Table 4 Meta-analyses effectiveness results: psychosocial outcomes
Author (year) | Outcome | N of studies (N of participants) | Population | Effect measure | Effect size (95% CI), p-value | Heterogeneity, I2, 95% CI, χ2, df | AMSTAR2 | Summary findings |
|---|---|---|---|---|---|---|---|---|
Hope | ||||||||
 Fuhr et al. (2014) [37] | Hope (up to 6 months follow-up) | 3 (967) | Adult service users with an SMI or depression diagnosis | SMD, Z | 0.24 (0.02, 0.46), Z = 2.16 (p = 0.03) | I2 = 65%, Tau2 = 0.02; χ2 = 5.74 (df = 2, p = 0.06) | Low | Significant improvement in hope |
 Lloyd-Evans et al. (2014) [22] | Hope (post-intervention) | 4 (1072) | Adults with SMI or those using secondary MH services | SMD |  − 0.14 (− 0.27, − 0.02) | I2 = 7%, χ2 = 3.21 (p = 0.36) | Low | Significant improvement in hope |
 Peck et al. (2023) [40]a | Hopefulness (time frame not stated) | 6 (1155) | Adults, majority diagnosed with schizophrenia, bipolar disorder or major affective disorders | SMD, Z | 0.31 (0.13, 0.49), Z = 3.35 (p = 0.0008) | I2 = 46%, Tau2 = 0.02, χ2 = 9.30 (df = 5, p = 0.10) | Critically low | Significant improvement in hopefulness |
 Wang et al. (2022) [44] | Hope (last follow-up) | 4 (1000) | Adult individuals or family members with SMI | SMD | 0.27 (0.06, 0.49); Z = 2.51, p = 0.01 | I2 = 58%; Tau2 = 0.03; χ2 = 7.16 (df = 3; p = 0.07) | Critically low | Significant improvement in hope |
 Lyons et al. (2021) [35]b | Hope (post-intervention) | 3 (1029) | Adults with any mental health condition (including SMI) | MD | 0.18 (− 0.34, 0.69), p = 0.50 | I2 = 0%, χ2 = 1.68 (df = 2) | Critically low | No effect |
 Sun et al. (2022) [43]b | Hopelessness (post-intervention) | 2 (114) | Adults and adolescents with any mental health problem including MH service users without reported diagnoses | SMD |  − 0.16 (− 0.52, 0.19), p = 0.37 | I2 = 0%, χ2 = 0 (df = 1, p = 0.99) | Critically low | No effect |
Hope: follow-up | ||||||||
 Lloyd-Evans et al. (2014) [22] | Hope (3–6 month follow-up) | 3 (967) | Adults with SMI or those using secondary MH services | SMD |  − 0.24 (− 0.46, − 0.02) | I2 = 65%, χ2 = 5.74 (p = 0.06) | Low | Significant improvement in hope |
 Chien et al. (2019) [21] | Hope SHS scale, medium term (1–6 months) | 2 (789) | Adults with schizophrenia or similar SMI | MD, Z | 0.37 (− 0.22,0.96), Z = 1.22, p < 0.22 | I2 = 0%, Tau2 = 0; χ2 = 0.01 (df = 1, p = 0.91) | High | No effect |
 Chien et al. (2019) [21] | Hope SHS scale, long term (> 6 months) | 3 (809) | Adults with schizophrenia or similar SMI | MD, Z | 0.41 (− 0.15, 0.97), Z = 1.44 (p = 0.15) | I2 = 0%, Tau2 = 0, χ2 = 1.48 (df = 2, p = 0.48) | High | No effect |
Empowerment | ||||||||
 Burke et al. (2019) [51] | Empowerment (group intervention, end of treatment) | 5 (923) | Adults (including veterans) with any mental health problem | Hedges’ g | 0.19 (0.03, 0.36), p = 0.02 | I2 = 30%, Tau2 = 0.01, Q = 5.69, p = 0.22 | Critically low | Significant improvement in empowerment end of treatment |
