The long-term outcomes of an effectiveness trial of group versus individual psychoeducation for bipolar disorders

•We tested long-term effects of Group Psychoeducation (GP) for Bipolar Disorders.•GP can be beneficial also to non-euthymic patients with repeated hospitalizations.•The current model is of limited benefit to patients with comorbid substance use.•GP can reduce psychiatric service usage for almost a decade compared to brief Individual Psychoeducation.

BackgroundIn this effectiveness trial we compared the long-term effects on hospitalizations of group psychoeducation (GP) versus individual psychoeducation (IP) for a heterogeneous sample of patients with BD recruited from general clinical settings.MethodsEighty-five patients with BD were randomized to receive 10 weekly sessions of GP followed by 8 booster-sessions over the next two years, or three sessions of IP. Time to first admission over the course of GP was the primary outcome measure, with additional outcomes examining the use of psychiatric services over about 8 years.ResultsPatients allocated to GP had longer survival time compared to IP over 27 months (p<0.05). There were also group differences in survival time over 8 years, but treatment allocation alone was no longer a significant predictor of survival time (p=0.07). There was an interaction between group (GP/IP) and harmful substance use (HSU), such that GP cases with comorbid HSU had the shortest survival time, whilst GP cases without HSU survived the longest (p=0.02). Also, GP cases had a small but significant reduction in hospital use compared with IP (p=0.04).LimitationsWe did not have a 'pure' treatment as usual group. Wide confidence intervals for some of the odds ratios suggest that the findings need to be treated with some caution. Insufficient sample size for more detailed subgroup analyses.ConclusionsGP is superior to IP in delaying hospitalizations in a clinically representative population. However, GP did not prevent or delay admissions in BD patients with HSU.