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Schizophr Bull. 2010 January; 36(1): 24–25.
Published online 2009 December 7. doi:  10.1093/schbul/sbp140
PMCID: PMC2800154

Monetary Incentives for Schizophrenia

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.

Objective

The objective is to assess the effect of monetary incentive/rewards for people with schizophrenia or schizophrenia-like illness.

Search Method

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

Selection Criterion

All relevant randomized controlled trials comparing monetary rewards with standard care or no monetary rewards were selected.

Data Collection and Analysis

Working independently, we selected studies for quality assessment and extracted relevant data. We analyzed on an intention-to-treat basis. Where possible and appropriate, we calculated the relative risks and their 95% confidence intervals (CIs). For continuous data, we calculated weighted mean differences (MDs) and their 95% CIs.

Results

Five trials that investigate one type of monetary reward over another had to be excluded. We could include one study, carried out more than 40 years ago, randomizing a total of 25 very chronically ill people who had been in hospital an average of 20 years.1 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 for dolls/d = −0.80, 95% CI = −1.41 to −0.19).

Authors' Conclusions

Monetary rewards have been the topic for sporadic evaluative research for decades, and this review shows that randomized studies are possible. Financial support for activity usually is motivating, but this is not illustrated from the single small outdated study included in this review. Modest reward may well be of value, and volunteering to be involved in studies may help clarify the issue. It would be important that the trials are of a high methodological quality and seek meaningful outcomes. This systematic review is fully reported elsewhere.2

Fig. 1.
Outcome: Target behaviour - average number of dolls assembled per day.

References

1. Thorpe JG. The response of chronic female schizophrenics to monetary incentives. Br J Soc Clin Psychol. 1962;1:192–198.
2. Michalczuk R, Mitchell A. Monetary incentives for schizophrenia. Cochrane Database Syst Rev. 2009;(4):CD007626. [PubMed]

Articles from Schizophrenia Bulletin are provided here courtesy of Oxford University Press