Effectiveness of the Japanese standard family psychoeducation on the mental health of caregivers of young adults with schizophrenia: a randomised controlled trial

Effects of brief family psychoeducation on family caregiver burden of people with schizophrenia provided by psychiatric visiting nurses: a cluster randomised controlled trial

BACKGROUND

The purpose of this study was to examine the effects of a brief family psychoeducation (BFP) programme provided by psychiatric visiting nurses on caregiver burden of family caregivers of people with schizophrenia through a cluster randomised controlled trial (cRCT).

METHODS

The study was a two-arm, parallel-group cRCT. Forty-seven psychiatric visiting nurse agencies were randomly allocated to the BFP programme group (intervention group) or treatment as usual group (TAU; control group). Caregivers of people with schizophrenia were recruited by psychiatric visiting nurses using a randomly ordered list. The primary outcome was caregiver burden, measured using the Japanese version of the Zarit Burden Interview. Outcome assessments were conducted at baseline, 1-month follow-up, and 6-month follow-up. Intention-to-treat analysis was conducted to examine the effects of the BFP programme on caregiver burden.

RESULTS

Thirty-four psychiatric visiting nurse agencies and 83 family caregivers of people with schizophrenia participated in the study. The participant attrition rate was less than 20%. Adherence to the program was 100%. Compared with TAU group, the BFP programme group had decreased caregiver burden. However, this improvement was not significant at 1-month follow-up (adjusted mean difference [aMD] = 0.27, 95% CI = - 5.48 to 6.03, p = 0.93, d = 0.01) or 6-month follow-up (aMD = - 2.12, 95% CI = - 7.80 to 3.56, p = 0.45, d = 0.11).

CONCLUSIONS

The BFP programme provided by psychiatric visiting nurses did not achieve significant decreases in caregiver burden. This result may be attributed to the difficulty in continuing the research due to the COVID-19 pandemic, which prevented us from achieving the targeted sample size necessary to meet the statistical power requirements, as well as to the participation of caregivers with relatively low burden. However, the program had the advantage of high adherence to treatment plan. Further studies should be conducted with a larger sample size and a more diverse sample that includes caregivers with a higher care burden.

TRIAL REGISTRATION

The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000038044) on 2019/09/18.

Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis

BACKGROUND

Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed.

METHODS

This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions.

RESULTS

In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions.

CONCLUSIONS

The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.

Improvements in Treatment Adherence after Family Psychoeducation in Patients Affected by Psychosis: Preliminary Findings

(1) Background: Family psychoeducation is a well-recognized intervention which aims to improve the outcomes of illness in patients affected by psychosis. It has benefits in treatment adherence and leads to a reduction in relapses, higher levels of patient insight, and lower levels of stress within the family and among caregivers. (2) Methods: Eight patients and their families were recruited and randomly assigned to a Falloon-based family psychoeducation (FPP) intervention, and nine patients and their families were randomized to a Gestalt-based family intervention (GT). We compared the outcomes of these two treatment groups at a baseline assessment (T0), at the end of the programs (T1), and 6 and 12 months after the end of the programs (T2 and T3). The assessments included examinations of cognition (The Mini-Mental State Examination (MMSE) and The Five Point Test (5 Point)), the psychopathology and severity of illness (The Brief Psychiatric Rating Scale (BPRS), The Positive and Negative Syndrome Scale (PANSS), and The Clinical Global Impression Scale (CGI)), expressed emotion in families (Expressed Emotionality (Family Questionnaire-EE)), patient quality of life (The World Health Organization Quality of Life-BREF (WHOQOL-B)), social functioning (The Personal Social Performance (SPS)), aggression (Modified Overt Aggression Scale (MOAS)), and treatment adherence (The Brief Medication Adherence Report Scale (BMARS)). The primary aim was to test whether the FFP vs. GT program was more effective in improving treatment adherence over time. (3) Results: treatment adherence improved much more in the FFP group over time at any follow-up: +43.1% at T1, +24.0% at T2, and +41.6% at T3. Other characteristics, including psychopathology and the clinical stability of the subject, did not change over time. (4) Discussion: Family psychoeducation based on the Falloon program was effective at improving treatment adherence and contributed to avoiding relapses in the long term. Further studies on larger samples should be conducted to confirm this evidence, and similar psychoeducational programs should be routinely promoted in the clinical setting.

