Review question.
To investigate the effectiveness of brief psychoeducation compared with standard care as a means of helping people with serious mental illness. To investigate whether any kind (individual/ family/group) of brief psychoeducation is better than others.
Background.
Schizophrenia is a serious, long-term mental illness where people experience hallucinations and/or delusions and are often unable to distinguish these experiences from reality. Hearing voices and seeing things can be disturbing, confusing and frightening and can lead to changes in behaviour. It is suggested that insight into the illness can help people to understand the need for treatment and subsequently improve the prognosis.
However, the nature of schizophrenia is such that it alters peoples thought processes and they are often unable to have insight into their illness. The stigma of having a mental illness can also influence a person's willingness to seek or take treatments. Effective education of people with schizophrenia can improve insight and understanding. Psychoeducation programmes have been developed, specifically aimed at people with mental health problems. It is not simply providing information to patients. Rather, it is a form of empowering training targeted at promoting awareness and providing tools to manage, cope and live with a mental illness. However, psychoeducation can be time consuming; brief psychoeducation has been developed as a possible solution to this problem. In this review the authors defined brief psychoeducation to be a psychoeducation programme of 10 sessions or less.
Study characteristics.
The review authors searched for randomised trials in 2013 and found 20 relevant studies with 2337 participants. Half of the studies were carried out in China. These trials randomised people to receive either brief psychoeducation sessions (these ranged from one-day psychoeducation to eight sessions of psychoeducation over a period of one year) or routine care.
Key results.
Based on information from a limited number of studies, brief psychoeducation does seem to reduce relapse and encourage people to take their medication. Those receiving brief psychoeducation also have more favourable results for mental state and social functioning.
Quality of the evidence.
Although initial results are encouraging, most information and data for the main outcomes of interest, were rated as low or very low quality, and the number of trials providing useful data is small. Until further large, high-quality studies become available, the usefulness of brief psychoeducation remains debatable.
Ben Gray, Senior Peer Researcher, McPin Foundation.http://mcpin.org/
Based on mainly low to very low quality evidence from a limited number of studies, brief psychoeducation of any form appears to reduce relapse in the medium term, and promote medication compliance in the short term. A brief psychoeducational approach could potentially be effective, but further large, high-quality studies are needed to either confirm or refute the use of this approach.
Those with serious/severe mental illness, especially schizophrenia and schizophrenic-like disorders, often have little to no insight regarding the presence of their illness. Psychoeducation may be defined as the education of a person with a psychiatric disorder regarding the symptoms, treatments, and prognosis of that illness. Brief psychoeducation is a short period of psychoeducation; although what constitutes 'brief psychoeducation' can vary. A previous systematic review has shown that the median length of psychoeducation is around 12 weeks. In this current systematic review, we defined 'brief psychoeducation' as programmes of 10 sessions or less.
To assess the efficacy of brief psychoeducational interventions as a means of helping severely mentally ill people when added to 'standard' care, compared with the efficacy of standard care alone.
The secondary objective is to investigate whether there is evidence that a particular kind (individual/ family/group) of brief psychoeducational intervention is superior to others.
We searched the Cochrane Schizophrenia Group register September 2013 using the phrase:
[*Psychoeducat* in interventions of STUDY]. Reference lists of included studies were also inspected for further relevant studies. We also contacted authors of included study for further information regarding further data or details of any unpublished trials.
All relevant randomised controlled trials (RCTs) comparing brief psychoeducation with any other intervention for treatment of people with severe mental illness. If a trial was described as 'double blind' but implied randomisation, we entered such trials in a sensitivity analysis.
At least two review authors extracted data independently from included papers. We contacted authors of trials for additional and missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. For continuous data, we calculated the mean difference (MD), again with 95% CIs. We used a fixed-effect model for data synthesis, and also assessed data using a random-effects model in a sensitivity analysis. We assessed risk of bias for each included study and created 'Summary of findings' tables using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
We included twenty studies with a total number of 2337 participants in this review. Nineteen studies compared brief psychoeducation with routine care or conventional delivery of information. One study compared brief psychoeducation with cognitive behavior therapy.
Participants receiving brief psychoeducation were less likely to be non-compliant with medication than those receiving routine care in the short term (n = 448, 3 RCTs, RR 0.63 CI 0.41 to 0.96, moderate quality evidence) and medium term (n = 118, 1 RCT, RR 0.17 CI 0.05 to 0.54, low quality evidence).
Compliance with follow-up was similar between the two groups in the short term (n = 30, 1 RCT, RR 1.00, CI 0.24 to 4.18), medium term (n = 322, 4 RCTs, RR 0.74 CI 0.50 to 1.09) and long term (n = 386, 2 RCTs, RR 1.19, CI 0.83 to 1.72).
Relapse rates were significantly lower amongst participants receiving brief psychoeducation than those receiving routine care in the medium term (n = 406, RR 0.70 CI 0.52 to 0.93, moderate quality evidence), but not in the long term.
Data from a few individual studies supported that brief psychoeducation: i) can improve the long-term global state (n = 59, 1 RCT, MD -6.70 CI -13.38 to -0.02, very low quality evidence); ii) promote improved mental state in short term (n = 60, 1 RCT, MD -2.70 CI -4.84 to -0.56, low quality evidence) and medium term; iii) can lower the incidence and severity of anxiety and depression.
Social function such as rehabilitation status (n = 118, 1 RCT, MD -13.68 CI -14.85 to -12.51, low quality evidence) and social disability (n = 118, 1 RCT, MD -1.96 CI -2.09 to -1.83, low quality evidence) were also improved in the brief psychoeducation group. There was no difference found in quality of life as measured by GQOLI-74 in the short term (n = 62, 1 RCT, MD 0.63 CI -0.79 to 2.05, low quality evidence), nor the death rate in either groups (n = 154, 2 RCTs, RR 0.99, CI 0.15 to 6.65, low quality evidence).