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Meta-Analysis
. 2015 Apr 9;2015(4):CD010823.
doi: 10.1002/14651858.CD010823.pub2.

Psychoeducation (brief) for people with serious mental illness

Sai Zhao  1 , Stephanie Sampson, Jun Xia, Mahesh B Jayaram
Affiliations
Meta-Analysis

Psychoeducation (brief) for people with serious mental illness

Sai Zhao et al. Cochrane Database Syst Rev. .

Abstract

Background: 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.

Objectives: 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.

Search methods: 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 We also contacted authors of included study for further information regarding further data or details of any unpublished trials.

Selection criteria: 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.

Data collection and 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).

Main results: 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).

Authors' conclusions: 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.

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Conflict of interest statement

All authors have no known conflict of interest, however JX received a grant from the Cochrane Schizophrenia Group to complete this protocol.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 1 Compliance: 1a. With medication ‐ non‐compliance.
1.2
1.2. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 2 Compliance: 1b. With medication ‐ partial compliance (medium term).
1.4
1.4. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 4 Compliance: 1d. With medication ‐ very good/ good compliance (numberic compliance scale).
1.5
1.5. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 5 Compliance: 2a. With follow‐up ‐ loss to follow‐up for any reason.
1.6
1.6. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 6 Relapse: 1. Relapse for any reason.
1.7
1.7. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 7 Relapse: 2. Relapse with readmission.
1.8
1.8. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 8 Knowledge: 1a. Average endpoint scale scores on various knowledge scales.
1.11
1.11. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 11 Knowledge: 2. Average endpoint scores (SAUMD, high = poor) (short term).
1.12
1.12. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 12 Global state: 2. Average endpoint scale score.
1.13
1.13. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 13 Service utilisation: rehospitalisation.
1.14
1.14. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 14 Mental state: 1a. Global ‐ average total endpoint scale scores (BPRS, high = poor).
1.15
1.15. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 15 Mental state: 1b. Global ‐ average change scale scores (GWB/SES, high = good) (medium term).
1.17
1.17. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 17 Mental state: 2a. Specific symptoms ‐ short term.
1.18
1.18. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 18 Mental state: 2b. specific symptoms ‐ average total endpoint scale score (high = poor) (short term).
1.20
1.20. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 20 Social functioning: 1a. Average change scores on various scales (high = poor) (medium term).
1.21
1.21. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 21 Expressed emotion: Participants with high EE relatives (FQ).
1.22
1.22. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 22 Expressed emotion for relatives: Average change scores on FQ scales (high = good).
1.23
1.23. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 23 Quality of life: 1a. Average endpoint scores (GQOLI‐74, high = good).
1.24
1.24. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 24 Quality of life: 1b. Average endpoint scores (FAD, high = poor).
1.26
1.26. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 26 Satisfaction with mental health services: 1. Average change score (VSS, high = good) (short term).
1.27
1.27. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 27 Satisfaction with mental health services: 2. Average change (VSS Scale, high = good) (long term at 1 year).
1.28
1.28. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 28 Patients' satisfaction with mental health services: average endpoint scores (CSQ, high = good) (short term).
1.29
1.29. Analysis
Comparison 1 ANY FORM OF BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 29 Adverse event: Death.
2.1
2.1. Analysis
Comparison 2 ANY FORM OF BRIEF PSYCHOEDUCATION vs CBT, Outcome 1 Compliance: With medication (numberic compliance scale, high = good).
2.2
2.2. Analysis
Comparison 2 ANY FORM OF BRIEF PSYCHOEDUCATION vs CBT, Outcome 2 Relapse: Relapse for any reason (medium term).
2.3
2.3. Analysis
Comparison 2 ANY FORM OF BRIEF PSYCHOEDUCATION vs CBT, Outcome 3 Service utilisation: hospitalisation (long term).
2.4
2.4. Analysis
Comparison 2 ANY FORM OF BRIEF PSYCHOEDUCATION vs CBT, Outcome 4 Mental state: Specific ‐ average endpoint PANSS scores (high = poor).
2.5
2.5. Analysis
Comparison 2 ANY FORM OF BRIEF PSYCHOEDUCATION vs CBT, Outcome 5 Quality of life: Average endpoint MSQoL‐54 score (high = good).
3.1
3.1. Analysis
Comparison 3 SUBGROUP ANALYSES 2. GROUP BRIEF PSYCHOEDUCATION/INDIVIDUAL PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 1 Compliance: 1a. With medication ‐ non‐compliance.
3.2
3.2. Analysis
Comparison 3 SUBGROUP ANALYSES 2. GROUP BRIEF PSYCHOEDUCATION/INDIVIDUAL PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 2 Compliance: 1b. With follow up ‐ loss to follow‐up for any reason.
3.3
3.3. Analysis
Comparison 3 SUBGROUP ANALYSES 2. GROUP BRIEF PSYCHOEDUCATION/INDIVIDUAL PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 3 Relapse: 1. Relapse for any reason.
4.1
4.1. Analysis
Comparison 4 SENSITIVITY ANALYSES 1 (without assumption for lost binary data): BRIEF PSYCHOEDUCATION vs CBT, Outcome 1 Relapse: Relapse for any reason (medium term).
4.2
4.2. Analysis
Comparison 4 SENSITIVITY ANALYSES 1 (without assumption for lost binary data): BRIEF PSYCHOEDUCATION vs CBT, Outcome 2 Relapse: Relapse for any reason (medium term)‐without assumption.
5.1
5.1. Analysis
Comparison 5 SENSITIVITY ANALYSES 2 (risk of bias): BRIEF PSYCHOEDUCATION vs ROUTINE CARE/INFORMATION, Outcome 1 Compliance: 1a. With medication ‐ non‐compliance.
See this image and copyright information in PMC

Update of

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Magliano 2004 {published data only}
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McFarlane 1995 {published data only}
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References to studies awaiting assessment

Bechdolf 2000 {published data only}
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Motlova 2002 {published data only}
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