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. 2014 Mar 5;2014(3):CD009802.
doi: 10.1002/14651858.CD009802.pub2.

Family intervention (brief) for schizophrenia

Uzuazomaro Okpokoro  1 , Clive E Adams, Stephanie Sampson
Affiliations

Family intervention (brief) for schizophrenia

Uzuazomaro Okpokoro et al. Cochrane Database Syst Rev. .

Abstract

Background: 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 over-involvement, 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.

Objectives: To assess the effects of brief family interventions for people with schizophrenia or schizophrenia-like conditions.

Search methods: We searched the Cochrane Schizophrenia Group Trials Register (July 2012), which 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.

Selection criteria: All relevant randomised studies that compared brief family-oriented psychosocial interventions with standard care, focusing on families of people with schizophrenia or schizoaffective disorder were selected.

Data collection and analysis: We reliably selected studies, quality assessed them and extracted data. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CI). For continuous outcomes, we estimated a mean difference (MD) between groups and their 95% CIs. We used GRADE to assess quality of evidence for main outcomes of interest and created a 'Summary of findings' table. We assessed risk of bias for included studies.

Main results: Four studies randomising 163 people could be included in the review. It is not clear if brief family intervention reduces the utilisation of health services by patients, as most results are equivocal at long term and only one study reported data for the primary outcomes of interest of hospital admission (n = 30, 1 RCT, RR 0.50, 95% CI 0.22 to 1.11, very low quality evidence). Data for relapse are also equivocal by medium term (n = 40, 1 RCT, RR 0.50, 95% CI 0.10 to 2.43, low quality evidence). However, data for the family outcome of understanding of family member significantly favoured brief family intervention (n = 70, 1 RCT, MD 14.90, 95% CI 7.20 to 22.60, very low quality evidence). No study reported data for other outcomes of interest including days in hospital; adverse events; medication compliance; quality of life or satisfaction with care; or any economic outcomes.

Authors' conclusions: The findings of this review are not outstanding due to the size and quality of studies providing data; the analysed outcomes were also minimal, with no meta-analysis possible. All outcomes in the 'Summary of findings' table were rated low or very low quality evidence. However, the importance of brief family intervention should not be dismissed outright, with the present state of demand and resources available. The designs of such brief interventions could be modified to be more effective with larger studies, which may then have enough power to inform clinical practice.

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Conflict of interest statement

Okpokoro Uzuazomaro ‐ none. Clive E Adams ‐ none. Stephanie Sampson ‐ none.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Study flow diagram.
4
4
Forest plot of comparison: 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, outcome: 1.1 Service utilisation: 1. hospital admission.
1.1
1.1. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 1 Service utilisation: 1. hospital admission.
1.2
1.2. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 2 Global state: 1. relapse.
1.3
1.3. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 3 Global state: 2. improved (GAS).
1.4
1.4. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 4 Global state: 3. antipsychotic dose increased.
1.5
1.5. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 5 Mental state: 1. positive symptoms, average score (PANSS, high score = worse).
1.6
1.6. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 6 Mental state: 2. negative symptoms, average score (PANSS, high score = worse).
1.7
1.7. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 7 Mental state: 3. total average score (PANSS, high = worse).
1.8
1.8. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 8 Family outcome: 1. understanding, average score for understanding of family member with schizophrenia (PRS, high score = greater acceptance).
1.9
1.9. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 9 Family outcome: 2. burden/stress, average score (BAS, high score = greater burden).
1.11
1.11. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 11 Family outcome: 4. expressed emotions, average score (FEICS, high score = greater EE).
1.12
1.12. Analysis
Comparison 1 BRIEF FAMILY INTERVENTION vs STANDARD CARE, Outcome 12 Leaving the study early.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009802

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