Year: 2014
Type: article
Abstract: 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 overinvolvement, 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. To assess the effects of brief family interventions (5 sessions or less) for people with schizophrenia or schizophrenia-like conditions. We searched the Cochrane Schizophrenia Group Trials Register (July 2012) that 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. All relevant randomized studies that compared brief family-oriented psychosocial interventions with standard care, focusing on families of people with schizophrenia or schizoaffective disorder. We reliably selected, quality-assessed and extracted data from studies. For binary outcomes, we calculated standard estimates of relative risk (RR) and their 95% confidence intervals (CI). For continuous outcomes, we estimated a mean difference (MD) between groups and their 95% confidence intervals. We used GRADE to assess quality of evidence for main outcomes of interest and create a summary of findings table. We assessed risk of bias for included studies. Four studies randomizing 163 people could be included in the review. It is not clear if brief family intervention reduces the utilization of health services by patients, as most results are equivocal and only 1 study reported data for the primary outcome of “hospital admission” ( n = 30, 1 randomized clinical trial [RCT], RR 0.50, 95% CI 0.22–1.11, very low-quality evidence). Data for “relapse” are also equivocal ( n = 40, 1 RCT, RR medium term 0.50, 95% CI 0.10–2.43, low-quality evidence). However, data for the family outcome of “understanding of family member” significantly favored brief family intervention ( n = 70, 1 RCT, MD 14.90, 95% CI 7.20–22.60, very low-quality evidence). No study reported data for “days in hospital,” “adverse events,” “medication compliance,” “quality of life,” “satisfaction with care,” or any economic outcomes ( table 1 ). Summary of Findings Table Note : RR , relative risk. a Mean baseline risk presented for single study. b Risk of bias: “very serious”—no blinding of participants or study personnel; 29% participant data not accounted; statistical data not reported. c Imprecision: “serious”—95% confidence intervals for best estimate of effect include both “no effect” and appreciable benefit/harm. d Risk of bias: “serious”—no blinding of participants or study personnel. e Risk of bias: “very serious”—no mention of allocation concealment/blinding; attrition at 65%—only n = 34 out of N = 200 completed the study and were included in data and analysis. f Indirectness: “serious”—scale-derived data. Summary of Findings Table Note : RR , relative risk. a Mean baseline risk presented for single study. b Risk of bias: “very serious”—no blinding of participants or study personnel; 29% participant data not accounted; statistical data not reported. c Imprecision: “serious”—95% confidence intervals for best estimate of effect include both “no effect” and appreciable benefit/harm. d Risk of bias: “serious”—no blinding of participants or study personnel. e Risk of bias: “very serious”—no mention of allocation concealment/blinding; attrition at 65%—only n = 34 out of N = 200 completed the study and were included in data and analysis. f Indirectness: “serious”—scale-derived data. The findings of this review are limited because data are so sparse. However, the importance of a brief version of family therapy should be properly investigated within well-designed, conducted, and reported trials with enough power to inform clinical practice. Please see Cochrane review for full details.
Source: Schizophrenia Bulletin
Authors: U. Okpokoro, S. Sampson
Institution: University of Nottingham
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2136740629