Clinical and cost-effectiveness of social recovery therapy for the prevention and treatment of long-term social disability among young people with emerging severe mental illness (PRODIGY): Randomised controlled trial

Clio Berry, Joanne Hodgekins, Paul French, Tim Clarke, Lee Shepstone, Garry Barton, Robin Banerjee, Rory Byrne, Rick Fraser, Kelly Grant, Kathryn Greenwood, Caitlin Notley, Sophie Parker, Jon Wilson, Alison R. Yung, David Fowler

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Abstract

Background Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. Aims We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. Method A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. Results We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. Conclusions We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.

Original languageEnglish
Pages (from-to)154-162
Number of pages9
JournalThe British Journal of Psychiatry
Volume220
Issue number3
Early online date26 Jan 2022
DOIs
Publication statusPublished - Mar 2022

Keywords

  • anxiety disorders
  • cognitive-behavioural therapies
  • depressive disorders
  • psychosocial interventions
  • Social functioning

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