The effectiveness of nursing psychoeducation toward family burden and quality life on caregiver of people with schizophrenia in the community

Introduction: The caregivers of people with schizophrenia have problems that include high family, burden and low quality of life at home. Therefore, this study aims to determine the effectiveness of nursing psychoeducation on family, burdens and quality of life in caregivers of schizophrenia patients in the community. Design and Methods: This study used a pre-test and post-test group control design and repeated measurement with a total of 100 respondents. The treatment group was given weekly nursing psychoeducation for seven sessions. Also, the general linear model (GLM) was used to analyze the result. Results: This study showed that before the intervention of nursing psychoeducation, the average family burden was 49,02 and 46.28 in the treatment and control groups, respectively. This decreased to 38.24 and 37.56 in the first and fourth weeks of posttreatment. Meanwhile, the control group was 44.86 in the first week and 45.62 in the fourth. The psychoeducation had an effect on decreasing the family burden with a p value < 0.001. Moreover, this study showed that before the intervention of nursing psychoeducation, the average caregiver quality of life was 75,72 and 74.24 in the treatment. After treatment, it increased to 91.22 in the first week after intervention and 92.54 in the fourth week of post-intervention. Therefore, the intervention effectively improved the caregiver quality of life with p < 0.001 Conclusions: Nursing psychoeducation can effectively reduce family burdens and improve the quality of life for caregivers.  

Determinants of Burden in Family Caregivers of Individuals With Schizophrenia: A Systematic Review

The current systematic review was performed to determine the specific burdens placed on families of individuals with schizophrenia. Scopus, PubMed, and CINAHL databases were searched, resulting in 21 articles that met inclusion criteria. Results showed that treatment of individuals with schizophrenia poses a burden on families. Most caregivers experienced emotional and financial problems that affected their quality of life. Influencing factors in caregivers were age, sex, educational level, family status, income, time spent with the individual per day, knowledge regarding schizophrenia, attitude, and psychological stress. Influencing factors in individuals with schizophrenia were age, sex, severity of illness, social function, and treatment adherence. Environmental factors were stigma, social support, and professional support from health care providers. Family caregivers of individuals with schizophrenia need to be empowered to improve resilience and acceptance in caring for these individuals. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 38-43.].

The Effects of a Mindfulness-Based Family Psychoeducation Intervention for the Caregivers of Young Adults with First-Episode Psychosis: A Randomized Controlled Trial

OBJECTIVE

In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program.

METHOD

We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes.

RESULTS

Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers' outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement.

CONCLUSIONS

A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size.

The effectiveness of psychoeducation in improving attitudes towards psychological disorders and internalized stigma in the family members of bipolar patients: A quasi‐experimental study

Family members of bipolar patients experience stigma following being labeled by others, which can disrupt their routine lives and result in social isolation. This study aims to evaluate the effectiveness of psychoeducation in improving the attitudes of bipolar patients' family members towards psychological disorders and internalized stigma. The present study is a quasi-experimental study with a pre- and post-test follow-up design, in which 74 individuals were selected by convenience sampling among families who had a member with a bipolar disorder who was referred to the largest psychiatric hospital in Iran in 2021. The participants were randomly divided into the experimental and control groups (n = 37 per group). The members of the experimental group then underwent eight 90-min sessions of psychoeducation. The control group also received psychoeducation at the end of the study. The results of analysis of covariance showed that psychoeducation reduced internalized stigma in the family members of bipolar patients and increased their positive attitudes towards psychological disorders compared with the control group (p < .01). On this basis, psychoeducation can be useful to reduce the internalized stigma of family members of bipolar patients and to increase their positive attitudes towards psychological disorders.

Mediating effects of care burden and sense of coherence between patients' disabilities and siblings' emotions in psychotic disorders

Aim

Care burden and sense of coherence (SOC) can facilitate an understanding of how family members interpret their caregiving experiences regarding a relative with psychosis. In informal caregiving, understanding siblings' experiences in this regard is necessary to mitigate negative emotions and strengthen positive ones. This study investigated whether care burden and SOC mediate the relationship between the disabilities of patients with psychosis and their siblings' emotions.

Methods

A nationwide online survey was used to screen and recruit adult siblings of patients with psychotic disorders. The patients' disabilities in their work lives, socializing, and family communication, the siblings' care burden and SOC, and the siblings' positive and negative emotions were assessed. Structural equation modeling (SEM) was employed to test the path model that illustrated the mediating effects of care burden and SOC on patients' disabilities and siblings' emotions.

Results

The sample included 237 siblings aged 42.3 years (mean) with a male-to-female ratio of 0.88 and 237 patients with schizophrenia (80.2%) or schizoaffective disorder (19.8%). In the SEM analyses, care burden connected each of the three disabilities with the two types of emotions through the pathways in which care burden positively predicted both negative and positive emotions. Additionally, SOC functioned as a mediator between disability in family communication and both types of emotions.

Conclusion

Siblings' negative emotions should be alleviated through interventions aimed at suppressing the care burden and enhancing SOC to address disabilities in patients' socializing and family communication. Nevertheless, care burden might contribute to their positive emotions.

Effects of the family support and psychoeducation program based on the Calgary Family Intervention Model on the coping, psychological distress and psychological resilience levels of the family caregivers of chronic psychiatric patients

AIMS

This study was aimed at investigating the effects of family support and psychoeducation program based on Calgary Family Intervention Model on coping, psychological distress and psychological resilience levels of families of chronic psychiatric patients.

