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Browne J, Sanders AS, Friedman-Yakoobian M, Guyer-Deason M, Keshavan M, Kim B, Kline E. Implementation case study: Multifamily group intervention in first-episode psychosis programs. Early Interv Psychiatry 2021; 15:1362-1368. [PMID: 33161640 PMCID: PMC8105421 DOI: 10.1111/eip.13066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/03/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
AIM Family interventions are a core component of first-episode psychosis (FEP) treatment; however, low implementation rates are consistently reported. As such, work is needed to understand the factors impacting real-world treatment delivery. The present paper describes the implementation of the McFarlane-model multifamily psychoeducational groups (MFG) in established FEP early intervention programs within a single state. The aims were to examine (a) training participation and implementation of MFG, (b) barriers and facilitators to implementation, and (c) modifications made to MFG. METHODS Practitioners from six established FEP early intervention programs received in-person training and ongoing consultation in MFG. Training participation data were obtained via attendance and implementation outcomes were obtained from practitioner reports. Fifteen months following the initial training, practitioners reported on clinic-specific barriers, facilitators, and modifications across four categories (context, intervention, practitioner, and recipient). RESULTS Twenty-three practitioners across six clinics received in-person training and were offered ongoing consultation to support implementation. Difficulties in starting MFG were salient as the earliest group was run 7 months after the initial training, thereby resulting in low overall frequency of groups. A number of barriers spanning context, intervention, practitioner, and recipient domains were noted, the majority of which were clinic-specific. Despite challenges, practitioners identified several facilitators and made modifications to the intervention and its delivery in service of implementation. CONCLUSIONS Results from this implementation case study highlighted the challenges of delivering MFG in real-world FEP early intervention programs. Further, this paper emphasizes the value in identifying and addressing clinic-specific factors when implementing MFG.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aliyah S. Sanders
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Michelle Friedman-Yakoobian
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | | | - Matcheri Keshavan
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Bo Kim
- Harvard Medical School, Boston, MA, USA
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Emily Kline
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
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2
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Hsiao CY, Lu HL, Tsai YF. Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan. J Ment Health 2020; 31:487-495. [PMID: 32930016 DOI: 10.1080/09638237.2020.1818703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated. AIMS This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services. METHODS A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics. RESULTS The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers. CONCLUSION Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.
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Affiliation(s)
- Chiu-Yueh Hsiao
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan City, Taiwan, Republic of China
| | - Huei-Lan Lu
- Department of Nursing, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan, Republic of China.,Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, Taiwan, Republic of China
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3
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Cheng SC, Backonja U, Buck B, Monroe-DeVita M, Walsh E. Facilitating pathways to care: A qualitative study of the self-reported needs and coping skills of caregivers of young adults diagnosed with early psychosis. J Psychiatr Ment Health Nurs 2020; 27:368-379. [PMID: 31930633 DOI: 10.1111/jpm.12591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In clinical psychiatry and mental health nursing practice, family caregivers are known to provide the bulk of care and play an important role in facilitating recovery outcomes for their loved ones diagnosed with psychosis. Providing services and interventions to family caregivers is as important as to patients in the early stage of psychotic experience for having a beneficial impact on the patients' clinical and social outcomes. Limited qualitative research has focused on family caregivers' subjective views of what they need during the critical period to identify early warning signs and connect their loved ones to professional help as they have no prior experience in caring for persons with psychosis. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Using qualitative analysis of family caregiver focus groups, this manuscript provides readers in clinical nursing practice with an understanding of family caregivers' lived experiences of supporting their loved one diagnosed with early psychosis. Understanding family caregivers' caregiving unmet needs in supporting their loved one diagnosed with early psychosis could inform both the technology-assisted intervention development and nursing practice in improving family-centred care and facilitate self-management practice. IMPLICATIONS FOR MENTAL HEALTH NURSING: Psychiatry and mental health nursing has long been engaged with the health and well-being of individuals with psychosis and supporting their families in the development, evaluation and implementation of innovative approaches to patient and family education. Digital technologies designed to deliver tailored intervention for family caregivers are underdeveloped, and the present study identifies a number of potential features that could comprise technology to meet the needs of this population. ABSTRACT: Introduction Caregivers play a critical role in detecting and managing psychotic symptoms before young people diagnosed with early psychosis present to care. Little is known about the specific needs of caregivers in navigating pathways to care for their loved one. Aim The purpose of this study was to understand the needs of family caregivers and their ways of coping on the pathway to care for early psychosis. Method Twenty family caregivers of individuals diagnosed with early psychosis participated in three focus groups that explored caregiving needs provision for early psychosis. Thematic analysis was conducted. Results We identified four major themes: education and skill training; raising wider awareness, such as police offers and teachers; adopting technologies for coping; and effective coping strategies. Implications for practice These findings provide important insights into caregiving needs and the ways for nurses to address those needs and better equip carers to recognize early symptoms, monitor behaviour changes and navigate care to support people with first-episode psychosis. Nursing researchers can use the information to develop on-demand and tailored family-centred intervention in addressing caregivers' needs in education, increasing awareness of early psychosis and fostering effective coping strategies.
