Monetary incentives for schizophrenia

Michalczuk R, Mitchell A

Published Online:

January 20, 2010

Money incentivises many. It has been used in experiments to promote various behaviours in people with schizophrenia. We found six trials, but only one compared monetary incentives to no incentives which was the focus of this particular review. This one, very small, study was undertaken in the early 1960s with people who had been in hospital for an average of two decades. It found no clear effect but little can be concluded from this outdated trial except that such studies are possible. We think more studies relevant to current circumstances are desirable.

Abstract (click to read)

Background:

There is evidence suggesting that people with serious mental illness are less responsive to everyday social rewards such as praise. Motivation and performance in social situations can be poor. Rewarding of tasks with money improves motivation to complete the tasks in everyday life. Careful use of targeted monetary rewards could also help people with troublesome symptoms of schizophrenia.

Objectives:

To assess the effect of monetary incentive/rewards for people with schizophrenia or schizophrenia-like illness.

Search strategy:

We searched the Cochrane Schizophrenia Group's Register (June 2008).

Selection criteria:

All relevant randomised controlled trials comparing monetary rewards with standard care or no monetary rewards.

Data collection and analysis:

Working independently, we selected studies for quality assessment and extracted relevant data. We analysed on an intention-to-treat basis. Where possible and appropriate we calculated the Relative Risk (RR) and their 95% confidence intervals (CI). For continuous data we calculated weighted mean differences (MD) and their 95% confidence intervals.

Main results:

Five trials are excluded that investigate one type of monetary reward over another and may be included in a future update. We did include one study, carried out over 40 years ago, randomising a total of 25 very chronically ill people who had been in hospital an average of 20 years. The targeted task that was being encouraged was assembly of dolls. People allocated to the payment group produced less dolls than those not paid at all although this difference did not reach conventional levels of statistical significance (MD -0.80 CI -1.44 to -0.16).

Authors' conclusions:

Monetary rewards have been the topic for sporadic evaluative research for decades and this review shows that randomised studies are possible. We suggest a design for a future informative trial.

This record should be cited as:

Michalczuk R, Mitchell A. Monetary incentives for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007626. DOI: 10.1002/14651858.CD007626.pub2

Assessed as up to date:

August 6, 2008

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Primary Review Group:

Schizophrenia Group

Health topics:

Mental health > Schizophrenia & psychosis > Management issues

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Monetary incentives for schizophrenia

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