Psychoeducation for brothers and/or sisters of people with severe mental illness (SMI)

Review question.

This review compares psychoeducation for siblings of people with severe mental illness versus standard care or any other intervention as a means of improving their own wellbeing and quality of life as well as coping with the care-giving for their mentally ill siblings.

Background.

Psychoeducation programmes aim to improve knowledge and understanding of mental health. Family members, inlcuding siblings, of people with severe mental illness are often offered psychoeducation. It is supposed that increased knowledge will help the brother or sister to cope more effectively with providing care for their mentally ill sibling and enhance their own wellbeing. Psychoeducational interventions involve an interaction between the information provider and the sibling of the mentally ill person. This can be delivered in different ways, such as face-to-face or via online forums or by a mixture of these methods.

Study characteristics.

A search for randomised trials investigating psychoeducation for the siblings of people with severe mental illness was run in 2013. Results of the search suggest that brothers and sisters form a small proportion of family members participating in studies of this kind. Only one study meeting the review criteria was found. This study included nine siblings and compared a psychoeducational intervention with standard care in a community care setting, over a period of 21 months.

Key results.

Better outcomes in terms of coping were identified for those siblings who received psychoeducation. However, the number of participants was small and the quality of evidence low, and there is no conclusive evidence that psychoeducation is of benefit for brothers/sisters in this and other important areas (such as wellbeing, quality of life) or for the outcomes of people with mental illness (such as mental state, hospital admission or length of hospital stay).

Quality of the evidence.

Further studies are needed to understand the role of psychoeducation in specifically helping brothers and/or sisters to cope with providing care for their mentally ill siblings. The scarcity of good quality studies means that it is not possible to assess which type of psychoeducation is the most effective, although interventions using a group format that brings many family members together to receive education and share their experiences seem well-received by the participants.

This plain language summary has been written by a consumer: Ben Gray, Senior Peer Researcher, McPin Foundation.http://mcpin.org/

Authors' conclusions: 

Most studies evaluating psychoeducational interventions recruited siblings along with other family members. However, the proportion of siblings in these studies was low and outcomes for siblings were not reported independently from those of other types of family members. Indeed, only data from one study with nine siblings were available for the review. The limited study data we obtained provides no clear good quality evidence to indicate psychoeducation is beneficial for siblings' wellbeing or for clinical outcomes of people affected by SMI. More randomised studies are justified and needed to understand the role of psychoeducation in addressing siblings' needs for information and support.

Read the full abstract...
Background: 

Many people with severe mental illness (SMI) have siblings. Siblings are often both natural agents to promote service users’ recovery and vulnerable to mental ill health due to the negative impact of psychosis within the family. Despite a wealth of research evidence supporting the effectiveness of psychoeducation for service users with SMI and their family members, in reducing relapse and promoting compliance with treatment, siblings remain relatively invisible in clinical service settings as well as in research studies. If psychoeducational interventions target siblings and improve siblings' knowledge, coping with caring and overall wellbeing, they could potentially provide a cost-effective option for supporting siblings with resulting benefits for service users' outcomes.

Objectives: 

To assess the effectiveness of psychoeducation compared with usual care or any other intervention in promoting wellbeing and reducing distress of siblings of people affected by SMI.

The secondary objective was, if possible, to determine which type of psychoeducation is most effective.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register and screened the reference lists of relevant reports and reviews (12th November 2013). We contacted trial authors for unpublished and specific data on siblings' outcomes.

Selection criteria: 

All relevant randomised controlled trials focusing on psychoeducational interventions targeting siblings of all ages (on their own or amongst other family members including service users) of individuals with SMI, using any means and formats of delivery, i.e. individual (family), groups, computer-based.

Data collection and analysis: 

Two review authors independently screened the abstracts and extracted data and two other authors independently checked the screening and extraction process. We contacted authors of trials to ascertain siblings' participation in the trials and seek sibling-specific data in those studies where siblings' data were grouped together with other participants' (most commonly other family members'/carers') outcomes. We calculated the risk difference (RD), its 95% confidence interval (CI) on an intention-to-treat basis. We presented continuous data using the mean difference statistic (MD) and 95% CIs. We assessed risk of bias for the included study and rated quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Main results: 

We found 14 studies that included siblings amongst other family members in receipt of psychoeducational interventions. However, we were only able to include one small trial with relevant and available data (n = 9 siblings out of n = 84 family member/carer-participants) comparing psychoeducational intervention with standard care in a community care setting, over a duration of 21 months. There was insufficient evidence to determine the effects of psychoeducational interventions compared with standard care on 'siblings' quality of life' (n = 9, MD score 3.80 95% CI -0.26 to 7.86, low quality of evidence), coping with (family) burden (n = 9, MD -8.80 95% CI -15.22 to -2.34, low quality of evidence). No sibling left the study early by one year (n = 9, RD 0.00 CI -0.34 to 0.34, low quality of evidence). Low quality and insufficient evidence meant we were unable to determine the effects of psychoeducational interventions compared with standard care on service users' global mental state (n = 9, MD -0.60 CI -3.54 to 2.38, low quality of evidence), their frequency of re-hospitalisation (n = 9, MD -0.70 CI -2.46 to 1.06, low quality of evidence) or duration of inpatient stay (n = 9, MD -2.60 CI -6.34 to 1.14, low quality of evidence), whether their siblings received psychoeducation or not. No study data were available to address the other primary outcomes: 'siblings' psychosocial wellbeing', 'siblings' distress' and adverse effects.

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