Programa Conjunto de Intervención Temprana para Cuidadores Informales de Pacientes Psiquiátricos (Ensemble)

The five-session Ensemble program provided to informal caregivers targeted support + SAU

Ensemble is a individualized programme to address informal caregiver's specific unmet needs, emotions and social resources, in order to offer a targeted support in five sessions.

• Conjunto

Informal caregivers have often to manage the situation in usual different ways. Support as usual (SAU) alone consists of an informal support by patient's clinical team. Specific psychoeducational programs depending on patient's illnes (like "Profamille" for schizophrenia) or peer-support depending to the voluntary work of families' associations. Some general professional services focused on informal caregivers or relatives in order to inform and orient them if they are avaible in the study area. No attempts have been made to standardize this treatement as SAU depend to informal caregiver's need and knowledge of the health system, also her/his capacity or possibility to be in contact with patient's clinical team.

• Apoyo como siempre

SAU alone which was chosen as a control condition.

Informal caregivers have often to manage the situation in usual different ways. Support as usual (SAU) alone consists of an informal support by patient's clinical team. Specific psychoeducational programs depending on patient's illnes (like "Profamille" for schizophrenia) or peer-support depending to the voluntary work of families' associations. Some general professional services focused on informal caregivers or relatives in order to inform and orient them if they are avaible in the study area. No attempts have been made to standardize this treatement as SAU depend to informal caregiver's need and knowledge of the health system, also her/his capacity or possibility to be in contact with patient's clinical team.

• Apoyo como siempre

The Brief Symptom Inventory (BSI) invlude normative data to detect clinical symptoms as indicators of emotional distress, with 53 items on a 5-point Likert-type scale (0-4), ranging from "not at all"=0 to "extremely=4." The items measure physical and psychological symptoms occurring in the preceding 7-day period. It includes three global indices: Global Severity Index (GSI, indicating the global distress level), Positive Symptom Total (PST, indicating the number of symptoms an individual reports) and Positive Symptom Distress Index (PSDI, indicating the average distress level).The Global Severity Index (GSI) is a composite score to measure global distress Min = 0; Max=212: Range 0-3.83, a higher score reprensent a severer global distress level. The interpretation

Assessement of optimism level (LOT-R scale). The Life Orientation Test - Revised (LOT-R) measures an individual's optimism regarding a given situation. This scale includes 10 items; three items measure optimism, three other measure pessimism, and four of the 10 items function as fillers. Items are answered by a Likert-type of scale which varies from 0 (strongly disagree) to 4 (strongly agree). LOT-R score can range from 0 to 24, Min=0, Max=40; 0-13 Low Optimism (High Pessimism); 14-18 Moderate Optimism; 19-24 High Optimism (Low Pessimism). Higher values represent better outcome.

36-item Medical Outcome Study Short-Form Health Survey (SF-36) measures health indicators related to the quality of life by 36 items, used in clinical and general population settings to evaluated eight health dimensions: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Higher score defines a more favorable health state. Each item is scored on a 0 to 100 range, 0 being the lowest and 100 being the highest possible scores.Two global scores, i) A Physical Component Score (PCS) and ii) the Mental Component Score (MCS) obtained by grouping dimensions to have global variables (min=0; max =400). MCS is the addition of the mean scores on the emotional well-being, social functioning,vitality and emotional limitation subscales. Lower MCS scores potentially indicate presence of psychological risk.

Assessment of the informal caregiver's burden level by the Zarit Burden Interview. This 22-item scale assesses the subjective burden (emotional, physical and financial) for an informal caregiver of an individual with loss of autonomy. The score is obtained by the addition of the 22 items. Scores range between 0 and 88, 61-88 is considered as a high burden, 41-60 is a moderate to high burden, 21-40 is a light to moderate burden and 0-20 is considered as no subjective burden.

Social and Occupational Functioning Assessment Scale (SOFAS) is a scale from 0 to 100 demonstrating the patient's social functioning. In this study, this score will be measured according to the informal caregiver's representation. It is used in psychiatry to evaluate how well a patient is functioning in daily life, work, and social relationships.High scores (≥70) indicate good to excellent functioning; Moderate scores (50-69) suggest some difficulties but still some level of independence; Low scores (<50) indicate serious impairments in daily life, often requiring intervention