Date Presented 04/05/19
Homeless adults in temporary shelter have unique stressors that can exacerbate mental illness, including exposure to violence, drug use, and theft. This study demonstrated that a six-week occupation-based psychoeducation group effectively helped participants feel less perceived stress compared to matched pairs. Perceived quality of life, however, was not altered. This study provides preliminary evidence that OT services can be used as an adjunct to psychiatry and medication.
Primary Author and Speaker: Sharon Gutman
Additional Authors and Speakers: Sara Barnett, Lauren Fischman, Jamie Halpern, Genni Hester, Colleen Kerrisk, Travis McLaughlin, Ezgi Ozel, Haisu Wang
PURPOSE: Although one-third of homeless adults in the US have a diagnosis of chronic mental illness and could benefit from interventions designed to manage the daily stress of illness, the occupational therapy literature has an absence of studies addressing stress management for this population. Homeless adults receiving temporary shelter services have a unique set of stressors that can exacerbate mental illness including exposure to violence, drug use, and theft; conflict with roommates and residents; insufficient food and medication; lack of transportation resources; and fear of becoming homeless again. The purpose of this study was to assess the effectiveness of a stress management intervention with a sample of 20 homeless adults residing in temporary shelter housing, who had formal diagnoses of chronic mental illness. Our research question asked, can a 6-week stress management program decrease residents’ perceived stress and enhance perceived quality of life in homeless adults with severe, chronic mental illness, compared to a control group of matched pairs?
DESIGN: This study used a two group, controlled design in which 10 participants in the intervention group were matched with 10 participants in the control group on the demographic variables of diagnosis, age, race, and gender. Participants were required to be their own legal guardian, have a formal psychiatric diagnosis, and be between 18-75 years old. Participants with severe behavioral disorders preventing cooperation with peers and staff were excluded. Participants were residents of a large, state funded, urban housing agency providing temporary shelter, beds, meals, case management, and medical and psychiatric services. Recruitment was achieved through a housing agency director who spoke with residents about potential participation.
METHOD: The Perceived Stress Scale (PSS) and WHO Quality of Life Scale are self-report Likert scales that were used to collect data at 1-week pre- and 1-week post-intervention. Intervention was implemented over 6 weeks, once per week for 1.5 hour sessions and consisted of a psychoeducation group of six modules: (1) anger management and conflict negotiation; (2) meditation and breathing techniques; (3) diet and nutrition; (4) exercise, leisure, and recreation; (5) sleep hygiene; and (6) wellness recovery action plan construction. Matched pairs did not receive intervention. A Mann Whitney U test was used to detect between group differences.
RESULTS: At post-intervention, a statistically significant difference between intervention and control groups was found on the PSS with a large effect size (Z=-2.285, p<.02, d=-1.176) (intervention group PSS scores: M=26.7±5.45; control group PSS scores: M=32.5±4.35). No statistically significant difference was found between the intervention and control groups on WHO QOL Scale scores (intervention group WHO QOL Scale scores: M=100.7±16.97; control group WHO QOL Scale scores: M=88.9±19.24).
CONCLUSION: Although our sample was small, our results demonstrate that a 6-week stress management intervention consisting of an occupation-based psychoeducation group effectively helped our participants to feel less perceived stress compared to a control group of matched pairs. Intervention group participants, however, did not experience change in quality of life at post-intervention that significantly differed from their matched pairs, perhaps because the intervention did not alter life events impacting their perceived quality of life—such as residing in temporary shelter, having inadequate financial resources, and depending on medication with undesirable side-effects. This study provides preliminary evidence that occupational therapy services can be used as an adjunct to traditional psychiatry and medication.
References
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