Change in Patient Activation and Mental Illness Symptoms after Communication Training: a Multisite Study with a Diverse Patient Sample

Authors

Mengchun Chiang, Carnegie Mellon University
Janet Chang, West Chester University
Ora Nakash, Smith CollegeFollow
Mario Cruz-Gonzalez, Massachusetts General Hospital
Mirko K. Fillbrunn, Massachusetts General Hospital
Margarita Alegría, Massachusetts General Hospital

Document Type

Article

Publication Date

1-1-2019

Publication Title

Psychiatric Services

Abstract

Objective: Patient activation involves patients’ ability and motivation to communicate about their health and health care. Research has demonstrated that clinician or patient interventions may improve patient activation. This study explored the degree to which clinician and patient interventions affected both patient activation and symptoms of depression and anxiety in a racially and ethnically diverse clinical sample. Methods: Data were from a randomized clinical trial that included 312 patients and 74 clinicians from 13 Massachusetts community- and hospital-based outpatient behavioral health clinics. Patients completed measures of patient activation and depression and anxiety symptoms. Secondary data analyses were conducted to examine the effect of patient and clinician interventions (DECIDE-PA and DECIDE-PC, respectively) on depression and anxiety symptoms and patient activation. A multilevel, mixed-effects simultaneous-equation model was estimated to assess the relationship between the interventions, changes in patients’ symptoms, and patient activation. Results: Clinicians’ greater intervention dosage (i.e., more completed DECIDE-PC training sessions) was associated with patients’ decreased anxiety symptoms, but associations with patient activation or depression symptoms were not significant. The effect of clinician training dosage on anxiety symptoms was stronger when patients and clinicians were not of the same race-ethnicity. The reduction in patients’ anxiety symptoms appeared to increase patient activation. Conclusions: Clinician interventions designed to boost patient-clinician communication and the therapeutic alliance may serve to lessen patients’ anxiety and may ultimately improve patient activation.

Volume

70

Issue

8

First Page

696

Last Page

702

DOI

10.1176/appi.ps.201800216

ISSN

10752730

Comments

Peer reviewed accepted manuscript.

Recommended Citation

Chiang, Mengchun; Chang, Janet; Nakash, Ora; Cruz-Gonzalez, Mario; Fillbrunn, Mirko K.; and Alegría, Margarita, "Change in Patient Activation and Mental Illness Symptoms after Communication Training: a Multisite Study with a Diverse Patient Sample" (2019). School for Social Work: Faculty Publications, Smith College, Northampton, MA.
https://scholarworks.smith.edu/ssw_facpubs/42