DEVELOPMENT OF ENHANCING SELF - ESTEEM AND DECREASING DEPRESSIVE SYMPTOMS PROGRAM FOR PATIENTS WITH SCHIZOPHRENIA

  • Preeyanun Salasawadi Institute of psychiatry Somdet Chao Praya
  • Acharaporn Seeherunwong Faculty of Nursing, Mahidol University
Keywords: Self-esteem, Depressive symptoms, Schizophrenia, Psychosocial intervention

Abstract

Objectives: To develop the program to enhance self-esteem and decrease depressive symptoms for patients with schizophrenia and to test the feasibility, acceptability, and effectiveness of the program.

Methods: This study was a research and development based on the guideline of Develop­ment and Evaluating Complex Interventions by Medical Research Council (MRC, 2008). The study was conducted in three stages. The first stage was to develop the intervention using information from four sources including patients, caregivers, nurses and research evidences. The second stage was to test feasibility and acceptability of the program implementation with 10 schizophrenic patients with depressive symptoms and their caregivers and 7 nurses who implemented the program. The third stage was to examine the effectiveness of the program by using quasi experimental design. Outcomes were measured at before, immediately after, 1 month and 3 months after intervention. Participants were 63 inpatients diagnosed with schizophrenia and having mild to moderate level of depressive symptoms of a psychiatric hospital, 30 patients in the experimen­tal group and 33 patients in the control group. The control group received usual care. Research instruments used to measure outcomes were Hamilton Rating Scale for Depression (Thai version) and Rosenberg’s Self-Esteem Scale (Thai version). Descriptive statistics and repeated measures ANOVA were used for the data analysis.

Results: The developed psychosocial intervention program was named “The Enhancing Self-esteem and Decreasing Depressive Symptoms Program (SEDS)”. The SEDS program com­prised of four components conducted in 6 sessions. Five sessions were therapeutic group interventions and one session was a counselling session for a family including the patient and their caregivers. Strategies used as an intervention base were cognitive behavior therapy, acceptance and commitment therapy, and social support. The SEDS program was recognized and had the potential to be used in clinics at a very good level in terms of satisfaction, difficulty, application, and satisfactory clinical outcomes. Results of evaluating the effectiveness of the program showed that at immediately and 1, 3 months after the intervention self-esteem scores were significantly higher and depressive symptoms were significantly lowered than those before (p < .001) and than those in control group (p < .001). The group by time interaction effect for self-esteem and depressive symptoms was statistically significant (p < .001).

Conclusion: The SEDS program should be used in clinical practice. The effectiveness of the program, cost-effectiveness, and change process in large scale implementation according to the fourth stage of MRC should be further evaluated.

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References

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Published
2020-05-22
Section
Research Articles