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Uzuazomaro Okpokoro, Stephanie Sampson, Brief Family Intervention for Schizophrenia, Schizophrenia Bulletin, Volume 40, Issue 3, May 2014, Pages 497–498, https://doi.org/10.1093/schbul/sbu039
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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 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.
Objectives
To assess the effects of brief family interventions (5 sessions or less) for people with schizophrenia or schizophrenia-like conditions.
Search Methods
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.
Selection Criteria
All relevant randomized studies that compared brief family-oriented psychosocial interventions with standard care, focusing on families of people with schizophrenia or schizoaffective disorder.
Data Collection and Analysis
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.
Main Results
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 ).
Brief Family Intervention vs Standard Care for Schizophrenia . | ||||||
---|---|---|---|---|---|---|
Outcomes . | Illustrative Comparative Risks* (95% CI) . | Relative Effect (95% CI) . | No of Participants (Studies) . | Quality of the Evidence (GRADE) . | Comments . | |
Assumed Risk . | Corresponding Risk . | |||||
Standard Care . | Brief Family Intervention . | |||||
Service utilization—hospital admission follow-up: 12 mo | 667 per 1000a | 333 per 1000 (147 to 740) | RR 0.5 (0.22 to 1.11) | 30 (1 study) | ⊕⊝⊝⊝ very lowb,c | |
Service utilization—days in hospital | No study reported/measured this outcome | |||||
Global state—relapse follow-up: 4 mo | 200 per 1000a | 100 per 1000 (20 to 486) | RR 0.5 (0.1 to 2.43) | 40 (1 study) | ⊕⊕⊝⊝ lowc,d | |
Global state—compliance with medication | No study reported/measured this outcome | |||||
Quality of life/satisfaction with care | No study reported/measured this outcome | |||||
Family outcome—understanding, average Patient Rejection Scale endpoint score (high = more acceptance) follow-up: 2 mo | Mean family understanding score in control group 104.2 points | Mean family understanding score in intervention group 14.9 higher (7.2 to 22.6 higher) | 70 (1 study) | ⊕⊝⊝⊝ very lowe,f | ||
Economic outcomes | No study reported/measured this outcome |
Brief Family Intervention vs Standard Care for Schizophrenia . | ||||||
---|---|---|---|---|---|---|
Outcomes . | Illustrative Comparative Risks* (95% CI) . | Relative Effect (95% CI) . | No of Participants (Studies) . | Quality of the Evidence (GRADE) . | Comments . | |
Assumed Risk . | Corresponding Risk . | |||||
Standard Care . | Brief Family Intervention . | |||||
Service utilization—hospital admission follow-up: 12 mo | 667 per 1000a | 333 per 1000 (147 to 740) | RR 0.5 (0.22 to 1.11) | 30 (1 study) | ⊕⊝⊝⊝ very lowb,c | |
Service utilization—days in hospital | No study reported/measured this outcome | |||||
Global state—relapse follow-up: 4 mo | 200 per 1000a | 100 per 1000 (20 to 486) | RR 0.5 (0.1 to 2.43) | 40 (1 study) | ⊕⊕⊝⊝ lowc,d | |
Global state—compliance with medication | No study reported/measured this outcome | |||||
Quality of life/satisfaction with care | No study reported/measured this outcome | |||||
Family outcome—understanding, average Patient Rejection Scale endpoint score (high = more acceptance) follow-up: 2 mo | Mean family understanding score in control group 104.2 points | Mean family understanding score in intervention group 14.9 higher (7.2 to 22.6 higher) | 70 (1 study) | ⊕⊝⊝⊝ very lowe,f | ||
Economic outcomes | No study reported/measured this outcome |
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.
Brief Family Intervention vs Standard Care for Schizophrenia . | ||||||
---|---|---|---|---|---|---|
Outcomes . | Illustrative Comparative Risks* (95% CI) . | Relative Effect (95% CI) . | No of Participants (Studies) . | Quality of the Evidence (GRADE) . | Comments . | |
Assumed Risk . | Corresponding Risk . | |||||
Standard Care . | Brief Family Intervention . | |||||
Service utilization—hospital admission follow-up: 12 mo | 667 per 1000a | 333 per 1000 (147 to 740) | RR 0.5 (0.22 to 1.11) | 30 (1 study) | ⊕⊝⊝⊝ very lowb,c | |
Service utilization—days in hospital | No study reported/measured this outcome | |||||
Global state—relapse follow-up: 4 mo | 200 per 1000a | 100 per 1000 (20 to 486) | RR 0.5 (0.1 to 2.43) | 40 (1 study) | ⊕⊕⊝⊝ lowc,d | |
Global state—compliance with medication | No study reported/measured this outcome | |||||
Quality of life/satisfaction with care | No study reported/measured this outcome | |||||
Family outcome—understanding, average Patient Rejection Scale endpoint score (high = more acceptance) follow-up: 2 mo | Mean family understanding score in control group 104.2 points | Mean family understanding score in intervention group 14.9 higher (7.2 to 22.6 higher) | 70 (1 study) | ⊕⊝⊝⊝ very lowe,f | ||
Economic outcomes | No study reported/measured this outcome |
Brief Family Intervention vs Standard Care for Schizophrenia . | ||||||
---|---|---|---|---|---|---|
Outcomes . | Illustrative Comparative Risks* (95% CI) . | Relative Effect (95% CI) . | No of Participants (Studies) . | Quality of the Evidence (GRADE) . | Comments . | |
Assumed Risk . | Corresponding Risk . | |||||
Standard Care . | Brief Family Intervention . | |||||
Service utilization—hospital admission follow-up: 12 mo | 667 per 1000a | 333 per 1000 (147 to 740) | RR 0.5 (0.22 to 1.11) | 30 (1 study) | ⊕⊝⊝⊝ very lowb,c | |
Service utilization—days in hospital | No study reported/measured this outcome | |||||
Global state—relapse follow-up: 4 mo | 200 per 1000a | 100 per 1000 (20 to 486) | RR 0.5 (0.1 to 2.43) | 40 (1 study) | ⊕⊕⊝⊝ lowc,d | |
Global state—compliance with medication | No study reported/measured this outcome | |||||
Quality of life/satisfaction with care | No study reported/measured this outcome | |||||
Family outcome—understanding, average Patient Rejection Scale endpoint score (high = more acceptance) follow-up: 2 mo | Mean family understanding score in control group 104.2 points | Mean family understanding score in intervention group 14.9 higher (7.2 to 22.6 higher) | 70 (1 study) | ⊕⊝⊝⊝ very lowe,f | ||
Economic outcomes | No study reported/measured this outcome |
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.
Authors’ Conclusions
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.
Reference