 Peck et al. (2023) [40]a | Empowerment (time frame not stated) | 3 (348) | Adults, majority diagnosed with schizophrenia, bipolar disorder or major affective disorders | SMD, Z | 0.46 (0.25, 0.67), Z = 4.20 (p < .0001) | I2 = 0%, Tau2 = 0; χ2 = 1.69 (df = 2, p = 0.43) | Critically low | Significant improvement in empowerment |
 Lloyd-Evans et al. (2014) [22] | Empowerment (post-intervention) | 2 (286) | Adults with SMI or those using secondary MH services | SMD |  − 2.67 (− 7.35, 2.02) | I2 = 97%, χ2 = 38.87 (p < 0.001) | Low | No effect |
 Lyons et al. (2021) [35]b | Empowerment (post-intervention) | 4 (750) | Adults with any mental health condition (including SMI) | SMD | 0.17 (− 0.07, 0.40), p = 0.17 | I2 = 55%, χ2 = 6.67 (df = 3) | Critically low | No effect |
 Sun et al. (2022) [43]b | Empowerment (post-intervention) | 3 (245) | Adults and adolescents with any mental health problem including MH service users without reported diagnoses | SMD | 0.24 (− 0.01, − 0.50), p = 0.06 | I2 = 0%, χ2 = 0.86 (df = 2, p = 0.65) | Critically low | No effect |
 Wang et al. (2022) [44] | Empowerment (last follow-up) | 4 (2380) | Adult individuals or family members with SMI | SMD | –0.37 (–0.91, 0.17); Z = 1.34, p = 0.18 | I2 = 94%; Tau2 = 0.24; χ2 = 52.72 (df = 3, p < .00001) | Critically low | No effect |
Empowerment: follow-up | ||||||||
 Lloyd-Evans et al. (2014) [22] | Empowerment (6 months follow-up) | 2 (538) | Adults with SMI or those using secondary MH services | SMD |  − 0.25 (− 0.43, − 0.07) | I2 = 12%, χ2 = 1.13 (p = 0.29) | Low | Significant improvement in empowerment |
 White et al. (2020) [45]a | Empowerment (6–12 months follow-up) | 4 (519) | Adults using mental health services with any diagnoses | SMD, Z | 0.23 (0.04, 0.42), Z = 2.31, p = 0.02 | I2 = 14%, Tau2 = 0.01; χ2 = 3.48 (df = 3, p = 0.32) | Critically low | Significant improvement in empowerment |
 Lyons et al. (2021) [35]b | Empowerment (3 weeks–6 months follow-up) | 4 (750) | Adults with mental health conditions | SMD | 0.17 (− 0.07, 0.40), p = 0.17 | I2 = 55%, χ2 = 6.67 (df = 3) | Critically low | No effect |
Quality of life | ||||||||
 Fuhr et al. (2014) [37] | Quality of Life (up to 6 months follow-up) | 2 (639) | Adult service users with an SMI or depression diagnosis | SMD, Z | 0.24 (0.08, 0.40), Z = 3.02 (p = .003) | I2 = 0%, Tau2 = 0, χ2 = 0 (df = 1, p = .98) | Low | Significant improvement in quality of life |
 Wang et al. (2022) [44] | Quality of life (last follow-up) | 11 (2397) | Adult individuals or family members with SMI | SMD | 0.14 (0.06, 0.22); Z = 3.45, p = 0.0006) | I2 = 0%; Tau2 = 0; χ2 = 4.59 (df = 10, p = 0.92) | Critically low | Significant improvement in quality of life |
 Lloyd-Evans et al. (2014) [22] | Quality of life (post-intervention) | 5 (1039) | Adults with SMI or those using secondary MH services | SMD | 0.04 (− 0.16, 0.24) | I2 = 52%; χ2 = 8.38 (p = 0.08) | Low | No effect |
Quality of life: follow-up | ||||||||
 Lloyd-Evans et al. (2014) [22] | Quality of life (3–6 months follow-up) | 2 (639) | Adults with SMI or those using secondary MH services | SMD |  − 0.24 (− 0.40, − 0.08) | I2 = 0%, χ2 = 0.00 (p = 0.98) | Low | No effect |
