Effectiveness of a psychological support program for relatives of people with mental disorders compared to a control group: A randomized controlled trial (original) (raw)
Related papers
Behavior Modification, 2014
Living with a person who experiences mental health problems can have an adverse effect on well-being. The aim of this study is to evaluate the effectiveness of a psychological treatment for relatives of people with mental health problems, byusing an interrupted time-series design. The sample comprised 20 individuals, who completed assessment measures at baseline and 6 months later. Sixteen of these participants then received the treatment and were assessed again at the end of the program. There were no significant changes in outcomes between the baseline and the second assessments done 6 months later and there were significant improvements in well-being following treatment. The program shows promise as a treatment for relatives of people with mental health problems and therefore warrants further evaluation in more controlled studies.
BMC Psychiatry, 2011
Background: Depressive disorder is often chronic and recurrent, and results in a heavy psychosocial burden on the families of patients with this disorder. This study aims to examine the effectiveness of brief multifamily psychoeducation designed to alleviate their psychosocial burden. Methods: Thirty-two relatives of patients with major depressive disorder participated in an open study testing the effectiveness of brief multifamily psychoeducation. The intervention consisted of four sessions over the course of 6 weeks. Outcome measures focused on emotional distress, care burden and Expressed Emotion (EE).
PSYCHIATRIA DANUBINA, 2021
Background: The aim of the study is to improve the family relations of the patients who suffer for schizophrenia, to ensure the participation of the family in the treatment, to improve treatment compliance and to reduce relapse. Subjects and methods: A total of 80 caregivers of the patients, consisting of 40 people as a study group and 40 as a control group, the training was given in two sessions of forty five minutes twice a week, 24 sessions completed in approximately three months. It was applied in both groups at the beginning and end of the training the scales that are the test batteries. Results: While there was no difference between the two groups according to the pre-test scores obtained before the family psychological training program, according to the post-test scores, there was a significant difference between two groups in terms of symptoms of depression and anxiety, solutionoriented coping, emotion-oriented coping, dangerous perception of the disease and emotion expression. Conclusion: The training programme thought that the family psychological training support to be given to the relatives of patients with schizophrenia will both contribute positively to the treatment and play an effective role in the adaptation of the sease.
Working with Families with a Member Suffering from a Chronic Mental Health Problem: A Case Report
In this report we present a case example of a psychoeducational intervention in a single family in which both the mother and the son were suffering from schizoaffective or bipolar Type I disorders. Several characteristics of family functioning were initially assessed as also parental opinions about mentally ill persons and euthanasia. Outcome data is reported showing improvement on the levels of expressed emotion, on family functioning and communication and on relative’s burden of care. Psychoeducation played a core role as an auxiliary to the pharmacological treatment of both the identified patient and his mother.
Modes of action of family interventions in depression and schizophrenia: the same or different?
Journal of Family Therapy, 2003
The role of relatives' expressed emotion (EE) in mediating the efficacy of family interventions has been studied in randomized controlled trials (RCTs) involving people with schizophrenia and depression. Reanalysis of two RCTs (n 5 48) by indicated that lowering relatives' EE and/or reducing social contact between the patient and family members accounted for the efficacy of the intervention for schizophrenia. However, this relationship has not been investigated previously with regard to depression, and this paper presents the results of a recent RCT which included measurement of EE and other possible mediating variables. In this study, amelioration of the critical attitude of the partner did not account for the superiority of couples therapy over antidepressant medication, since the same change occurred in the drug group. However, reducing the patient's exposure to the partner's hostility partially explained the efficacy of couples therapy. Further research on the process of change in families undergoing therapy is indicated to identify the variables that account for the efficacy of therapy.
Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence
2012
Risk of bias Internal validity: study design and the quality of individual studies included in the review. Study design limitations may bias the estimates of treatment effect (such as lack of allocation concealment, or lack of blinding). Other areas for potential bias include stopping early for benefit and selective outcome reporting. Consistency The effect sizes from the included studies are similar and have the same direction of effect (positive or negative). Directness Interventions are directly related to health outcomes. For CERs, headto-head comparisons are made. Indirectness is suspected if surrogate or intermediate outcomes are used instead of health outcomes. For CERs, indirectness is also suspected if more than one body of evidence is needed to link interventions, ad in the das with placebo controlled trials. Directness also includes applicability and relevance of the included studies to the VA population or to specific subpopulations within the VA. Applicability may also include settings (e.g., primary care vs. specialty care) and physician experience. Precision The degree of certainty surrounding an estimate of effect for each outcome of interest. Uncertainty of effect does not allow for a clinically useful conclusion, and is unable to rule out an important benefit or harm. Risk of publication bias Publication bias can result in an overestimate of effect. Publication bias is suspected if evidence is derived from a small number of commercially funded trials with small sample sizes and a small number of event. Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence Evidence-based Synthesis Program APPENDIX C. PEER REVIEW COMMENTS/AUTHOR RESPONSES REVIEWER COMMENT RESPONSE 1. Are the objectives, scope, and methods for this review clearly described? Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence Evidence-based Synthesis Program REVIEWER COMMENT RESPONSE Yes Yes 2. Is there any indication of bias in our synthesis of the evidence? No No No No. There is no indication of bias. No Although I understand ESP's rationale, I believe that given the undeveloped nature of this literature, limiting the review only to RCTs may have been overly limiting to understand the relevant clinical issues, trends, or promising practices. We certainly agree with the need to disseminate information on those promising interventions underdevelopment that are currently or soon to be subjected to more rigorous RCTs to evaluate their efficacy. Given the size of this review as it currently stands, limited to RCTs, it was beyond the scope of the project to expand our search to other study designs (e.g., open trials; quasi-experiments). We have added this to the limitation section. 3. Are there any published or unpublished studies that we may have overlooked? Please refer to reviews by Shirley Glynn and Lisa Dixon These reviews have both been integrated into the discussion section specific to findings for schizophrenia. No No No. I am not aware of studies that have been overlooked. No. Review appears extensive and literature search process is clearly displayed in Figure 2. Thank you. I was surprised to see that none of Candice Monson's work on couples therapy for PTSD was included. I don't have the studies in front of me, so it may be that is because they were not RCTs. If so, see my comment above. You are correct. Dr. Monson's currently published work did not meet our inclusion criteria (i.e., currently she has no published RCTs). We referenced this work in our limitations. 4. Please write any additional suggestions or comments below. If applicable, please indicate the page and line numbers from the draft report. Page 5 and 62 Recommendation for Future Research-PL lists eligible individuals for family services and that does not include close friends or intimate partner unless they are residing with the Veteran. Page 5 and 62 Family Services and Caregiver Services are administered from two different Program Offices and are conceptualized as different-perhaps introducing caregivers brings in a different topic? We have revised the introduction to better describe the two laws that have expanded services. In this explanation we also describe that PL 111-163 is only for a select group of family members. We have also highlighted the issue of who is eligible for these services in the discussion. Overall, the review was comprehensive and inclusive, providing a critical snapshot of the state of the evidence for family-involved psychosocial treatments for mental health conditions of relevance to Veterans. Thank you. Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence Evidence-based Synthesis Program REVIEWER COMMENT RESPONSE 5. Are there any clinical performance measures, programs, quality improvement measures, patient care services, or conferences that will be directly affected by this report? If so, please provide detail. Thank you-we will share these suggestions with the people responsible for dissemination of the report. Findings should be of direct relevance to the mission of the VA's Family Services Program Every major VA medical center will be affected by this report in that the effectiveness of family involved services, especially in reducing relapse for substance abuse and alcohol disorders The report appears to indicate that evidence for most couples and family-based interventions is largely insufficient to warrant widespread implementation within VHA. The intervention that does appear to be supported by consistent evidence, CRAFT, is not very well suited to implementation within VHA because it is delivered by a mental health professional to a family member whose loved on is not seeking treatment. It may have