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Meta-Analysis
. 2010 Dec 8:(12):CD000088.
doi: 10.1002/14651858.CD000088.pub2.

Family intervention for schizophrenia

Fiona Pharoah  1 , Jair Mari, John Rathbone, Winson Wong
Affiliations
Meta-Analysis

Family intervention for schizophrenia

Fiona Pharoah et al. Cochrane Database Syst Rev. .

Abstract

Background: People 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.

Objectives: To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared with standard care.

Search strategy: We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008).

Selection criteria: We 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 analysis: We independently extracted data and calculated fixed-effect 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 mean differences (MD).

Main results: This 2009-10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to 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' conclusions: Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.

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Figures

Analysis 1.4
Analysis 1.4
Review: Family intervention for schizophrenia Comparison: 1 ANY FAMILY-BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE Outcome: 4 Global state: 1. Relapse
Figure 1
Figure 1. Forest plot of comparison: 1 ANY FAMILY-BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse (without use of data from China)
Figure 2
Figure 2. Funnel plot of comparison: 1 ANY FAMILY-BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse
Figure 3
Figure 3. Funnel plot of comparison: 1 ANY FAMILY-BASED INTERVENTIONS (> 5 sessions) vs STANDARD CARE, outcome: 1.4 Global state: 1. Relapse (minus Chinese trials)
Figure 4
Figure 4. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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References to other published versions of this review

    1. Mari J, Streiner D. An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings. Psychological Medicine. 1994;23:565–78. - PubMed
    1. Mari JJ, Streiner D. Family intervention for people with schizophrenia. Cochrane Database of Systematic Reviews. 1996;(1) DOI: 10.1002/14651858.CD000088. - PubMed
    1. Pharoah FM, Mari JJ, Streiner D. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews. 2000;(2) DOI: 10.1002/14651858.CD000088. - PubMed
    1. Pharoah FM, Rathbone J, Mari JJ, Streiner D. Family intervention for schizophrenia. Cochrane Databaseof Systematic Reviews. 2003;(4) DOI: 10.1002/14651858.CD000088. - PubMed

    1. * Indicates the major publication for the study