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Affiliation(s)
- Sunny Chieh Cheng
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA.,Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | - Uba Backonja
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA.,Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA.,Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin Buck
- Denver-Seattle Center of Innovation (COIN), Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Maria Monroe-DeVita
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elaine Walsh
- Department of Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA
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4
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Farhall J, Cugnetto ML, Mathews S, Ratcliff K, Farnan S, Higgins K, Constantine E. Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition. Psychol Med 2020; 50:1099-1109. [PMID: 31030696 DOI: 10.1017/s0033291719000965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative. METHODS Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model. RESULTS While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication. CONCLUSIONS This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.
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Affiliation(s)
- John Farhall
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | - Marilyn L Cugnetto
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | - Stephanie Mathews
- Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia
- Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
| | | | - Sue Farnan
- Wellways Australia, Fairfield, Australia
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Service evaluation of a sole-session psychoeducational intervention to improve caregivers’ key illness beliefs after first episode psychosis (FEP). COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Carers of people experiencing a first episode of psychosis are at an increased risk of developing their own physical and mental health problems. Psychoeducation has been found to improve carer wellbeing and reduce distress. However, few psychoeducation interventions have considered the resource constraints on mental health services and the impact that these can have on the implementation of any such interventions. The present service evaluation aimed to evaluate an abbreviated version (sole session) of a previously tested psychoeducation intervention (three sessions) that targets less adaptive illness beliefs (n = 17). Pre–post effect sizes reveal that all of the carers’ illness beliefs changed in the desired direction, with four out of the 10 illness beliefs associated with large to moderate improvements. When compared with the outcomes obtained in our evaluation of the more intensive, three-session version of the intervention, the between-group effects largely favoured the three-session version but were mostly small. Moderate to large effects in favour of the three-session version were found for two of the 10 illness beliefs. These findings support the further investigation of the sole session psychoeducation intervention as part of a randomised controlled trial.
Key learning aims
(1)
To evaluate the impact of a sole-session psychoeducation intervention on illness beliefs.
(2)
To compare the outcomes of the sole-session psychoeducation intervention to the previous, more intensive (three-session) version of the same intervention.
(3)
To consider the value of research approaches to evaluating psychoeducation interventions for carers of people with psychosis.
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Yu Y, Liu ZW, Zhou W, Zhao M, Tang BW, Xiao SY. Determining a cutoff score for the family burden interview schedule using three statistical methods. BMC Med Res Methodol 2019; 19:93. [PMID: 31068131 PMCID: PMC6505248 DOI: 10.1186/s12874-019-0734-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background While it is widely acknowledged that family burden can be ameliorated with effective psycho-social interventions, how to measure family burden and define a valid cutoff to identify family caregivers in need of such interventions remains a key question. The purpose of the present study was to determine a statistically valid cutoff score for the Family Burden Interview Schedule (FBIS), using the cutoff scores of the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) as the reference. Methods The FBIS, PHQ-9, and GAD-7 were administered to a representative community sample of 327 family caregivers of schizophrenia patients. A FBIS cutoff score was determined using three different statistical methods: tree-based modeling, K-means clustering technique and linear regression. Contingency analysis was conducted to compare the FBIS cutoff with depression and anxiety scale scores. Results Findings proposed a cutoff score of 23 for the FBIS, with sensitivity being 76% for PHQ-9 and 74% for GAD-7, specificity being 68% for PHQ-9 and 67% for GAD-7. Conclusion This cutoff score would enable health care providers to assess family caregivers at risk and provide necessary interventions to improve their quality of life. Electronic supplementary material The online version of this article (10.1186/s12874-019-0734-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu Yu
- Hospital Evaluation Office, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Zi-Wei Liu
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Renmin Middle Road 139, Changsha, 410011, Hunan, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China
| | - Mei Zhao
- Social medicine and health management department, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, 410008, Hunan, China
| | - Bing-Wei Tang
- Social medicine and health management department, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, 410008, Hunan, China
| | - Shui-Yuan Xiao
- Mental Health Center, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, Hunan, China.
