A Randomized Controlled Trial on Mutual Support Group Intervention for Families of People With Recent-Onset Psychosis: A Four-Year Follow-Up

Wai Tong Chien, Daniel Bressington, Sally W C Chan, Wai Tong Chien, Daniel Bressington, Sally W C Chan

Abstract

Introduction: Recent research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care. Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (≤5 years of illness) was conducted between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group (n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine psychiatric outpatient care. Results: Patients and families in the mutual support group reported consistently greater improvements in overall functioning [family functioning, F (2, 203) = 8.13, p = 0.003; patient functioning, F (2, 203) = 6.01, p = 0.008] and reductions in duration of hospitalizations [F (2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant increases of medication dosages or service use by both the family support and psycho-education groups over time. Conclusions: The peer-led family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family functioning and re-hospitalizations. Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.

Keywords: family intervention; mutual support group; psycho-education; randomized controlled trial; recent-onset psychosis.

Figures

Figure 1
Figure 1
Flow diagram of the controlled trial procedure. The figure shows the main procedure of this randomized controlled trial according to the latest CONSORT statement (27). Families of patients with recent-onset psychosis in three outpatient clinics (N = 800 per clinic) were assessed and 290–315 of them were found eligible in this study. Two hundred ten of them (70 per clinic) were randomly selected and after baseline measurement, were then randomly allocated into one of the three study groups [Family-led Mutual Support Group (FMSG), Family Psychoeducation Group, or Treatment-As-Usual (TAU) only; 70 subjects per group]. After completion of the interventions, majority of them in the FMSG, Family Psychoeducation Group and TAU (n = 69 in each group) continued to be followed up for 48 months and only a few lost/withdrew from the study. On intention-to-treat basis, 69 in the FMSG and 68 in the other two study groups were included into final outcome analysis.

