Self-management interventions for people with severe mental illness: systematic review and meta-analysis

Lean, Melanie; Fornells-Ambrojo, Miriam; Milton, Alyssa; Lloyd-Evans, Brynmor; Harrison-Stewart, Bronwyn; Yesufu-Udechuku, Amina; Kendall, Tim; Johnson, Sonia

doi:10.1192/bjp.2019.54

Cited by 213Mental Health and Patient InvolvementSchizophrenia research and treatmentPsychiatric care and mental health services

Self-management interventions for people with severe mental illness: systematic review and meta-analysis

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Lean, Melanie, Fornells-Ambrojo, Miriam, Milton, Alyssa, Lloyd-Evans, Brynmor, Harrison-Stewart, Bronwyn, Yesufu-Udechuku, Amina, Kendall, Tim, Johnson, Sonia·2019·The British Journal of Psychiatry

DOI 10.1192/bjp.2019.54PMC PMC6499726

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Abstract

BACKGROUND: Self-management is intended to empower individuals in their recovery by providing the skills and confidence they need to take active steps in recognising and managing their own health problems. Evidence supports such interventions in a range of long-term physical health conditions, but a recent systematic synthesis is not available for people with severe mental health problems.AimsTo evaluate the effectiveness of self-management interventions for adults with severe mental illness (SMI). METHOD: A systematic review of randomised controlled trials was conducted. A meta-analysis of symptomatic, relapse, recovery, functioning and quality of life outcomes was conducted, using RevMan. RESULTS: A total of 37 trials were included with 5790 participants. From the meta-analysis, self-management interventions conferred benefits in terms of reducing symptoms and length of admission, and improving functioning and quality of life both at the end of treatment and at follow-up. Overall the effect size was small to medium. The evidence for self-management interventions on readmissions was mixed. However, self-management did have a significant effect compared with control on subjective measures of recovery such as hope and empowerment at follow-up, and self-rated recovery and self-efficacy at both time points. CONCLUSION: There is evidence that the provision of self-management interventions alongside standard care improves outcomes for people with SMI. Self-management interventions should form part of the standard package of care provided to people with SMI and should be prioritised in guidelines: research on best methods of implementing such interventions in routine practice is needed.Declaration of interestsNone.