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Luderowski A, Boden ZV. Love and incomprehensibility: The hermeneutic labour of caring for and understanding a loved one with psychosis. Health (London) 2019; 24:737-754. [PMID: 30935237 DOI: 10.1177/1363459319829189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers' perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one's psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers' effortful quest to understand their loved one's experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic 'mooring points', making sense of their loved one's unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful - it is hermeneutic labour - done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems.
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8
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Chien WT, Bressington D, Chan SWC. A Randomized Controlled Trial on Mutual Support Group Intervention for Families of People With Recent-Onset Psychosis: A Four-Year Follow-Up. Front Psychiatry 2018; 9:710. [PMID: 30618880 PMCID: PMC6305581 DOI: 10.3389/fpsyt.2018.00710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction: Recent research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care. Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (≤5 years of illness) was conducted between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group (n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine psychiatric outpatient care. Results: Patients and families in the mutual support group reported consistently greater improvements in overall functioning [family functioning, F (2, 203) = 8.13, p = 0.003; patient functioning, F (2, 203) = 6.01, p = 0.008] and reductions in duration of hospitalizations [F (2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant increases of medication dosages or service use by both the family support and psycho-education groups over time. Conclusions: The peer-led family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family functioning and re-hospitalizations. Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Bressington
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sally W. C. Chan
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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9
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Onwumere J, Glover N, Whittaker S, Rahim S, Chu Man L, James G, Khan S, Afsharzadegan R, Seneviratne S, Harvey R, Georgiades A, Raune D. Modifying illness beliefs in recent onset psychosis carers: Evaluating the impact of a cognitively focused brief group intervention in a routine service. Early Interv Psychiatry 2018; 12:1144-1150. [PMID: 28517041 DOI: 10.1111/eip.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 11/02/2016] [Accepted: 12/24/2016] [Indexed: 02/03/2023]
Abstract
AIMS At first-episode psychosis (FEP), many patients will be routed within familial networks and supported by informal carers who are predominately close family members such as parents. Carer burden, distress and poorer coping styles are associated with different illness beliefs. The current study sought to examine the impact and acceptability of a 3 session, cognitively informed, group intervention targeting illness beliefs previously linked to distress and poorer caregiving experiences in FEP carers. METHODS Carers attending a routine FEP service were invited to attend the group intervention and completed a measure of illness beliefs at baseline and post intervention. RESULTS Data on 68 carers with complete datasets are presented. Carers were predominately females (64.2%). Group attendance was linked to positive improvements in carer baseline beliefs about the negative consequences of the illness for the patient and themselves, attributions of blame about the illness to the patient and themselves and their overall understanding about the illness. Significant improvements in their understanding of the illness timeline and course, and confidence in dealing with difficulties were also identified. CONCLUSIONS A cognitively informed group approach to targeting the less adaptive illness beliefs reported by FEP carers may offer an effective and acceptable pathway to facilitate their understanding of the illness and adjustment. Further studies using controlled designs are required.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychiatry & Neuroscience King's College London, London, UK
| | - Naomi Glover
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sarah Whittaker
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Shireen Rahim
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Sanna Khan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Saal Seneviratne
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Raythe Harvey
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow & Hillingdon Early Intervention in Psychosis Service, The Pembroke Centre, Central and North West London NHS Foundation Trust, London, UK
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Grácio J, Gonçalves-Pereira M, Leff J. Key Elements of a Family Intervention for Schizophrenia: A Qualitative Analysis of an RCT. FAMILY PROCESS 2018; 57:100-112. [PMID: 27896805 DOI: 10.1111/famp.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Schizophrenia is a complex biopsychosocial condition in which expressed emotion in family members is a robust predictor of relapse. Not surprisingly, family interventions are remarkably effective and thus recommended in current treatment guidelines. Their key elements seem to be common therapeutic factors, followed by education and coping skills training. However, few studies have explored these key elements and the process of the intervention itself. We conducted a qualitative and quantitative analysis of the records from a pioneering family intervention trial addressing expressed emotion, published by Leff and colleagues four decades ago. Records were analyzed into categories and data explored using descriptive statistics. This was complemented by a narrative evaluation using an inductive approach based on emotional markers and markers of change. The most used strategies in the intervention were addressing needs, followed by coping skills enhancement, advice, and emotional support. Dealing with overinvolvement and reframing were the next most frequent. Single-family home sessions seemed to augment the therapeutic work conducted in family groups. Overall the intervention seemed to promote cognitive and emotional change in the participants, and therapists were sensitive to the emotional trajectory of each subject. On the basis of our findings, we developed a longitudinal framework for better understanding the process of this treatment approach.
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Affiliation(s)
- Jaime Grácio
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Clínica Psiquiátrica de S. José, Sisters Hospitallers, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Chronic Diseases Research Center (CEDOC), Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Julian Leff
- King's College London, London, UK
- University College London, London, UK
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11
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Selick A, Durbin J, Vu N, O'Connor K, Volpe T, Lin E. Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review. Early Interv Psychiatry 2017; 11:365-374. [PMID: 28418227 DOI: 10.1111/eip.12400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented.
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Affiliation(s)
- Avra Selick
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Janet Durbin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nhi Vu
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Karen O'Connor
- Canadian Mental Health Association, Peel Dufferin Branch, Brampton, Ontario, Canada
| | - Tiziana Volpe
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Lin
- Provincial System Support Program Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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12
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Day K, Starbuck R, Petrakis M. Family group interventions in an early psychosis program: A re-evaluation of practice after 10 years of service delivery. Int J Soc Psychiatry 2017; 63:433-438. [PMID: 28537124 DOI: 10.1177/0020764017710301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The role of family in supporting service users in coping with illness and engaging in relapse prevention in early psychosis is important. Taking on this caring though is stressful and challenging, and it has been found that support and information for carers assists in their coping and reduces isolation. AIMS To evaluate the current utility of a psychoeducation group program in a public adult mental health service, for the families of people experiencing early psychosis. METHODS A purpose-designed pre- and post-intervention questionnaire was administered to quantitatively measure group participants' changes in perceptions of their understanding of mental illness and its treatment through attending the group. Additional qualitative items were used to determine other knowledge, benefits and any critical feedback. RESULTS The group program continues to result in highly significant improvements in family members' understanding of psychosis, recovery, medications, relapse prevention and substance co-morbidities. Additional feedback reaffirmed previous findings that family members find group peer support valuable and that this reduces isolation and the experience of stigma. CONCLUSION The current evaluation, conducted following 10 years of early psychosis group work, found there to be efficacy in family peer support groups and that it is important to provide family interventions in public early psychosis mental health services.