References

    1. Van Os J, Linscott R, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychol Med. (2009) 39:179–95. 10.1017/S0033291708003814
    1. Gonçalves-Pereira M, Xavier M, van Wijngaarden B, Papoila AL, Schene AH, Caldas-de-Almeida JM. Impact of psychosis on Portuguese caregivers: a cross-cultural exploration of burden, distress, positive aspects and clinical-functional correlates. Soc Psychiatry Psychiatr Epidemiol. (2013) 48: 325–35. 10.1007/s00127-012-0516-7
    1. Kuipers E, Yesufu-Udechuku A, Taylor C, Kendall T. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ (2014) 348:g1173. 10.1136/bmj.g1173
    1. Ribé JM, Salamero M, Pérez-Testor C, Mercadal J, Aguilera C, Cleris M. Quality of life in family caregivers of schizophrenia patients in Spain: caregiver characteristics, caregiving burden, family functioning, and social and professional support. Int J Psychiatry Clin Pract. (2018) 22:25–33. 10.1080/13651501.2017.1360500
    1. American Psychiatric Association Understanding Mental Disorders: Your Guide to DSM-5. Washington, DC: American Psychiatric Publishing; (2014).
    1. National Institute for Health and Care Excellence Psychosis and Schizophrenia in Adults: Prevention and Management 2014]. London: NICE; (2014).
    1. Dixon L, Perkins D, Calmes C. Guideline Watch (September 2009): Practice Guideline for the Treatment of Patients with Schizophrenia. Washington, DC: American Psychiatric Association; (2009). 10.1176/appi.books.9780890423929
    1. Onwumere J, Bebbington P, Kuipers E. Family intervention in early psychosis: specificity and effectiveness. Epidemiol Psychiatr Sci. (2011) 20:113–9 10.1017/S2045796011000187
    1. Lobban F, Postlethwaite A, Glentworth D, Pinfold V, Wainwright L, Dunn G, et al. . A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev. (2013) 33:372–82. 10.1016/j.cpr.2012.12.004
    1. Cragin CA, Straus MB, Blacker D, Tully LM, Niendam TA. Early psychosis and trauma-related disorders: clinical practice guidelines and future directions. Front Psychiatry (2017) 8:33. 10.3389/fpsyt.2017.00033
    1. Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. . Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry (2016) 50:410–72. 10.1177/0004867416641195
    1. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry (2010) 197:350–6. 10.1192/bjp.bp.109.074526
    1. Fisher H, Theodore K, Power P, Chisholm B, Fuller J, Marlowe K, et al. . Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiatry Psychiatr Epidemiol. (2008) 43:960–7. 10.1007/s00127-008-0386-1
    1. Cabral RRF, Chaves AC. Multi-family group intervention in a program for patients with first-episode psychosis: a Brazilian experience. Int J Soc Psychiatry (2010) 56:527–32 10.1177/0020764009102754
    1. Claxton M, Onwumere J, Fornells-Ambrojo M. Do Family interventions improve outcomes in early psychosis? A systematic review and meta-Analysis. Front Psychol. (2017) 8:371. 10.3389/fpsyg.2017.00371
    1. Riley G, Gregory N, Bellinger J, Davies N, Mabbott G, Sabourin R. Carer's education groups for relatives with a first episode of psychosis: an evaluation of an eight-week education group. Early Interv Psychiatry (2011) 5:57–63. 10.1111/j.1751-7893.2010.00195.x
    1. Chan SW, Yip B, Tso S, Cheng BS, Tam W. Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Educ Couns. (2009) 75:67–76. 10.1016/j.pec.2008.08.028
    1. Cook JA, Heller T, Pickett-Schenk SA. The effect of support group participation on caregiver burden among parents of adult offspring with severe mental illness. Fam Relations (1999) 48:405–10. 10.2307/585248
    1. Chien WT, Norman I. The effectiveness and active ingredients of mutual support groups for family caregivers of people with psychotic disorders: a literature review. Int J Nurs Stud. (2009) 46:1604–23. 10.1016/j.ijnurstu.2009.04.003
    1. Humphreys K, Moos RH. Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: 2-year clinical and utilization outcomes. Alcohol Clin Exp Res. (2007) 31:64–8. 10.1111/j.1530-0277.2006.00273.x
    1. Glynn SM, Cohen AN, Dixon LB, Niv N. The potential impact of the recovery movement on family intervention for schizophrenia: opportunities and obstacles. Schizophr Bull. (2006) 32:451–63. 10.1093/schbul/sbj066
    1. Pistrang N, Barker C, Humphreys K. Mutual help groups for mental health problems: a review of effectiveness studies. Am J Community Psychol. (2008) 42:110–21. 10.1007/s10464-008-9181-0
    1. Duckworth K1, Halpern L. Peer support and peer-led family support for persons living with schizophrenia. Curr Opin Psychiatry (2014) 27:216–21. 10.1097/YCO.0000000000000051
    1. Chien WT, Thompson DR. A randomized controlled trial with 3-year follow-up of peer support groups for Chinese families of people with schizophrenia. Psychiatr Serv. (2013) 64:997–1005. 10.1176/appi.ps.201200243
    1. Chien WT, Chan WCS. The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: a randomised controlled trial with 24-month follow-up. Int J Nurs Stud. (2013) 50:1326–40. 10.1016/j.ijnurstu.2013.01.004
    1. Bae SW, Kung WWM. Family intervention for Asian Americans with a schizophrenic patient in the family. Am J Orthopsychiatry (2000) 70:532–41. 10.1037/h0087789
    1. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P, CONSORT NPT Group. CONSORT statement for randomized trials of non-pharmacologic treatments: a 2017 update and a CONSORT extension for non-pharmacologic trial abstracts. Ann Intern Med. (2017) 167:40–7. 10.7326/M17-0046
