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Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT

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Abstract

There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment (‘STEM’). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3–F31.5, F32–F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients’ treatment benefit. However, factors contributing to improvement need to be explored.

The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.

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Acknowledgements

The study has been funded by a research grant of the Federal Ministry of Education and Research (BMBF; research Grant 01GX1011).

We want to thank all study participants and all collaborators of the STEM work group who contributed to this study.

STEM work group (all facilities are located in Germany): Gaebel W, Cleveland, H, Conradt B, Feiertag N, Heise F, Janssen B, Riesbeck M, Sauter S, Siegert A, Zäske H; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, LVR-Klinikum, Düsseldorf. Klingberg S, Hesse K, Richter J, Nentwich B; Department of Psychiatry and Psychotherapy, University of Tübingen. Ohmann C, Grebe J, See B, Verde P; Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf. Icks, A; Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich Heine University, Düsseldorf. Schneider F, Backes V; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen. Wolff-Menzler C, Guse B; Department of Psychiatry, University Medical Center Göttingen, Göttingen. Bock T, Frey J; Department of Psychiatry and Psychotherapy of the University Medical Center Hamburg-Eppendorf. Jockers-Scherübl MC, Krüger T; Charité, Universitätsmedizin Berlin, Berlin, Germany Hennigsdorf: Oberhavel Kliniken GmbH, Klinik Hennigsdorf. Jessen F, Bechdolf A, v. Pützfeld V, Zarafonitis S. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne. Kircher T, Konrad C. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg. Falkai P, Schaub A. Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich. Rudolph M; Mittelrhein-Klinik for Psychosmatics and Rehabilitation, Bad Salzig. Köllner, V; Department of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel. Schmidt-Ott G, Stock Gissendanner S; Department of Psychosomatics, Berolina Clinic Löhne. Linden, M, Lieberei B; Department of Behavioral Medicine, Rehabilitation Center Seehof, Berlin. Stuhlinger M; Psychiatric-psychotherapeutic Rehabilitation Center grund.stein, Tübingen. Sommerfeld S, Schumacher A, Krenge S; AHG Klinik, Waren. Gereke S, Mönter N, Navarro-Urena A; Psychiatric Practices, Berlin. Frosch G, Kuhlbusch FJ; Psychiatric Practices, Düsseldorf.

Author information

Author notes

  1. Wolfgang Gaebel and Harald Zäske contributed equally to trial development and implementation as well as the preparation of this paper.

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

    Wolfgang Gaebel, Harald Zäske, Helen Cleveland & Mathias Riesbeck

  2. WHO Collaborating Center for Quality Assurance and Empowerment of Mental Health, LVR-Klinikum Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany

    Wolfgang Gaebel & Mathias Riesbeck

  3. Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany

    Klaus Hesse & Stefan Klingberg

  4. Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

    Christian Ohmann, Jürgen Grebe & Henrike Kolbe

  5. Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

    Andrea Icks

  6. German Diabetes Center, Düsseldorf, Germany

    Andrea Icks

  7. Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany

    Frank Schneider & Volker Backes

  8. University Hospital, Heinrich Heine University, Düsseldorf, Germany

    Frank Schneider

  9. Department of Psychiatry, University Medical Center Göttingen, Göttingen, Germany

    Claus Wolff-Menzler & Birgit Guse

  10. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jürgen Gallinat & Thomas Bock

  11. Charité Universitätsmedizin Berlin, Berlin, Germany

    Maria-Christiane Jockers-Scherübl & Timo Krüger

  12. Oberhavel Kliniken GmbH, Klinik Hennigsdorf, Hennigsdorf, Germany

    Maria-Christiane Jockers-Scherübl & Timo Krüger

  13. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany

    Frank Jessen & Andreas Bechdolf

  14. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany

    Tilo Kircher & Carsten Konrad

  15. Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany

    Peter Falkai & Annette Schaub

  16. Mittelrhein-Klinik for Psychosmatics and Rehabilitation, Bad Salzig, Germany

    Matthias Rudolph

  17. Department of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel, Germany

    Volker Köllner

  18. Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany

    Volker Köllner, Michael Linden & Barbara Lieberei

  19. Department of Psychosomatics, Berolina Clinic, Löhne, Germany

    Gerhard Schmid-Ott

  20. Psychiatric-Psychotherapeutic Rehabilitation Center grund.stein, Tübingen, Germany

    Monika Stuhlinger

  21. AHG Klinik, Waren, Germany

    Sebastian Sommerfeld, Albrecht Schumacher & Sabine Krenge

  22. Psychiatric Practices Berlin, Berlin, Germany

    Stephanie Gereke, Norbert Mönter & Alicia Navarro-Urena

  23. Psychiatric Practices Düsseldorf, Düsseldorf, Germany

    Günter Frosch & Franz-Josef Kuhlbusch

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  1. Wolfgang Gaebel
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  2. Harald Zäske
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  3. Klaus Hesse
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  9. Frank Schneider
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  26. Michael Linden
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  31. Sabine Krenge
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  32. Stephanie Gereke
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  33. Norbert Mönter
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  34. Alicia Navarro-Urena
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  35. Günter Frosch
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  36. Franz-Josef Kuhlbusch
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  37. Helen Cleveland
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  38. Mathias Riesbeck
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Corresponding author

Correspondence to Wolfgang Gaebel.

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Conflicts of interest

J. Gallinat has received research funding from the German Federal Ministry of Education and Research, German Science Foundation, and speaker fees from Lundbeck, Janssen-Cilag, Lilly and Otsuka. All other authors state that they have no conflicts of interest.

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Gaebel, W., Zäske, H., Hesse, K. et al. Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT. Eur Arch Psychiatry Clin Neurosci 270, 501–511 (2020). https://doi.org/10.1007/s00406-019-01064-3

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