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Affiliation(s)
- Kate Day
- 1 Mental Health Service, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Rachael Starbuck
- 1 Mental Health Service, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Melissa Petrakis
- 1 Mental Health Service, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Vasconcelos E Sa D, Barrowclough C, Hartley S, Wearden A. Self-blame attributions in relatives of people with recent-onset psychosis: Associations with relatives' distress and behavioural control. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:172-188. [PMID: 28397280 DOI: 10.1111/bjc.12132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES There is evidence that self-blame is an important predictor of distress and depression in relatives of people with long-term psychosis, but there is limited research investigating the nature and correlates of self-blame in relatives of people with recent-onset psychosis. Self-blame motivates a tendency to engage with others and to repair wrongdoings; it might be that such cognitions also impact on relatives' behaviours towards the patient. This study examined the association between self-blame and psychological distress, and tested the prediction that greater self-blame would be associated with more behavioural control attempts to patients in a sample of relatives of people with recent-onset psychosis. METHODS Statements pertaining to self-blame and behavioural control were extracted and rated from 80 interviews with relatives, who also completed the General Health Questionnaire-28. Content analysis was used to examine the nature of self-blame attributions. Regression analyses were used to explore the links between self-blame attributions and distress, and between self-blame and behavioural control in this recent-onset population. RESULTS Higher levels of self-blame were associated with more behavioural control attempts, and self-blame predicted relatives' behavioural responses when adjusting for the contribution of control attributions. Self-blame was also linked with distress, but did not emerge as an independent predictor in multivariate analysis. Most relatives who blamed themselves did so for not overseeing their family member's mental health problems properly or for perceiving themselves generally as poor carers. CONCLUSIONS This study extends findings related to self-blame to a population of relatives of people with recent-onset psychosis and highlights the possible role of blaming cognitions in promoting interpersonal engagement through behavioural control. PRACTITIONER POINTS Self-blaming beliefs were linked with increased distress in relatives of people with recent-onset psychosis; Increased self-blame was associated with more behavioural control attempts; Most relatives blamed themselves for not overseeing their family member's mental health problems properly, and for perceiving themselves generally as poor carers. The cross-sectional study design limits inferences about causality.
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Affiliation(s)
| | | | - Samantha Hartley
- School of Psychological Sciences, The University of Manchester, UK
| | - Alison Wearden
- School of Psychological Sciences & Manchester Centre for Health Psychology, The University of Manchester, UK
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14
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Caqueo-Urízar A, Rus-Calafell M, Craig TKJ, Irarrazaval M, Urzúa A, Boyer L, Williams DR. Schizophrenia: Impact on Family Dynamics. Curr Psychiatry Rep 2017; 19:2. [PMID: 28097634 DOI: 10.1007/s11920-017-0756-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile.
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Mar Rus-Calafell
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| | - Alfonso Urzúa
- Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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15
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Grácio J, Gonçalves-Pereira M, Leff J. What do We Know about Family Interventions for Psychosis at the Process Level? A Systematic Review. FAMILY PROCESS 2016; 55:79-90. [PMID: 25900627 DOI: 10.1111/famp.12155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The evidence regarding effectiveness of family interventions for psychosis (FIP) is strong and consistent. However, there is a gap in the research on the process of these interventions, and little is known about their active ingredients. This review aims to identify the active ingredients of FIP. We conducted a systematic literature review, focusing on qualitative research, and analyzed 22 papers in total. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of process-related variables. The key elements of FIP seem to be the so-called "common therapeutic factors", followed by education about the illness and coping skills training. This review supports the value of a stepped model of intervention according to the needs of the families. However, the evidence reviewed also reveals a gap in the research findings based on the limited research available. FIP are complex, psychosocial interventions with multiple components, and more intensive, qualitative research is needed to establish linkages between process and outcome.
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Affiliation(s)
- Jaime Grácio
- Clínica Psiquiátrica de S. José, Sisters Hospitallers, Lisbon, Portugal
- Department of Mental Health and Centro de Estudos de Doenças Crónicas, NOVA Medical School / Faculdade de Ciências Médicas (NMS/FCM), CEDOC, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- Department of Mental Health and Centro de Estudos de Doenças Crónicas, NOVA Medical School / Faculdade de Ciências Médicas (NMS/FCM), CEDOC, Lisbon, Portugal
| | - Julian Leff
- Department of Mental Health Sciences, University College London, London, UK
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Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatr Dis Treat 2015; 11:145-51. [PMID: 25609970 PMCID: PMC4298308 DOI: 10.2147/ndt.s51331] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients' care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers.
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Affiliation(s)
| | - Mar Rus-Calafell
- Department of Social Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alfonso Urzúa
- Alfonso Urzúa Morales, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Jorge Escudero
- Departamento de Filosofía y Psicología, Universidad de Tarapacá, Arica, Chile
| | - José Gutiérrez-Maldonado
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Barcelona, Barcelona, Spain
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17
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Stigma of mental illness: A study in the Indian Armed Forces. Med J Armed Forces India 2014; 70:354-9. [DOI: 10.1016/j.mjafi.2013.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/15/2013] [Indexed: 11/18/2022] Open
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