    1. National Health and Medical Research Council . Randomization. Sydney: NHMRC Clinical Trials Centre, University of Sydney; (2013). p. 1–2. Availble online at:
    1. Chien WT, Bressington D. A randomized controlled trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics. Psychiatry Res. (2015) 229:277–86. 10.1016/j.psychres.2015.07.012
    1. Han B, Enas NH, McEntegart D. Randomization by minimization for unbalanced treatment allocation. Stat Med. (2009) 28:3329–46. 10.1002/sim.3710
    1. Department of Mental Health and Substance Abuse World Health Organization Creating Peer Support Groups in Mental Health and Related Areas - WHO QualityRights Training to Act, Unite and Empower for Mental Health (pilot version), WHO/MSD/MHP/17.13. Licence: CC BY-NC-SA 3.0 IGO. Geneva: WHO; (2017).
    1. Chan AK, Tan S. Filial Piety in Chinese Thouht and History. London: Routledge; (2004).
    1. Lin J-P, Yi C-C. A comparative analysis of intergenerational relations in East Asia. Int Sociol. (2013) 28:297–315. 10.1177/0268580913485261
    1. Chien WT, Chan WCS, Thompson DR. Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. Br J Psychiatry (2006) 189:41–9. 10.1192/bjp.bp.105.008375
    1. Galinsky MJ, Schopler JH. (eds). Support Groups: Current Perspectives on Theory and Practice. London: Routledge; (2014). p. 142.
    1. Steinberg DM. The Mutual-Aid Approach to Working With Groups: Helping People Help Each Other, 2nd Edn. London: Routledge; (2004).
    1. McFarlane WR, Lukens E, Link B, Dushay R, Deakins SA, Newmark M, et al. . Multiple-family groups and psychoeducation in the treatment of schizophrenia. Arch Gen Psychiatry (1995) 52:679–87. 10.1001/archpsyc.1995.03950200069016
    1. Lehman AF, Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB, Goldberg R, et al. . The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. (2003) 30:193–216. 10.1093/oxfordjournals.schbul.a007071
    1. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci D, Ory M, et al. Enhancing treatment fidelity in health behaviour change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. (2004) 23:443–51. 10.1037/0278-6133.23.5.443
    1. Chien WT, Bressington D, Yip A, Karatzias T. An international multi-site, randomized controlled trial of a mindfulness-based psycho-education group program for people with schizophrenia. Psychol Med. (2017) 47:2081–96. 10.1017/S0033291717000526
    1. Bezchlibnyk-Butler KZ, Jeffries JJ, Procyshyn RM, Virani AS. Clinical Handbook of Psychotropic Drugs, 20th Edn. Boston: Hogrefe and Huber; (2013).
    1. Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Fam Ther. (1983) 9:171–80.
    1. Pai S, Kapur RL. Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family. Psychol Med. (1982) 12:651–8.
    1. Chien WT, Norman I. The validity and reliability of a Chinese version of the Family Burden Interview Schedule. Nurs Res. (2004) 53:314–22. 10.1097/00006199-200409000-00006
    1. Heller T, Factor A. Permanency planning for adults with mental retardation living with family caregivers. Am J Ment Retard. (1991) 96:163–76.
    1. Schneider LC, Struening EL. SLOF: a behavioral rating scale for assessing the mentally ill. Soc Work Res Abstr. (1983) 19:9–21.
    1. Bell M, Milstein R, Beam-Goulet J, Lysaker P, Cicchetti D. The positive and negative syndrome scale and brief psychiatric rating scale: reliability, comparability, and predictive validity. J Nerv Ment Dis. (1992) 180:723–8. 10.1097/00005053-199211000-00007
    1. Tabachnick BG, Fidell LS. Using Multivariate Statistics, 3rd Edn. Boston: Allyn and Bacon; (2001).
    1. Bademli K, Duman ZC. Effects of a family-to-family support program on the mental health and coping strategies of caregivers of adults with mental illness: a randomized controlled study. Arch Psychiatr Nurs. (2014) 28:392–8. 10.1016/j.apnu.2014.08.011
    1. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. (2006) 12:CD000088 10.1002/14651858.CD000088.pub2
    1. Hjärthag F, Persson K, Ingvarsdotter K, Östman M. Professional views of supporting relatives of mental health clients with severe mental illness. Int J Soc Psychiatry (2017) 63:63–9. 10.1177/0020764016682268
    1. Li Z, Arthur D. Family education for people with schizophrenia in Beijing, China. Br J Psychiatry (2005) 187:339–45. 10.1192/bjp.187.4.339
    1. Dyck DG, Hendryx MS, Short RA, Voss WD, McFarlane WR. Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatr Serv. (2002) 53:749–54. 10.1176/appi.ps.53.6.749
    1. Cook JA, Copeland ME, Corey L, Buffington E, Jonikas JA, Curtis LC, et al. . Developing the evidence base for peer-led services: changes among participants following Wellness Recovery Action Planning (WRAP) education in two statewide initiatives. Psychiatr Rehab J. (2010) 34:113–20. 10.2975/34.2.2010.113.120
    1. Girón M, Nova-Fernández F, Mañá-Alvarenga S, Nolasco A, Molina-Habas A, Fernández-Yañez A, et al. . How does family intervention improve the outcome of people with schizophrenia? Soc Psychiatry Psychiatr Epidemiol. (2015) 50:379–87. 10.1007/s00127-014-0942-9
    1. Chung AY. Saving Face: The Emotional Costs of the Asian Immigrant Family Myth. New Brunswick, NJ: Rutgers University Press; (2016). p. 256.
    1. Chien WT, Yeung FKK, Chan AHL. Perceived stigma of patients with severe mental illness in Hong Kong: relationships with patients' psychosocial conditions and attitudes of family caregivers and health professionals. Adm Policy Ment Health (2014) 41:237–51. 10.1007/s10488-012-0463-3

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere