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Non-uniform effectiveness of structured patient–clinician communication in community mental healthcare: an international comparison

van den Brink, R., Wiersma, D., Wolters, K. , Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., McCabe, R. ORCID: 0000-0003-2041-7383, Rössler, W., Salize, H., Svensson, B., Torres-Gonzales, F. & Priebe, S. (2011). Non-uniform effectiveness of structured patient–clinician communication in community mental healthcare: an international comparison. Social Psychiatry and Psychiatric Epidemiology, 46(8), pp. 685-693. doi: 10.1007/s00127-010-0235-x


The effectiveness of psychosocial interventions in community mental healthcare has been shown to depend on the setting in which they are implemented. Recently structured patient–clinician communication was found to be effective in a multi-centre trial in six European countries, the DIALOG trial. In the overall study, differences between centres were controlled for, not studied. Here, we test whether the effectiveness of structured patient–clinician communication varies between services in different countries, and explore setting characteristics associated with outcome.

The study is part of the DIALOG trial, which included 507 patients with schizophrenia or related disorder, treated by 134 keyworkers. The keyworkers were allocated to intervention or treatment as usual.

Positive effects were found on quality of life (effect size 0.20: 95% CI 0.01–0.39) and treatment satisfaction (0.27: 0.06–0.47) in all centres, but reductions in unmet needs for care were only seen in two centres (−0.83 and −0.60), and in positive, negative and general symptoms in one (−0.87, −0.78, −0.87). The intervention was most effective in settings with patient populations with many unmet needs for care and high symptom levels.

Psychosocial interventions in community mental healthcare may not be assumed to have uniform effectiveness across settings. Differences in patient population served and mental healthcare provided, should be studied for their influence on the effectiveness of the intervention. Structured patient–clinician communication has a uniform effect on quality of life and treatment satisfaction, but on unmet needs for care and symptom levels its effect differs between mental healthcare settings.

Publication Type: Article
Additional Information: This is a post-peer-review, pre-copyedit version of an article published in Social Psychiatry and Psychiatric Epidemiology. The final authenticated version is available online at:
Publisher Keywords: Physician–patient relations, Computer-assisted decision making, Community mental health services, Population characteristics, Health services research
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
[thumbnail of Centre differences DIALOG paper accepted by SPPE.pdf]
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