important training implications for community-based providers and possibly staff members of Vet Centers. The other finding with moderate strength of evidence, that behavioral couples therapy can slow the rate of relapse for substance abuse disorders, is not very impressive given the lack of impact of this intervention on arguably more important outcomes such as abstinence rates. Regarding the strength of evidence of BCT, since the initial peer review, we have conducted pooled analyses comparing BCT to individual treatment in improving rates of abstinence and improving family adjustment. These findings are more supportive of BCT then our previous narrative review of the number of studies finding significant versus non-significant differences. Would expect that findings would have implications in terms of future VA research funding. May also have implications for current evidence-based treatment rollouts. The Office of Mental Health Operations should review to determine if there is any relevance of the information in this report to their Mental Health Information System, which monitors a variety of practices in the field. 6. Please provide any recommendations on how this report can be revised to more directly address or assist implementation needs. I am still struggling with the bottom line-probably effective-won't cause harm? How does the research supporting family interventions compare to the research supporting other interventions currently being used in the VA? To adequately address how family interventions compare to the population of interventions currently provided by the VA, a systematic review of individually-oriented interventions would be required. This is beyond the scope of the review. However, we have taken care to better highlight the primary take home points in the executive summary and in our final discussion section. We have included additional pooled analyses of the BCT studies comparing BCT to individual therapy, which provide greater clarity to our conclusions regarding the comparative effectiveness of BCT to individual therapy. A potential conclusion from the findings of the report is that the state-of-the-science is that more efficacy and effectiveness research is needed on Veteran-focused family-involved psychosocial treatments to inform dissemination and implementation. We agree and have highlighted these issues in the discussion section. The review's scope would have to be expanded significantly to discuss effective implementation strategies, but this would indeed be highly valuable for VA. As mentioned above, comorbidity is the rule, rather than the exception, and very few studies address comorbidity. Clinicians have very little guidance as to how to proceed in these circumstances. A brief (and very common) clinical scenario that illustrates the problem: A 34 yo Veteran with PTSD, depression, and TBI violently pushes his wife after weeks of arguments over money, his at-risk alcohol use, and discipline of their children. He recently entered VA care and is open to treatment. Possible interventions include individual alcohol treatment, BCT for alcohol abuse, IBCT, anger management, and cognitive rehabilitation. The couple is asking for couples counseling for their arguing because they realize it upsets their 4 yo son. The Veteran is unconvinced he has a drinking problem. We agree that identifying and evaluating effective implementation strategies would be valuable; however, it is outside the scope of this report. See above. 107 Family Involved Psychosocial Treatments for Adult Mental Health Conditions: A Review of the Evidence Evidence-based Synthesis Program REVIEWER COMMENT RESPONSE It may be helpful if the authors would recommend research priorities related to the area. Several interventions are promising, but research is very limited and trials with Veterans are lacking. A set of recommendations about which interventions might be prioritized for investigation within VHA research mechanisms might be helpful. We have included a more expansive future research section and address these issues there. I think the report could benefit from greater consideration of...
Australian and New Zealand Journal of Psychiatry, 1987
In the aftermath of deinstitutionalisation and the move to community management of schizophrenia, relatives play an increasing role in the management of the illness. Families often complain of being misinformed and ill equipped to aid in the treatment. A supportive/ educational intervention for relatives is described and evaluated. Seven parents with a schizophrenic offspring participated in a descriptive pilot study employing a pre-post-treatment design. To test the hypotheses that treatment would impact on participants' distress, burden, family conflict, isolation and knowledge of schizophrenia, before and after measures were taken on self-report indices utilising these features. Generalisation effects on family coping were assessed via tri-weekly telephone interviews for the duration of the study. The intervention included information and sharing sessions. There was a substantial reduction in distress symptoms, anxiety, depression, burden and the amount of family conflict; there was an increase in the duration of home visits, out of home excursions and knowledge of schizophrenia. Most of the subjects' needs were met by the intervention. These gains were achieved with a high level of consumer acceptance. It was concluded that this kind of education has an important role in psychosocial intervention with relatives of the mentally ill.
The impact of caring for family members with mental illnesses on the caregiver: a scoping review
Health Promotion International, 2022
A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.