METHODS

The sample of this quasi-experimental study consisted of the caregivers of chronic psychiatric patients who were admitted to the adult psychiatry inpatient and outpatient unit of a university hospital and the caregivers of chronic psychiatric patients registered with the Schizophrenia Solidarity Association. Nonparametric analysis was used in the analysis of the data.

RESULTS

It was found that there was a significant decrease between the mean distress scores the caregivers participating in the Calgary Family Intervention-Based Family Support and Psychoeducation Program obtained from the measurements before, right after, and 3 and 6 months after the intervention (p < 0.05). There was no statistically significant difference between the coping scores and psychological resilience scores the caregivers obtained from the measurements before, right after, and 3 and 6 months after the intervention (p > 0.05).

CONCLUSION

It was concluded that the family support and psychoeducation program based on the Calgary Family Intervention Model applied to family members giving care to individuals with chronic mental illnesses had positive effects on the general health status of the caregivers.

The Experience of Caregivers with First-Episode Psychosis Children at General Hospital of Dumai, Riau Province

BACKGROUND: Caregivers with first-episode psychosis (FEP) children often encounter problems and challenges. The importance of caregiver role in managing FEP appropriately will influence the life quality of a person with psychosis. AIM: The study aimed to explore the experience of caregivers who have children with FEP at General Hospital of Dumai. METHODS: The study was a qualitative study with a phenomenology approach. In-depth interviews were conducted with eight primary caregivers aged 41–58 years with FEP children at General Hospital of Dumai. The interview transcript was analyzed using the Colaizzi method. RESULTS: Based on the study, five essential themes emerged, for example, caring for FEP is harder than looking after a thousand buffaloes, mixed feelings, believing that the child experiences mystical things, the extended family is a supporter in caring for FEP, and praying and surrender to God. CONCLUSION: The implications for nursing practice are implementing support group therapy and family psychoeducation programs for reduce the caregiver burden.

Culturally Adapted Psychoeducation among Family Caregivers of Schizophrenic Clients: A Scoping Review

Background: As psychoeducation was originally developed from Western, this intervention should be integrated with a culture to obtain effective outcomes. However, how culturally adapted psychoeducation on family caregivers of schizophrenic client developed in previous studies has not been systematically documented. The purpose of this review was to map culturally adapted psychoeducation in previous studies. Methods: This scoping review followed Arksey & O'Malley approach. Inclusion criteria including family caregiver, culture, psychoeducation, schizophrenia. Non-primary and non-experiment studies, non-English language and non-free articles were excluded. Advanced search technique used keywords family caregiver, culture, psychoeducation, schizophrenia on CINAHL, PubMed, and PsycInfo databases. Screening was done by checking duplication, title, and abstract. Full text of relevant articles was read in detail to select eligible articles. Selection results were described in the PRISMA flow chart. Data were analyzed after these were extracted and resumed on the table.   Result: A total of 8 studies were included in this review. More than half of  articles used randomized control trial (RCT) but these studies did not conduct follow up. Most of studies were  in Asia (6) and it conducted  in the outpatient department (6). Almost all studies modified multifamily group psychoeducation with culture theories. The longest duration of intervention was 12 months. Multidiscipline health professional delivered the intervention and most of the were psychiatrist. Coping was the most family caregiver outcomes in reviewed studies. Conclusion: In conclusion, limited studies were obtained in various ethnics and ways. Further studies need to measure effectiveness of the intervention in long term effect.  

Family Psychoeducation as an Intervention Tool in the Management of Schizophrenia and the Psychological Wellbeing of Caregivers

Background:

Caregivers need to be imparted with specialized skills to retain their psychological well-being and to manage the patient with schizophrenia effectively.

Aim:

This study aims to understand the role of family psychoeducation (FPE) in the management of schizophrenia and the well-being of caregiver.

Materials and Methods:

The sample included 40 caregivers and patients, 20 each assigned randomly in treatment group (psychoeducation given) and the control group. Pre and post assessment of psychological wellbeing (PWB), symptoms of the patient, and emotional regulation was done through the scales mentioned in the study and analyzed through analysis of variance.

Results:

Statistically significant improvement in emotional regulation of caregivers and patient (P = 0.05) and improvement of PWB in caregivers (P = 0.01) as well as significant reduction in symptoms of patients (P = 0.01) found in the treatment group.

Conclusion:

FPE was found to be effective in improving PWB of caregivers and effective management of a patient with schizophrenia.

Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies

BACKGROUND

Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. This systematic review and meta-analysis examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma.

METHODS

Following a pre-defined protocol (PROSPERO: CRD42019123606), we searched three electronic databases (PubMed, Web of Science, and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness, and stigma. Of these, 13 studies were included in meta-analysis.

RESULTS

Continuum beliefs are consistently associated with lower stigma. Interventions were effective at manipulating continuum beliefs but differ in their effects on stigmatising attitudes.

CONCLUSIONS

We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of 'us' and a process of identification with the person with mental illness. We discuss implications for the design of future interventions.