at the end of the intervention (SMD
=–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD
=–1.57, 95% CI −1.79 to −1.35); these effects were maintained at
follow-up. The quality of the evidence was mainly low and very low.
Evidence for combining these interventions and for self-help and
self-management was inconclusive.
Carer-focused interventions appear to improve the experience of caring
and quality of life and reduce psychological distress of those caring for
people with severe mental illness, and these benefits may be gained in
first-episode psychosis. Interventions for carers should be considered as
part of integrated services for people with severe mental health
Hogervorst and colleagues review the complex topic of soy effects on cognition and risk of dementia. In an attempt to address one aspect of this complexity, they conducted a comparative analysis of fermented (e.g., tempe) versus non-fermented (e.g., tofu) forms. Results of their analyses indicate that high intake of tofu was associated with lower cognitive function and an increased risk for dementia, particularly in those participants who were older than 68 years of age. These findings are consistent with previous analyses of hormone therapy and tofu consumption. They also found a complex association with genistein levels. Relatively younger participants (52–68 years of age) appeared to have optimal genistein levels relating to optimal memory function, whereas persons older than 68 years of age with high genistein levels exhibited lower cognitive performance and an increased risk of dementia. These results are reminiscent of the window of opportunity theory (Chapters 4 and 5) or the healthy cell bias theory (Chapter 6). Higher folate levels within tempe (which contains high phytoestrogen levels) may be a mediating factor for its reported protective effects. Further studies to determine the interaction between serum phytoestrogens and folate levels and their relationship to dementia risk are suggested.