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There is evidence of the efficacy of self-guided interventions, which aim to empower individuals in their recovery by providing them with skills and confidence to recognize and manage their health problems.
“Another strength of Well-being Online is its self-guided nature because there is evidence of the efficacy of this type of interventions, which aim to empower individuals in their recovery by providing them with the skills and confidence they need to recognize and manage their health problems (Lean et al., 2019).”
From Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial (2024) · cites this paper as Lean et al., 2019
The Abstract’s Background defines self-management as building the skills and confidence to recognise and manage health problems, and its Results report benefits from self-management interventions for people with severe mental illness. But the Results’ Study characteristics show that most interventions were clinician- or peer-facilitated; the review does not establish efficacy specifically for self-guided interventions. (LLM, conf=0.87)
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Recommendations for implementing gamification for mental health and wellbeing
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Recommendations for the use of long-term experience sampling in bipolar disorder care: a qualitative study of patient and clinician experiences
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The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19–Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey
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Informe mundial sobre la salud mental: Transformar la salud mental para todos
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Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators
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Interventions to Reduce the Environmental Impact of Medicines: A UK perspective✰
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Prehabilitation in Patients before Major Surgery: A Review Article
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Extending the vulnerability–stress model of mental disorders: three-dimensional NPSR1 × environment × coping interaction study in anxiety
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A qualitative study of stakeholder views on the use of a digital app for supported self-management in early intervention services for psychosis
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The Joint Crisis Plan: A Powerful Tool to Promote Mental Health
Lequin, P., Ferrari, P., Suter, C., Milovan, M., Besse, C. S., Silva, B., Golay, P., Bonsack, C., & Favrod, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.621436 · Cited by 36 · see citing works
Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial
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A trust based framework for the envelopment of medical AI
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Understanding Mobile Health and Youth Mental Health: Scoping Review
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Experiences of digital exclusion and the impact on health in people living with severe mental illness
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Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life
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Self-care interventions for women’s health and well-being
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Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review
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Effects of empowerment‐based illness management on the medication adherence and recovery of persons with schizophrenia: A systematic review and meta‐analysis
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Relationship Between Social Skills and Social Support with Peers' Academic Confidence on Boarding High School Students
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Modelling of self‐management in schizophrenia: The role of neurocognition, self‐efficacy and motivation
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AI-Driven Neuro-Monitoring: Advancing Schizophrenia Detection and Management Through Deep Learning and EEG Analysis
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Effect of educational intervention based on PRECEDE model on lifestyle modification, self-management behaviors, and hypertension in diabetic patients
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Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs
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Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial
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A systematic review of influences on implementation of supported self-management interventions for people with severe mental health problems in secondary mental health care settings
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Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD
Chang, E.-M., Chen, L., Li, Y.-T., & Chen, C.-T. (2023) · Respiratory Care · doi:10.4187/respcare.10416 · Cited by 20 · see citing works
Effects of peer‐delivered self‐management , recovery education interventions for individuals with severe and enduring mental health challenges: A meta‐analysis
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Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review
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Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study
Milton, A. C., Ozols, I., Cassidy, T., Jordan, D., Brown, E., Arnautovska, U., Cook, J., Phung, D., Lloyd‐Evans, B., Johnson, S., et al. (2024) · JMIR Formative Research · doi:10.2196/49110 · Cited by 19 · see citing works
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A systematic review of users experiences of using digital interventions within psychosis: a thematic synthesis of qualitative research
Dennard, S., Patel, R., Garety, P. A., Edwards, C., & Gumley, A. I. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02692-4 · Cited by 19 · see citing works
Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts
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Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial
Roosenschoon, B.-J., van Weeghel, J., Deen, M. L., van Esveld, E. W., Kamperman, A. M., & Mulder, C. L. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.723435 · Cited by 17 · see citing works
Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation
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Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis
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Enhancing physical health care for patients with severe mental illness: describing the implementation of a physical health liaison nurse in a mental health outreach team for long-term care
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FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study
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Why doesn't God say “enough”? Experiences of living with bipolar disorder in rural Ethiopia
Demissie, M., Hanlon, C., Ng, L. C., Fekadu, A., & Mayston, R. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113625 · Cited by 12 · see citing works
Early recognition method for patients with schizophrenia or bipolar disorder in community mental health care: Illness insight, self‐management and control
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An adapted management of early warning signs of relapse questionnaire: Validity and reliability
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Exploring the Barriers to and Facilitators of Using Virtual Reality Relaxation for Patients With Psychiatric Problems: Qualitative Focus Group Study
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Social capital, serious mental illness, and the intersection of disaster: Recommendations for enabling resilience
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Construing journeys to recovery from psychosis: A qualitative analysis of first‐person accounts