 White et al. (2020) [45]a | Quality of life (12–24 months follow-up) | 5 (688) | Adults using mental health services with any diagnoses | SMD, Z | 0.08 (− 0.11, 0.26), Z = 0.8 (p = 0.424) | I2 = 32%, χ2 = 5.9 (p = 0.206) | Critically low | No effect |
Satisfaction with care | ||||||||
 Lloyd-Evans et al. (2014) [22] | Satisfaction (post-intervention) | 3 (332) | Adults with SMI or those using secondary MH services | SMD | 0.02 (− 0.02, 0.23) | I2 = 0%, χ2 = 0.95 (p = 0.62) | Low | No effect |
Satisfaction with treatment (PSW in a professional role, time point not stated) | 2 (213) | Adults with severe mental health diagnoses | SMD, Z |  − 0.22 (− 0.69, 0.25), Z = 0.93 (p = 0.35) | I2 = 65.69%, Tau2 = 0.08; χ2 = 2.91 (df = 1; p = 0.09) | Low | No effect | |
Satisfaction with service (PSW as an adjunct to care, time point not stated) | 2 (125) | Adults with severe mental health diagnoses | SMD, Z | 0.76 (− 0.59, 2.10), Z = 1.1 (p = 0.27) | I2 = 63.11%, Tau2 = 0.64; χ2 = 2.71 (df = 1, p = 0.1) | Low | No effect | |
 Wang et al. (2022) [44] | Satisfaction (last follow-up) | 3 (838) | Adult individuals or family members with SMI | SMD | –2.17 (–5.18, 0.84); Z = 1.41, p = 0.16 | I2 = 100%; Tau2 = 7.04; χ2 = 464.22 (df = 2, p < .00001) | Critically low | No effect |
Satisfaction with care: follow-up | ||||||||
 White et al. (2020) [45]a | Satisfaction with services (12–18 months follow-up) | 2 (286) | Adults using mental health services with any diagnoses | SMD, Z | 0.19 (− 0.05, 0.42), Z = 1.6 (p = 0.116) | I2 = 0%, χ2 = 0.0 (p = 0.878) | Critically low | No effect |
Relational support | ||||||||
Relationship between treatment provider and service user (participant assessed, time point not stated) | 2 (160) | Adults with severe mental health diagnoses | SMD | 0.22 (− 0.10, 0.53), p = 0.18) | I2 = 0% | Low | No effect | |
 Wang et al. (2022) [44] | Social support (last follow-up) | 4 (600) | Adult individuals or family members with SMI | SMD | 0.09 (–0.08, 0.26); Z = 1.08, p = 0.28 | I2 = 0%; Tau2 = 0; χ2 = 2.59 (df = 3, p = 0.46) | Critically low | No effect |
 Wang et al. (2022) [44] | Building positive relationships (last follow-up) | 2 (293) | Adult individuals or family members with SMI | SMD | –0.62 (–3.02, 1.78); Z = 0.51, p = 0.61 | I2 = 99%; Tau2 = 2.97; χ2 = 82.45 (df = 1, p < .00001) | Critically low | No effect |
Wang et al. (2022) [44] | Family burden (last follow-up) | 2 (540) | Adult individuals or family members with SMI | SMD, Z | –1.75 (–3.63, 0.12), Z = 1.83, p = 0.07 | I2 = 99%, Tau2 = 2.69, χ2 = 143.20 (df = 2, p < 0.00001) | Critically low | No effect |
 White et al. (2020) [45]a | Social network support (12–24 months follow-up) | 4 (512) | Adults using mental health services with any diagnoses | SMD, Z | 0.09 (− 0.25, 0.42), Z = 0.5 (p = 0.602) | I2 = 67%, χ2 = 9.2, p = 0.027 | Critically low | No effect |
Self-efficacy | ||||||||
 Burke et al. (2019) [51] | Self-efficacy (group interventions, end of treatment) | 6 (1388) | Adults (including veterans) with any mental health problem | Hedges’ g | 0.20 (0.09, 0.31), p < 0.01 | I2 = 0%, Tau2 < 0.01, Q = 3.55, p = 0.62 | Critically low | Significant improvement in self-efficacy at the end of treatment |
