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Psychiatric Advance Directives Effective for Mental Disorders

Peer worker-facilitated PADs are effective for reducing compulsory hospital admissions, improving some mental health outcomes

MONDAY, Aug. 22, 2022 (HealthDay News) — Peer worker-facilitated psychiatric advance directives (PW-PAD) are effective for decreasing compulsory hospital admissions among people with mental disorders, according to a study recently published in JAMA Psychiatry.

Aurélie Tinland, M.D., Ph.D., from Aix-Marseille University in France, and colleagues determined the efficacy of PW-PAD in mental disorders in a multicenter randomized clinical trial. Adults with a diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months were enrolled. The primary outcome was the rate of compulsory admission 12 months after randomization in 394 participants (196 assigned to the PW-PAD group and 198 to the control group).

The researchers found that 27.0 and 39.9 percent of participants in the PW-PAD and control groups, respectively, had compulsory admissions. There were no significant differences observed between the groups in the rate of overall admission, therapeutic alliance score, or quality of life. Fewer symptoms, greater empowerment, and a higher recovery score were seen for participants in the PW-PAD group versus the control group (effect sizes, 0.20, 0.30, and 0.44, respectively).

“These findings support the use of PW-PADs for people with schizophrenia, bipolar I disorder, or schizoaffective disorder,” the authors write. “Legal and organizational initiatives that promote supported decision making can develop the activity of peer workers to fulfill this mission.”

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