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Family intervention for schizophreniaPharoah F, Mari J, Rathbone J, Wong W
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SummaryFamily intervention for schizophreniaPeople with schizophrenia are more likely to experience a relapse within family groups when there are high levels of expressed emotion (hostility, criticism or over involvement) within the family, compared to families who tend to be less expressive of their emotions. There are several psychosocial interventions available involving education, support and management to reduce expressed emotion within families. In this review we compare the effects of family psychosocial interventions in community settings for the care of people with schizophrenia or schizophrenia-like illnesses. Studies were conducted in Europe, Asia and North America with packages of family intervention varying between studies; although there were no clear differences in study design. Results indicated that family intervention may reduce the risk of relapse and improve compliance with medication. However data were often inadequately reported and therefore unusable. As this package of care is widely employed there should be a further study to properly clarify several of the short-term and long-term outcomes.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 25. 1995 AbstractBackgroundPeople with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families are now widely used. ObjectivesTo estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared to standard care. Search strategyWe updated previous searches by searching The Cochrane Schizophrenia Group's Register (November 2002 and June 2005), searched references of all new included studies for further trial citations, and contacted authors of trials. Selection criteriaWe selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. Data collection and analysisWe independently extracted data and calculated fixed effects relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). Main resultsThis 2005-6 update adds data of 15 additional trials (1765 participants, 43% of the total 4124). Family intervention may decrease the frequency of relapse (n=857, 16 RCTs, RR 0.71 CI 0.6 to 0.8, NNT 8 CI 6 to 11), although some small but negative studies may not have been identified by the search. Family intervention may also reduce hospital admission (8 RCTs, n=481, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) - and this finding is a change to the previous equivocal data reported in 2002. Family intervention may also encourage compliance with medication (n=369, 7 RCTs, RR 0.74 CI 0.6 to 0.9, NNT 7 CI 4 to 19) but does not obviously affect the tendency of individuals/families to drop out of care (n=481, 6 RCTs, RR 0.86 CI 0.5 to 1.4). It may improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. Authors' conclusionsClinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are applicable to routine care. |