Buried in Treasures: A Randomized Controlled Trial and Cost-Effectiveness Evaluation of a Peer-Support Intervention for Individuals with Hoarding Disorder in Social Services

Research problem and specific questionsHoarding disorder (HD) is a prevalent (2.5%) mental disorder which represents a severe public health problem and is often encountered the Swedish social services. However, support for individuals with HD in the social services is highly limited.

Although specialized hoarding teams, delivering in-home decluttering, have emerged in some municipalities, they are labor-intensive and not accepted by all sufferers.

The overarching purpose of this project is to evaluate the efficacy and cost-effectiveness of a peer-facilitated low-threshold intervention (Buried in treasures; BiT) for individuals with HD.

BiT has an extensive evidence base but has yet to be evaluated in Sweden and when delivered by peer-supporters employed in the social services.Data and methodsWe propose to partner with peer-supporters, interest organizations, and social services to first pilot BiT in at two social services units, one in Stockholm and one in Göteborg (n=16; Aim 1).

With lessons learned from the pilot, we will then optimize the delivery of BiT in social services and conduct a fully powered randomized controlled trial of BiT plus usual care, compared to usual care alone (N=108; Aim 2).

Finally, we will evaluate the cost-effectiveness of the intervention from a societal perspective (Aim 2).Societal relevance and utilisationThis proposal originates as a direct response to a demand from social services and individuals with HD who lack proper support from social services and health care.

If successful, this project could present a new model for fostering hope, a sense of community and improving functioning, which will not only contribute to the holistic recovery of the individual, but also have wider benefits for society.Plan for project realisationThe project brings together a multidisciplinary team of researchers with a track record in HD research, clinical trials, social work, biostatistics and health economics.

The team also includes service users and interest organizations that will contribute with their lived experience and will be carried out in close collaboration with the social services.