Brief family intervention for schizophrenia

Schizophrenia is a serious mental illness that affects a persons thoughts, perceptions and emotions. Research has found that the chance of someone with mental illness having a relapse is greater when their family is over-involved, hostile, critical and dissatisfied - a concept known as 'expressed emotions'. Family interventions have been shown to improve outcomes for people with schizophrenia and are now widely used. They are designed to promote positive family environments and reduce levels of expressed emotions within families as well as providing insight into the signs and symptoms of mental illness, so family members can anticipate and help stop relapse. There have been various psychosocial programmes designed over the years, including: counselling groups for family members; family therapy; educational groups for relatives; group therapy for family members; and educational lectures for family members. These are delivered by skilled, trained mental health professionals, who work with the families every two weeks or so, sometimes across considerable time periods, such as one year.

Brief family intervention is a form of family intervention where a mental health professional educates the person with schizophrenia and their family members about the illness over a limited number of sessions.

This review investigates the effects of brief family intervention for people with schizophrenia, compared to standard or usual care. A search of the Cochrane Schizophrenia Group's trial register was carried out in July 2012. Four randomised studies, with a total of 163 participants were included. Results were limited, so it is not clear if brief family intervention reduces admission to hospital, decreases people using health services and reduces relapse for people with schizophrenia. The review found some evidence that brief family intervention might increase the understanding of family members about mental illness. However, all main findings are not strong and based on low or very low quality evidence. Despite this, the authors of the review suggest that brief family intervention should not be completely dismissed, as it is in a current state of demand and there are usually resources or local services available for people with mental health problems and their families to participate in as a part of recovery. The authors also suggest that brief family intervention could be improved to be more effective but this would depend on larger and better studies of brief family intervention being carried out, which would help guide good practice and lead to better outcomes for people with schizophrenia.

This plain language summary has been written by a consumer, Ben Gray, from RETHINK.

Authors' conclusions: 

The findings of this review are not outstanding due to the size and quality of studies providing data; the analysed outcomes were also minimal, with no meta-analysis possible. All outcomes in the 'Summary of findings' table were rated low or very low quality evidence. However, the importance of brief family intervention should not be dismissed outright, with the present state of demand and resources available. The designs of such brief interventions could be modified to be more effective with larger studies, which may then have enough power to inform clinical practice.

Read the full abstract...
Background: 

Supportive, positive family environments have been shown to improve outcomes for patients with schizophrenia in contrast with family environments that express high levels of criticism, hostility, or over-involvement, which have poorer outcomes and have more frequent relapses. Forms of psychosocial intervention, designed to promote positive environments and reduce these levels of expressed emotions within families, are now widely used.

Objectives: 

To assess the effects of brief family interventions for people with schizophrenia or schizophrenia-like conditions.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register (July 2012), which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted authors of trials for additional information.

Selection criteria: 

All relevant randomised studies that compared brief family-oriented psychosocial interventions with standard care, focusing on families of people with schizophrenia or schizoaffective disorder were selected.

Data collection and analysis: 

We reliably selected studies, quality assessed them and extracted data. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CI). For continuous outcomes, we estimated a mean difference (MD) between groups and their 95% CIs. We used GRADE to assess quality of evidence for main outcomes of interest and created a 'Summary of findings' table. We assessed risk of bias for included studies.

Main results: 

Four studies randomising 163 people could be included in the review. It is not clear if brief family intervention reduces the utilisation of health services by patients, as most results are equivocal at long term and only one study reported data for the primary outcomes of interest of hospital admission (n = 30, 1 RCT, RR 0.50, 95% CI 0.22 to 1.11, very low quality evidence). Data for relapse are also equivocal by medium term (n = 40, 1 RCT, RR 0.50, 95% CI 0.10 to 2.43, low quality evidence). However, data for the family outcome of understanding of family member significantly favoured brief family intervention (n = 70, 1 RCT, MD 14.90, 95% CI 7.20 to 22.60, very low quality evidence). No study reported data for other outcomes of interest including days in hospital; adverse events; medication compliance; quality of life or satisfaction with care; or any economic outcomes.

Share/Save