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Self-management interventions for common long-term conditions in low- and middle-income countries: a synthesis of current evidence
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Participants’ Evaluation and Outcomes following Integration of Self-Management Support into Outpatient Schizophrenia Case Management
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Schizophrenia and type 2 diabetes: Perceptions and understandings of illness management in everyday life
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Home Environment as a Therapeutic Target for Prevention and Treatment of Chronic Diseases: Delivering Restorative Living Spaces, Patient Education and Self-Care by Bridging Biophilic Design, E-Commerce and Digital Health Technologies
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Feasibility of online psychosocial interventions to promote mental health recovery and well-being
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Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec
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Characteristics and Outcomes of mHealth Interventions in Psychosis: Systematic Mapping Review
Loh, P. Y., Martinengo, L., Heaukulani, C., Tan, X., Hng, M., Cheah, Y. Y., Morris, R. J. T., Car, L. T., & Lee, J. (2024) · Journal of Medical Internet Research · doi:10.2196/55924 · Cited by 8 · see citing works
Testing Efficacy of Relapse Prevention Intervention among Patients Diagnosed with Schizophrenia in Jordan
Sabra, M. A. A., Hamaideh, S. H., & Hamdan‐Mansour, A. M. (2022) · Issues in Mental Health Nursing · doi:10.1080/01612840.2022.2025634 · Cited by 8 · see citing works
Community mental health interventions for people with major depressive disorder: A scoping review
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Innovations in community-based mental health care: an overview of meta-analyses
Carrà, G., Bartoli, F., Capogrosso, C. A., Cioni, R. M., Moretti, F., Piacenti, S., Riboldi, I., Crocamo, C., & Bebbington, P. (2022) · International Review of Psychiatry · doi:10.1080/09540261.2022.2113043 · Cited by 8 · see citing works
A novel digital intervention to facilitate diabetes self-management among people with schizophrenia and related disorders: development and acceptability testing of SMART
Arnautovska, U., Ritchie, G., Soole, R., Menon, A., Korman, N., Milton, A., Varnfield, M., Kelly, J., Jansen, P., Baker, A., et al. (2025) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s513272 · Cited by 7 · see citing works
“Eligibility criteria included: aged 18 years or older; diagnosis of schizophrenia or schizoaffective disorder, diagnosis of T2D, pre-diabetes, or metabolic syndrome; able to use a mobile phone; and to provide consent and read/understand”
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Hybrid mHealth care: Patient perspectives of blended treatments for psychosis. A systematic review
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Action Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline
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Behind the Gaps: A Narrative Review of Healthcare Barriers for Individuals with Serious Mental Illness
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An Umbrella Review of Self-Management Interventions for Health Conditions With Symptom Overlap With Traumatic Brain Injury
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Illness (self) management, clinical and functional recovery as determinants of personal recovery in people with severe mental illnesses: A mediation analysis
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The Mediating Role of General Self-Efficacy in Health Self-Management and Psychological Stress Among Older Adults in Shanghai: A Structural Equation Modeling Analysis
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The Relationship Between Societal Stigma and General Self-Efficacy in Adults With Self-Reported Mental Health Conditions
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Promoting resilience in persons with serious mental health conditions during the Coronavirus pandemic.
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Omani Families Caring for a Member with Mental Illness: A Descriptive Qualitative Study
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Exploring user perspectives on SMART: qualitative study of novel digital intervention targeting metabolic care in schizophrenia and related disorders
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Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial
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Beyond medications: a multifaceted approach to alleviating comorbid anxiety and depression in clinical settings
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Implementing mHealth for Schizophrenia in Community Mental Health Settings: Hybrid Type 3 Effectiveness-Implementation Trial
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Beyond Pharmacotherapy for Bipolar Disorder: The Role of Adjunctive Psychological Treatments
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A short form of the Recovery Assessment Scale‐Domains and Stages: Development and validation among adults with anxiety disorders
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Self-Management Technical Modules As Personal Guidance and Counseling Media For High School Students
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Experiences of imagery‐based treatment for anxiety in bipolar disorder: A qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial
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Impact of four integrated self-management interventions on psychiatric readmissions in patients at suicide risk: An interrupted time series analysis in Switzerland
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A randomized controlled trial of a peer-facilitated self-management program for people with recent-onset psychosis
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A smartphone-based self-care application for patients with urinary tract stones: identification of information content and functional capabilities
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Exploring pathways to compulsory detention in psychiatric hospital and ways to prevent repeat detentions; Service user perspectives
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Authors: Lean, M., Fornells-Ambrojo, M., Milton, A., Lloyd-Evans, B., Harrison-Stewart, B., Yesufu-Udechuku, A., Kendall, T., & Johnson, S.
Affiliations: University College London (GB)
The University of Sydney (AU)
National Health Service (GB)
Corresponding author: Lean, Melanie
ORCID: Lean, Melanie
Milton, Alyssa
Lloyd-Evans, Brynmor
Kendall, Tim
Johnson, Sonia
Venue: The British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2019-03-22
Volume: 214
Issue: 5
Pages: 260-268
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.2019.54
PMC: PMC6499726
OpenAlex: W2923541661
Cited by: 211
References: 67
Citations by year: 2026: 25 · 2025: 32 · 2024: 37 · 2023: 42 · 2022: 25 · 2021: 26 · 2020: 20 · 2019: 4
FWCI: 3.45
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (unspecified)
Locations: The British Journal of Psychiatry (publishedVersion, cc-by-nc-nd)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: National Institute for Health and Care Research (RP-PG-0109-10078)
Programme Grants for Applied Research (RP-PG-0109-10078)
Topics: Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords: self-management interventions, severe mental illness, recovery, relapse, symptom relief, hospital readmission, functioning, quality of life, empowerment, hope, self-efficacy
MeSH terms: Self-Management, Mental Disorders, Humans, Quality of Life

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Self-management interventions for people with severe mental illness: systematic review and meta-analysis

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