Impact of group psychoeducation on insight, treatment adherence, quality of life and the feeling of loneliness in patients with schizophrenia

Introduction: Loneliness is a growing problem in the world of individualization and patients with schizophrenia struggle even harder. Loneliness can make gaining insight more difficult, as well as initiating or continuing treatment [1]. While psychoeducation is recommended as an integral part of the treatment of schizophrenia, its potential to improve quality of life and percieved loneliness is underinvestigated. Little is known on the complex interplay between providing information, gaining insight and treatment adherence and the role of the group context.

Aims: This prospective study aims to evaluate changes in insight, medication adherence, quality of life, and perceived loneliness among patients with schizophrenia during their treatment in a Daycare setting. Furthermore, the study seeks to differentiate whether active participation in psychoeducation modules yields superior outcomes compared to other psychosocial rehabilitation components.

Methods: This is a research proposal for a prospective, longitudinal study at the Clinic of Psychiatry, UMHAT “Alexandrovska”, Sofia, Bulgaria. We will recruit 60 patients diagnosed with Schizophrenia (ICD-10, F20.x) over a 6-month period. Participants will be divided into three equal groups (n=20 each): 1. Outpatients receiving standard care; 2. Daycare unit patients participating in psychosocial rehabilitation without psychoeducation; 3. Daycare unit patients actively participating in a specific psychoeducation program for psychosis. At recruitment all patients will be in a non-acute state. Assessment will be performed at three time points: Baseline (T0), Day 30 (T1), and Day 90 +/- 5 (T2). The research tools include:

Demographic and Clinical Data: A structured questionnaire for demographic data, history of the illness, comorbidities, and medication
Severity of Illness: Transdiagnostic Severity Scale (TGI-P)
Insight: Birchwood Insight Scale (BIS)
Adherence: Medication Adherence Rating Scale (MARS)
Quality of Life: The Short Form (36) Health Survey (SF-36)
Loneliness: UCLA Loneliness Scale

The research protocol is approved by the Ethic Committee of Medical University-Sofia.

Data will be analyzed using repeated measures ANOVA to track changes over time and correlational analysis to determine the impact of group psychoeducation attendance on clinical outcomes.

Results: We hypothesize that participation in group psychoeducation is a key driver for significant improvements in the Birchwood Insight Scale and MARS scores. We expect that the overall psychosocial program will lead to a statistically significant reduction in UCLA Loneliness Scale scores and a corresponding increase in SF-36 quality of life domains from baseline to the 90-day follow-up. We expect greater improvement in TGI-P from baseline to the 90-day follow-up for patients in the Daycare unit compared to outpatients.

Conclusions: If the hypotheses are confirmed, this study will emphasize the role of group psychoeducation in enhancing treatment adherence and insight. Practically, the study aims to establish “best practice” protocols for psychosocial support within the Bulgarian mental health system. Theoretically, it will identify accessible interventions that effectively reduce the burden of loneliness and improve the daily functioning of individuals living with schizophrenia.

References

Lee, C.Y., Ahmed, N., Ikhtabi, S., Duffett, P., Alhilow, Y., Richardson, L., et al. (2024) The experience of loneliness among people with psychosis: Qualitative meta-synthesis. PLoS ONE 19(12): e0315763. https://doi.org/10.1371/journal.pone.0315763