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  • Mediators of quality of life change in people with severe psychotic disorders treated in integrated care: ACCESS II study

  • Romy Schröter, Martin Lambert, Anja Rohenkohl, Vivien Kraft, Friederike Rühl, Daniel Luedecke, Jürgen Gallinat, Anne Karow, Stefanie J. Schmidt
  • Journal:
    European Psychiatry / Volume 66 / Issue 1 / 2023
    Published online by Cambridge University Press:
    04 November 2022, e1
    • Article
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  • Background

    Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood.

    Methods

    The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models.

    Results

    The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = −0.20, p < 0.001) to QoL (12 months, β = −0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05).

    Conclusions

    Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.

Governance and Politics in the Post-Crisis European Union
  • Edited by Ramona Coman, Amandine Crespy, Vivien A. Schmidt
  • Published online:
    31 October 2020
    Print publication:
    27 August 2020
  • The European Union of today cannot be studied as it once was. This original new textbook provides a much-needed update on how the EU's policies and institutions have changed in light of the multiple crises and transformations since 2010. An international team of leading scholars offer systematic accounts on the EU's institutional regime, policies, and its community of people and states. Each chapter is structured to explain the relevant historical developments and institutional framework, presenting the key actors, the current controversies and discussing a paradigmatic case study. Each chapter also provides ideas for group discussions and individual research topics. Moving away from the typical, neutral account of the functioning of the EU, this textbook will stimulate readers' critical thinking towards the EU as it is today. It will serve as a core text for undergraduate and graduate students of politics and European studies taking courses on the politics of the EU, and those taking courses in comparative politics and international organizations including the EU.

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