 Sun et al. (2022) [43]b | Self-efficacy (post-intervention) | 3 (250) | Adults and adolescents with any mental health problem including MH service users without reported diagnoses | SMD | 0.31 (0.06, 0.56), p = 0.01 | I2 = 0%, χ2 = 0.18 (df = 2, p = 0.91) | Critically low | Significant improvement in self-efficacy |
 Wang et al. (2022) [44] | Self-efficacy (last follow-up) | 3 (301) | Adult individuals or family members with SMI | SMD | 0.34 (0.12, 0.57); Z = 2.95, p = 0.003 | I2 = 0%; Tau2 = 0; χ2 = 2 (df = 2, p = 0.37) | Critically low | Significant improvement in self-efficacy |
Functioning | ||||||||
 Wang et al. (2022) [44] | Psychosocial functioning (last follow-up) | 3 (407) | Adult individuals or family members with SMI | SMD, Z |  − 2.47 (− 2.95, − 1.98), Z = 9.96, p < 0.00001 | I2 = 68%, Tau2 = 0.12; χ2 = 6.15 (df = 2, p = 0.05) | Critically low | Significant improvement in psychosocial functioning |
 Wang et al. (2022) [44] | Functioning (last follow-up) | 7 (1081) | Adult individuals or family members with SMI | SMD |  − 0.33 (− 1.44, 0.77); Z = 0.59, p = 0.55 | I2 = 98%; Tau2 = 2.17; χ2 = 346.35 (df = 6, p < .00001) | Critically low | No effect |
 Wang et al. (2022) [44] | Family functioning (last follow-up) | 4 (646) | Adult individuals or family members with SMI | SMD, Z | 0.9 (− 0.50, 2.30), Z = 1.26; p = 0.21 | I2 = 98%, Tau2 = 1.94; χ2 = 160.98 (df = 3, p < 0.00001) | Critically low | No effect |
 White et al. (2020) [45]a | General and social functioning (6–12 months follow-up) | 3 (181) | Adults using mental health services with any diagnoses | SMD, Z | 0.01 (− 0.32, 0.35), Z = 0.1 (p = 0.937) | I2 = 21%, χ2 = 2.5 (p = 0.283) | Critically low | No effect |
Other psychosocial outcomes | ||||||||
 Sun et al. (2022) [43]b | Self-stigma (post-intervention) | 7 (580) | Adults and adolescents with any mental health problem including MH service users without reported diagnoses | SMD |  − 0.32 (− 0.49, − 0.16), p = 0.0001 | I2 = 19%, χ2 = 7.39 (df = 6; p = 0.29) | Critically low | Significant decrease in self-stigma |
 Sun et al. (2022) [43]b | Stigma-related stress (post-intervention) | 3 (238) | Adults and adolescents with any mental health problem including MH service users without reported diagnoses | SMD |  − 0.71 (− 1.11, − 0.30), p = 0.0007 | I2 = 58%, Tau2 = 0.07, χ2 = 4.71 (df = 2, p = 0.09) | Critically low | Significant decrease in stigma-related stress |
 Fuhr et al. (2014) [37] | Loneliness (post-intervention-12 months follow-up) | 2 (641) | Adults service users with an SMI or depression diagnosis | SMD, Z | 0.27 (− 0.19, 0.72), Z = 1.14 (p = 0.25) | I2 = 57%, Tau2 = 0.07; χ2 = 2.30 (df = 1, p = 0.13) | Low | No effect |
 Wang et al. (2022) [44] | Self-esteem (last follow-up) | 3 (759) | Adult individuals or family members with SMI | SMD |  − 0.91 (− 2.78, 0.96); Z = 0.95, p = 0.34 | I2 = 99%; Tau2 = 2.71; χ2 = 223.44 (df = 2, p < .00001) | Critically low | No effect |