TY - JOUR

T1 - Effectiveness of structured group psychoeducation for people with bipolar disorder in Rwanda

T2 - A randomized open-label superiority trial

AU - Arnbjerg, Caroline J.

AU - Musoni-Rwililiza, Emmanuel

AU - Rurangwa, Nelly Umulisa

AU - Bendtsen, Maja Grønlund

AU - Murekatete, Chantal

AU - Gishoma, Darius

AU - Carlsson, Jessica

AU - Kallestrup, Per

N1 - Publisher Copyright: © 2024 The Authors

PY - 2024

Y1 - 2024

N2 - Background: Psychoeducation is a cornerstone as an add-on to pharmacotherapy in standard care for individuals with bipolar disorder. However, evidence of the effectiveness of psychoeducation in low-resource settings is scarce. Aims: We aimed to assess the effectiveness of structured group psychoeducation versus waiting list on relapse prevention for individuals with bipolar disorder in Rwanda, a low-income country. Methods: This was a randomized open-label superiority trial. Participants aged 18 years or older with bipolar disorder were recruited at the two referral hospitals for mental health in Rwanda and randomly assigned 12 sessions of group psychoeducation or a waiting list. The program was tailored to the setting and co-designed with patients and clinicians. The follow-up period was 12 months, and the primary outcome mean number of psychiatric hospitalizations. Results: In February and March 2021, 154 participants were randomly assigned to receive group psychoeducation (n = 78) or to a waiting list (n = 76). The retention rate was high, with only three discontinuing the psychoeducation once they had received a session. Despite limited use of first-line pharmacotherapy, the psychoeducation reduced the risk of hospitalization by half during the 12-month follow-up (RR: 0.50(95 % CI 0.26–0.95)). Yet, no change in medical adherence was observed. Limitation: Weekly assessment of clinical status was not feasible. Conclusion: Structured group psychoeducation for bipolar disorder in a low-resource setting has a protective effect against readmission despite limited access to first-line pharmacotherapy. Further studies are needed to assess the effectiveness of the program in more decentralized settings with less highly trained staff. Trial registration: NCT04671225

AB - Background: Psychoeducation is a cornerstone as an add-on to pharmacotherapy in standard care for individuals with bipolar disorder. However, evidence of the effectiveness of psychoeducation in low-resource settings is scarce. Aims: We aimed to assess the effectiveness of structured group psychoeducation versus waiting list on relapse prevention for individuals with bipolar disorder in Rwanda, a low-income country. Methods: This was a randomized open-label superiority trial. Participants aged 18 years or older with bipolar disorder were recruited at the two referral hospitals for mental health in Rwanda and randomly assigned 12 sessions of group psychoeducation or a waiting list. The program was tailored to the setting and co-designed with patients and clinicians. The follow-up period was 12 months, and the primary outcome mean number of psychiatric hospitalizations. Results: In February and March 2021, 154 participants were randomly assigned to receive group psychoeducation (n = 78) or to a waiting list (n = 76). The retention rate was high, with only three discontinuing the psychoeducation once they had received a session. Despite limited use of first-line pharmacotherapy, the psychoeducation reduced the risk of hospitalization by half during the 12-month follow-up (RR: 0.50(95 % CI 0.26–0.95)). Yet, no change in medical adherence was observed. Limitation: Weekly assessment of clinical status was not feasible. Conclusion: Structured group psychoeducation for bipolar disorder in a low-resource setting has a protective effect against readmission despite limited access to first-line pharmacotherapy. Further studies are needed to assess the effectiveness of the program in more decentralized settings with less highly trained staff. Trial registration: NCT04671225

KW - Bipolar disorder

KW - Global mental health

KW - Low-income countries

KW - Low-resource setting

KW - Psychoeducation

KW - Psychosocial intervention

U2 - 10.1016/j.jad.2024.04.071

DO - 10.1016/j.jad.2024.04.071

M3 - Journal article

C2 - 38640974

AN - SCOPUS:85190587044

VL - 356

SP - 405

EP - 413

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -