A systematic review of online interventions for families of patients with severe mental disorders

Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up

OBJECTIVES

To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people.

METHODS

A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups.

RESULTS

Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention.

CONCLUSIONS

Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care.

CLINICA LTRIAL REGISTRATION

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Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice

AIM

Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals.

METHODS

Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups.

RESULTS

An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations.

CONCLUSIONS

Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry

Background

The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden.

Methods

A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months).

Results

Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified.

Conclusion

The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.

Two-year evaluation of a multifamily psychoeducational program (PROTEC) in the family burden and prognosis of bipolar patients

INTRODUCTION

Bipolar disorder causes a significant burden on the lives of patients and their families. The family is one of the targets for therapeutic intervention, related to the prognosis in patients with bipolar disorder.

AIM

To assess the effectiveness of a multifamily psychoeducational program for people with bipolar disorder, in the family burden: objective and subjective and in the variables related to the course of the patients with bipolar disorder (symptoms, adherence, functionality, hospitalizations), comparing it with a control group (CG).

MATERIALS AND METHODS

A total of 148 relatives of bipolar patients and 148 bipolar patients were recruited. The sample was randomized (experimental group [EG] and CG) and with single-blind evaluations (baseline, at 5 months and one year). Clinical and sociodemographic variables were collected from families and patients (family burden self-report scale, Strauss-Carpenter Scale, Global Assessment of Functioning, Morisky Green adherence Scale). Both, EG and CG received 8 multifamily sessions, applied exclusively on the relatives of patients with bipolar disorder, but in the EG a psychoeducational treatment was carried out and in the CG only playful and current topics were discussed. Bivariate and logistic regression models were used, among others.

RESULTS

The caregivers and patients of the EG and CG did not differ in any of the baseline variables (sociodemographic and clinical) (P>.001). In the total sample, the baseline objective burden was light (mean 0.6±0.4) and the subjective ones was medium-moderate (mean 1.1±0.3). During the follow-up, in relation to the variables of the caregivers, there was a greater reduction in the objective burden in the EG compared to the CG (5 months P=.006; one year P=.002). It was found that the objective burden (P=.006) and the subjective burden (P=.003) were significantly reduced over a year in EG but not in the CG. During the follow-up, the patients whose caregivers belonged to the EG showed a greater increase in the frequency of social activity (P=.008), in the work activity (P=.002), and global functioning (P=.002), and reduced their symptoms (P≤.001). Longitudinal analyses, over a year, showed that patients in the EG had a greater improvement in functionality compared to patients in the CG (P=.001). After the intervention, adherence to pharmacological treatment improved more in EG than in the CG (P≤.001). Regarding hospitalizations, any patients in the CG were hospitalized during the 5 months after the intervention, while 27.8% of the patients in the CG were hospitalized (P≤.001); the difference between groups remained significant in the long term (one year: P≤.001; 2 years: P≤.001). There were no significant differences between groups in the pharmacological treatment of the patients in any of the evaluations.

CONCLUSIONS

The multifamily psychoeducational intervention group improved the family burden after the intervention. Likewise, bipolar patients, whose families attended the EG, improved significantly, over a year, the functionality, the frequency of social contacts, the work status, the adherence to treatment, and reduced their symptoms. In addition, in the EG, the percentage of hospitalizations during the 2 years of follow-up was significantly reduced.

Effectiveness of Psychoeducation on Burden among Family Caregivers of Adults with Schizophrenia: A Systematic Review and Meta-Analysis

Caring for relatives living with schizophrenia could lead to caregivers' burden. It is believed that lack of information and understanding about schizophrenia and lack of skills to cope effectively while caring for their adult relatives largely contribute to the burden they experience. The burden is assessed using assessment scales. This review aims to assess the effectiveness of psychoeducation in alleviating the burden experienced by family caregivers of adults living with schizophrenia and to identify essential factors that facilitate positive outcomes. Five databases (ASSIA, CINAHL, Embase, MEDLINE EBSCO, and PsycINFO) were systematically searched using combinations of the following key terms: "family caregivers," "schizophrenia," "burden," "psychoeducation," and "adults." Meta-analysis of included studies was conducted using RevMan 5.4. Five RCTs with 320 family caregivers were included in the review. Overall, none of the studies showed a low risk of bias. The evidence suggests that face-to-face group psychoeducation reduced family caregivers' burden when measured across different time points: one-week postintervention (mean difference -3.87 and Cl -6.06 to -1.70), six months (MD -8.76 and Cl -12.38 to -5.13), and twelve months (MD -7.38 and Cl -9.85 to -4.91). Measurements immediately after the intervention, one month, and three months postintervention when reported narratively also showed a reduction in family caregivers' burden. Face-to-face group psychoeducation provided for family caregivers effectively alleviates the burden they experience. Factors such as program content and teaching methods facilitated positive outcomes. It is recommended that psychoeducation should be integrated as a routine intervention for family caregivers.

Effects of eHealth interventions on stress reduction and mental health promotion in healthcare professionals: A systematic review

AIMS

To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; 'third-wave' psychotherapies vs. other types).

BACKGROUND

Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access.

DESIGN

A systematic review of quantitative studies.

METHODS

A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools.

RESULTS

The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents ('third-wave' psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found.

CONCLUSION

The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and 'third-wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions.

PROTOCOL REGISTRATION

PROSPERO CRD42022310199. No Patient or Public Contribution.

Effectiveness of internet-based psychosocial interventions on psychological distress, expressed emotion, and knowledge about psychosis among family caregivers of people with schizophrenia: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the effectiveness of internet-based psychosocial interventions versus active comparators (such as in-person interventions, bibliotherapy, or telephone interventions) and passive comparators (such as usual psychiatric care) on psychological distress, expressed emotion, and knowledge about psychosis in family caregivers of people with schizophrenia.

INTRODUCTION

Family caregivers of individuals with schizophrenia are at increased risk of developing mental disorders. Despite the widespread dissemination of reliable guidelines for caring for people with schizophrenia and their family caregivers, these have been poorly implemented. Hence, internet-based interventions with caregivers of people with schizophrenia could be an effective and feasible option.

INCLUSION CRITERIA

This review will include studies focusing on the family caregivers of individuals diagnosed with schizophrenia. Internet-based psychosocial interventions will be defined as any psychosocial intervention that is internet-based compared with active comparators (such as in-person interventions, bibliotherapy, or telephone interventions) and passive comparators (such as usual psychiatric care). The primary outcomes of this review will include psychological distress, expressed emotion, and knowledge about the psychosis of family caregivers of people with schizophrenia. The secondary outcome will be the hospitalization of people with schizophrenia.

METHODS

MEDLINE (PubMed), CINAHL (Ovid), Scopus, Cochrane Library, and ProQuest Dissertations and Theses will be systematically searched for published and unpublished studies from 2010 in English and Thai. Two reviewers will select studies, critically appraise them, and perform data extraction independently. Finally, when possible, the studies will be pooled through statistical meta-analysis and grading of the certainty of evidence by each outcome.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021255318.

Operationalising a Recovery-Oriented Support and Information Programme Online: The EOLAS Programme

Evidence demonstrates that psychoeducation interventions have clinical and recovery-related benefits for people experiencing psychosis and their family members. The EOLAS programmes are one example of recovery-oriented psychoeducation programmes for psychosis. They differ from other programmes in that they are co-designed and co-facilitated (peer and clinician) group programmes. Due to the COVID-19 pandemic, EOLAS went online using a videoconferencing platform. The study examined the feasibility, acceptability and usefulness of EOLAS-Online and explored whether some of the positive recovery outcomes reported by attendees regarding the in-person programmes were replicated online. Data were collected through an online survey and semi-structured interviews. Quantitative data were analysed using descriptive statistics. Thematic analysis was used for qualitative data. Fifteen attendees (40% of attendees) completed the surveys and eight participated in interviews. A total of 80% were satisfied/very satisfied with the programme. The programme was rated highly for increased knowledge of mental health, coping strategies, and engaging with peers. The use of technology was mostly unproblematic, although some audio and video-related challenges were identified. Engaging with the online programme was experienced positively, including facilitator support to engage. The overall findings indicate that EOLAS-Online is feasible, acceptable and useful in supporting attendees' recovery journeys.

Use of an Online Forum for Relatives of People With Psychosis and Bipolar Disorder: Mixed Methods Study

BACKGROUND

Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial.

OBJECTIVE

We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used.

METHODS

The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum.

RESULTS

A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives' distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context.

CONCLUSIONS

Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support, and guidance and to offer detailed information about their experiences. The topics raised highlighted the burden carried by relatives and the potential value of easy-access, moderated, peer-supported forums in helping relatives to manage the challenges they faced.

An online program with individualized vs automated support for significant others of depressed individuals - study protocol of a randomized controlled trial

BACKGROUND

Due to budget restrictions in mental health care, non-professional caregivers are increasingly burdened with the emotional and practical care for their depressed relatives. However, informal family caregiving is mostly a stressful role with negative consequences on the physical and mental health of the caretakers to the extent that they have an elevated risk of experiencing psychiatric disorders themselves. While psychoeducation for relatives of depressed individuals showed positive results both in terms of the caretakers' strain and the depressive symptoms of the affected person, there are major barriers to participate in presence in those programs. Digital programs might be a viable alternative. We found no empirically evaluated digital program available for informal caregivers of depressed patients.

METHODS

An online program for relatives of depressed individuals has been developed including four interactive modules on 1) psychoeducation, 2) how to strengthen the relationship with the depressed person, 3) how to deal with the depressive symptoms of the patient, and 4) find the right balance between caring for the depressed person and self-care. We investigate if this self-help program is more effective when used with individualized versus automated e-mail support, and if both supported conditions are more effective than treatment-as-usual (TAU in form of written information material) in terms of the risk of mental diseases in caregivers. The primary outcome is the reduction of the caregiver's nonspecific mental distress as measured by the change of the Kessler Psychological Distress Scale score from baseline to four weeks after randomization. Caregivers (n = 500:500:250) will be randomized to one of the three conditions.

DISCUSSION

Psychological support for caregivers of individuals with mental disorders such as depression should be offered as part of integrated services. There is a huge potential to develop and implement interactive online approaches to support informal caregivers of patients with depression to function in their multiple roles and to help them to remain healthy.

TRIAL REGISTRATION

DRKS, DRKS00025241 . Registered 5 Mai 2021.

Theory of Planned Behavior: Exploring the Use of Digital Mental Health Interventions in Israel

ABSTRACT

Based on the theory of planned behavior (TPB), this study aimed to examine factors influencing therapist uptake of digital mental health interventions in Israel. Two hundred twenty-nine mental health professionals recruited through a convenience sample completed a background and demographic questionnaire, as well as the TPB-based electronic-therapy attitudes and process questionnaire. Regressions were used to examine the contribution of attitudes, perceived behavioral control, subjective norms, and behavioral intentions. Intention to use and use of digital interventions were significantly predicted by attitudes, subjective norms, and perceived behavioral control, as suggested by the TPB. The use of cognitive behavioral therapy (CBT) and higher perceived behavioral control increased the likelihood of using digital interventions. Having a positive attitude, having expectations/social pressure from one's professional environment, and having a sense of control over the process were found to predict the intent to use, as well as the actual use of, digital interventions.

Social Semiotics of Gangstalking Evidence Videos on YouTube: Multimodal Discourse Analysis of a Novel Persecutory Belief System

BACKGROUND

Gangstalking refers to a novel persecutory belief system wherein sufferers believe that they are being followed, watched, and harassed by a vast network of people in their community who have been recruited as complicit perpetrators. They are frequently diagnosed as mentally ill, although they reject this formulation. Those affected by this belief system self-identify as targeted individuals (TIs). They seek to prove the veracity of their persecution and dispute the notion that they are mentally ill by posting videos online that purport to provide evidence of their claims.

OBJECTIVE

The objective of the study was to characterize the multimodal social semiotic practices used in gangstalking evidence videos.

METHODS

We assembled a group of 50 evidence videos posted on YouTube by self-identified TIs and performed a multimodal social semiotic discourse analysis using a grounded theory approach to data analysis.

RESULTS

TIs accomplished several social and interpersonal tasks in the videos. They constructed their own identity as subjects of persecution and refuted the notion that they suffered from mental illness. They also cultivated positive ambient affiliation with viewers of the videos but manifested hostility toward people who appeared in the videos. They made extensive use of multimodal deixis to generate salience and construe the gangstalking belief system. The act of filming itself was a source of conflict and served as a self-fulfilling prophecy; filming was undertaken to neutrally record hostility directed toward video bloggers (vloggers). However, the act of filming precipitated the very behaviors that they set out to document. Finally, the act of filming was also regarded as an act of resistance and empowerment by vloggers.

CONCLUSIONS

These data provide insight into a novel persecutory belief system. Interpersonal concerns are important for people affected, and they construe others as either sympathetic or hostile. They create positive ambient affiliation with viewers. We found that vloggers use multimodal deixis to illustrate the salience of the belief system. The videos highlighted the Derridean concept of différance, wherein the meaning of polysemous signifiers is deferred without definitive resolution. This may be important in communicating with people and patients with persecutory belief systems. Clinicians may consider stepping away from the traditional true/false dichotomy endorsed by psychiatric classification systems and focus on the ambiguity in semiotic systems generally and in persecutory belief systems specifically.

'Triadic' shared decision making in mental health: Experiences and expectations of service users, caregivers and clinicians in Germany

Background

Shared decision making (SDM) in mental health may contribute to greater patient satisfaction and is sometimes associated with better health outcomes. Here, SDM should not only involve service users and clinicians but also involve the service users' caregivers.

Aim

This study aimed to achieve better insight into the current SDM patterns of triads of service users, caregivers and clinicians in inpatient mental health care and the three parties' expectations towards the prospects of triadic SDM.

Design

The current research uses data from a representative cross‐sectional study on caregivers in psychiatric inpatient treatment. We analysed data on n = 94 triads of service users, their caregivers and their clinicians.

Results

All three parties acknowledge caregivers to be of great support to monitor the progress with mental disease. The caregiver's role during consultations is most often described as being an expert, receiving or providing information and supporting service users. However, caregivers at times try to seek support for themselves during caregiver‐clinician interaction, or their behaviour was described as unhelpful. The potential prospects of caregiver involvement are clearly acknowledged despite the low implementation of caregiver involvement in this sample (only in one‐third of the cases).

Conclusion

Triadic SDM rarely takes place in routine inpatient care. First, there should be a focus on interventions aiming at inviting caregivers to consultations. Only in the second step should a better conceptualisation of triadic SDM be undertaken.

Public Contribution

Early results were discussed with a local peer support group for caregivers of individuals living with mental illness.