Caregiver psychoeducation for schizophrenia: is gender important?

Efficacy of a Low-threshold, Culturally-Sensitive Group Psychoeducation Programme for Asylum Seekers (LoPe): study protocol for a multicentre randomised controlled trial

INTRODUCTION

Despite high levels of mental distress, accessing psychological treatment is difficult for asylum seekers in Western host countries due to a lack of knowledge about mental disorders, and the health system, as well as due to cultural and language barriers. This study aims to investigate whether brief culturally sensitive and transdiagnostic psychoeducation is effective in increasing mental health literacy.

METHODS AND ANALYSIS

The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either culturally sensitive, low-threshold psychoeducation ('Tea Garden' (TG)) or a waitlist (WL) control group. It takes place at four study sites in Germany. A total of 166 adult asylum seekers who report at least mild mental distress will be randomly assigned. The TG consists of two 90 min group sessions and provides information about mental distress, resources and mental health services in a culturally sensitive manner. The primary outcome is the percentage of participants in the TG, as compared with the WL, achieving an increase in knowledge concerning symptoms of mental disorders, individual resources and mental healthcare from preintervention to postintervention. The further trajectory will be assessed 2 and 6 months after the end of the intervention. Secondary outcomes include changes in mental distress, openness towards psychotherapy and resilience. Furthermore, healthcare utilisation and economics will be assessed at all assessment points.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Commission of the German Psychological Society (ref: WeiseCornelia2019-10-18VA). Results will be disseminated via presentations, publication in international journals and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare.

TRIAL REGISTRATION NUMBER

DRKS00020564; Pre-results.

PROTOCOL VERSION

2020-10-06, version number: VO2F.

Gender differences in patient and caregiver psychoeducation for schizophrenia

Objective:

The aim of this research is to detect gender-related differences in patients and caregivers regarding knowledge about schizophrenia and attitudes towards drugs as well as gender as predictor for changes in these variables during psychoeducation.

Methods:

Data sets of one randomised-controlled (study 1) and one naturalistic psychoeducation study (study 2) were reanalysed. Main outcome measures (knowledge about schizophrenia, drug attitude, confidence in medication) were assessed at baseline, post-intervention and 12 months after index discharge.

Results:

The reanalysed samples consisted in total of 1002 patients and 176 caregivers. In study 2, baseline knowledge was significantly better in male patients and female caregivers. All participants improved significantly their knowledge. The amount of knowledge gain did not differ between genders in either study or either group. Gender was not a major predictor of baseline knowledge or knowledge gain. Only in study 1 did gender significantly impact the knowledge gain from baseline to follow-up. Regarding improvement of drug attitude, females seemed to benefit significantly better from psychoeducation. In both studies, however, changes in drug attitudes respectively confidence in medication were best explained by lower corresponding baseline scores, not gender. Patients’ gender did not influence outcomes of their caregivers.

Conclusion:

Our findings suggest that psychoeducational programs might be better adapted to males in order to improve their drug attitude. Concerning knowledge, gender-related changes do not seem to be necessary.

Caregiver psychoeducation for first-episode psychosis

Introduction

International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.

Methods

Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme.

Results

Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p < .01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement.

Discussion

This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.

Schizophrenia: A five-year follow-up of patient outcome following psycho-education for caregivers

Introduction

There is evidence that psycho-education courses for caregivers of individuals with schizophrenia improve the short-term outcome of the condition. However, most of the outcome studies are limited to two-year follow-up.

Materials and methods

This study is a five-year retrospective case-control follow-up of an original cohort of 63 patients and their 101 caregivers who completed a six-week Caregiver Psycho-education Programme (CPP) for schizophrenia and psychosis between 2002 and 2005, and 60 controls, matched for age, gender and severity of their psychotic illness.

Results

Patients whose caregivers learned more from the six-week psycho-education course had a significantly longer time to relapse (P = 0.04) and a significantly shorter length of stay during their first relapse (P < 0.05). Patients whose caregivers attended the six-week psycho-education course (regardless of how much the caregivers learned) had a significantly better outcome than controls. This included a significantly smaller number of relapses (P < 0.01), longer time to relapse (P < 0.01), shorter length of stay during their first relapse (P < 0.01) and smaller number of bed days over five years (P < 0.01). The odds ratio of controls relapsing, although insignificant at one year, was 4.13 (1.85–9.21) at five years. Outcome was not affected by either the numbers of caregivers attending for each patient, or caregiver gender.

Discussion and conclusions

This study, which is among the first to examine outcome over five years, supports the efficacy of psycho-education for caregivers in improving outcome for patients. Caregivers should be encouraged to take up psycho-education where it is available.

Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan

BACKGROUND

Schizophrenia is a serious form of mental illness that often requires long term care. Empirical findings indicate that combining a psycho-educational intervention (PEI) with neuroleptic medication to treat schizophrenia is effective. However, there is little information on the therapeutic mechanism of PEIs.

METHODS

A qualitative process evaluation was conducted with a purposive sample of people diagnosed with schizophrenia (PDwS, n = 8) and their Primary Caregivers (PCs, n = 9) who had received PEI as a part of an exploratory randomized controlled trial. Semi-structured interviews were conducted to explore potential processes underpinning any observed effect. Thematic analysis was used to analyze and identify prominent patterns in the data. Interviews were conducted between April 2013 and August 2013.

RESULTS

Three themes emerged from the qualitative interviews, 'Awareness of schizophrenia', 'Positive impact on health and wellbeing', 'empowerment and enhanced confidence', which described the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued.

CONCLUSION

This study identified that individual understanding varied between PDwS and PCs and led to differences in the ways that they used knowledge gained from the PEI in everyday situations. These data support the importance of improving understanding of schizophrenia by PDwS and their PCs to enable them to benefit more fully from medication.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN78084871 . Retrospectively registered 28 December 2015.

Using a Narrative Film to Increase Knowledge and Interpersonal Communication About Psychosis Among Latinos

Narrative communication is effective in increasing public awareness while generating dialogue about varied health topics. The current study utilized narrative communication in the form of a 15-minute motivational film titled La CLAve to help Latinos recognize symptoms of psychosis and begin a discussion about serious mental illness. The study aimed to explore the participants' response to the film and whether the film led to further dialogue about psychosis. Four focus groups were conducted with 40 Spanish-speaking participants, mostly foreign-born Latinas, with a mean age of 49 years. Results indicate that participants engaged with the film as reflected in their ability to recall the storyline in detail. Reports of psychosis knowledge gains included recognition of key symptoms, such as hallucinations and disorganized speech. Participants attributed symptoms of psychosis, observed in a film character, to social stressors and other previously constructed views of mental illness. Many participants discussed the content of the film within their immediate social networks. Other findings include discussions of key barriers and facilitators to seeking mental health treatment among Latino families, such as denial and family support. Results suggest that narrative films offer a promising strategy to stimulate dialogue about serious mental illness among Latinos.

[Cross-sectional study of informal caregiver burden and the determinants related to the care of dependent persons]

OBJECTIVE

To describe the burden of informal carers of dependent people and to identify related variables.

DESIGN

Descriptive observational cross-sectional study.

LOCATION

Primary Health Care in the southern area of Pontevedra.

PARTICIPANTS

97 caregivers of dependent persons.

KEY MEASUREMENTS

We collected socioeconomic data and health conditions from caregivers and dependent persons, time spent on the daily care and caregiver burden (Zarit abbreviate) through a personal interview. Besides the description of the sample-including their burden level-, a contrast mean was used to identify characteristics that influenced in punctuation of Zarit scale. A logistic regression was used to analyse characteristics that increase the likelihood to experiment burden.

RESULTS

61.9% of caregivers are subject to intense burden. The item on the scale which contributes most to the caregiver burden is the lack of time for oneself, followed by the negative effects of interpersonal relationships. Contrast means shows that degree of relationship, number of care hours, caregiver health and aggressiveness of dependent persons produce significant differences in Zarit scale. Physic and psychological health of caregivers and aggressiveness of dependent persons is associated with the likelihood of developing caregiver burden.

CONCLUSIONS

Informal caregivers of dependent persons show a high level of burden, both related to their characteristics and those of the dependent persons. Caregiver burden rethinks the need for public policies focused on dependence to adopt an integrative caregiver-dependent vision.

Knowledge in schizophrenia: The Portuguese version of KAST (Knowledge About Schizophrenia Test) and analysis of social-demographic and clinical factors' influence

Schizophrenia is a complex disorder, and the knowledge about it can have a positive impact. The purpose of this study was to make the translation and cultural adaptation of the Knowledge About Schizophrenia Test (KAST) into Portuguese and determine the influence of clinical and socio-demographic factors on knowledge. The test was applied to 189 caregivers of patients enrolled in Schizophrenia Program of the Federal University of São Paulo, 30 caregivers of clinical patients of the General Outpatient Clinic of the same University, and 30 health professionals. The face and content validity of the test was established. The mean value (SD) obtained with the application of the final version to caregivers of schizophrenic patients was 12.96 (2.45) - maximum 17. Level of knowledge increased considering the following order: caregivers of clinical patients, caregivers of patients with schizophrenia and mental health professionals. The intraclass correlation coefficient (0.592) obtained in the test-retest was statistically significant. An influence of social class, race, gender and education of the caregiver on the test was observed, and the last two factors were more relevant. The KAST translated and adapted into Portuguese is a valid instrument and can be used as an evaluation tool on psychoeducational interventions.

Predictors of quality of life and caregiver burden among maternal and paternal caregivers of patients with eating disorders

This prospective study investigated quality of life and caregiver burden of 244 parent caregivers of 113 Spanish patients with Eating Disorders (ED). One hundred eleven mothers and 70 fathers fulfilled the inclusion criteria. ED patients completed the Hospital Anxiety and Depression Scale (HADS) and the Eating Attitudes Test-26. Caregivers completed the HADS, the Short Form-12 (SF-12), the Involvement Evaluation Questionnaire-EU version, and the Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square and Fisher's exact test were applied. Among mothers, anxiety and depression and patient age contributed to poorer quality of life. Caregiver variables that affected the burden for mothers were marital status, the mental subscale of the SF-12, and the mother's perception of the severity of her child's illness. Caregiver variables that affected the burden for fathers were the caregiver's anxiety and the physical domain of the SF-12. Among mothers but not fathers, being married was a protective factor of caregiver burden. Our findings suggest that mothers and fathers have different perceptions of their quality of life and caregiver burden, and that mothers of patients with ED may be in considerable need for extra psychosocial support.

Empowering caregivers: impact analysis of FamilyLink Education Programme (FLEP) in Hong Kong, Taipei and Bangkok

BACKGROUND

Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants.

METHOD

One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested.

RESULTS

FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy.

CONCLUSIONS

Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.

The effect psychoeducation intervention has on the caregiving burden of caregivers for schizophrenic patients in Turkey

This study was conducted to determine the effects psychoeducation given to caregivers of schizophrenic patients has on the level of care burdens. The model used was one group pre-test post-test pre-experimental model. It was conducted on 31 caregivers in psychiatry clinics between October 2007 and June 2008. Data were collected using the 'Zarit Caregiver Burden Scale' and the questionnaire form that determined the introductory features of caregivers. The study group participated in eight psychoeducation sessions. The average pre-test score of care burden for caregivers was 57.2 ± 9.9, and the average post-test score was 34.3 ± 9.9. The distinction between the average pre-test and post-test score of care burden for caregivers was significant (P = 0.001). Psychoeducation, given for caregivers of patients with schizophrenia, had a significant effect in decreasing individuals' caregiving burdens. Psychoeducation programmes directed at families should be considered as a therapeutic strategy for patients with schizophrenia.

Telepsychiatry and carer education for schizophrenia

OBJECTIVE

Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ.

METHOD

We delivered the carer education course for schizophrenia simultaneously to a carers group in rural north west Ireland (remote) via three ISDN lines and live to a carers group in a city (host). We compared knowledge gains using the Knowledge Questionnaire before and after each course.

RESULTS

Fifty-six carers of people with schizophrenia participated in the trial. At baseline, participants at the remote and host centers did not differ in terms of knowledge about schizophrenia. After the course, carers at both centers improved significantly and the knowledge gains between groups were equivalent at 6 weeks.

CONCLUSION

Telepsychiatry can deliver effective carer education programmes about schizophrenia and may provide one solution to bridging the chasm between scientific evidence and clinical reality.

Gender aspects of parents' needs of schizophrenia patients

BACKGROUND

Most studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients' mothers.

METHODS

101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the "Carers' Needs Assessment for Schizophrenia".

RESULTS

Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers' problems was predicted by not living with a partner and by a shorter duration of the patients' illness. The number of mothers' needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients' illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.

CONCLUSIONS

Fathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer's gender in clinical work.

Psychoeducation in schizophrenia: new developments and approaches in the field

PURPOSE OF REVIEW

The aim of this review is to summarize the literature on psychoeducation in schizophrenia published during the past year; this literature shows that pragmatic approaches and new adaptations have been developed.

RECENT FINDINGS

The current literature indicates that studies on psychoeducation in schizophrenia in real-world settings show results comparable to those in experimental settings; brief psychoeducational interventions may have long-term effects on relapse and rehospitalization rates; and combining diagnoses may be helpful for new, short psychoeducational formats, but also for smaller hospitals with too few patients with the same diagnosis for group psychoeducation. Peer-to-peer education programs for families and patients have been developed, and culturally sensitive topics, the patients' perspective, quality-of-life issues and sex aspects were integrated into psychoeducation. A new meta-analysis on psychoeducation shows that there is a medium effect size for relapse and rehospitalization reduction if both the patient and the family participate.

SUMMARY

Up to the present, patient-directed approaches are much more frequent in clinical practice than bifocal psychoeducation. Therefore, future research must focus on patient-directed psychoeducation and, here especially, on integrating the more stable outpatients, who appear to profit more from psychoeducation than do symptomatic inpatients.

A little knowledge: caregiver burden in schizophrenia in Malawi

OBJECTIVE

To determine the relationship between schizophrenia knowledge and burden of care among caregivers of people with schizophrenia in Mzuzu, Malawi.

METHOD

We recruited 90 patients and 90 caregivers to a randomized, controlled trial of group caregiver education in schizophrenia. At baseline, we administered the Family Questionnaire, which measures caregivers' knowledge of biomedical and psychosocial aspects of schizophrenia. We measured caregiver burden with the Involvement Evaluation Questionnaire. Using multivariate analysis, we examined the relationship between knowledge and burden, controlling for other patient and caregiver variables. We hypothesised that knowledge and burden would be inversely related.

RESULTS

Caregiver burden was associated with knowledge (p = 0.001), but contrary to our hypothesis, greater knowledge was associated with greater burden.

CONCLUSION

In this population, knowledge about schizophrenia was associated with higher caregiver burden. This does not prove that knowledge causes burden, but suggests that cultural factors may mediate the relationship between knowledge and burden, and that care is needed when introducing caregiver education in new cultures.