Psychoeducation should be routinely offered to family members of schizophrenia patients as early as possible following diagnosis, findings from a mixed-method systematic review indicate.
The results, based on quantitative and qualitative research from 44 studies across the world carried out over the past 3 decades, showed that early provision of psychoeducation to family members increased their knowledge of schizophrenia and gave them the skills to better cope with caring.
Even family members of individuals with first-episode psychosis, who would have been recruited in the early stages of their involvement with healthcare services, would have liked psychoeducation provided earlier than it was.
Family members were more likely to be satisfied with psychoeducation if it was provided in a group format that allowed the sharing of common experiences and peer support and by skilful mental health professionals, who engaged well with family carers.
But, researchers Jacqueline Sin and Ian Norman, from King's College London in the UK, note that psychoeducation was less effective for more entrenched issues such as family members' psychologic morbidities, burden, or expressed emotion.
There were common themes across the studies regarding the implementation of effective psychoeducation interventions, including running sessions outside of office hours for family members who work and repeating sessions two or more times to enhance flexible scheduling. Incorporating ethnic-cultural considerations into the program content was also recognized as important to family member satisfaction.
The researchers comment in the Journal of Clinical Psychiatry that the duration of psychoeducational programs varied across the studies, ranging from 6 to 42 hours across 4 to 52 weeks. It was therefore difficult to identify an optimal interval duration, although the contact time of successful interventions was estimated to be 16 to 18 hours over 8 to 24 weeks.
Booster sessions may also be beneficial, but their use was underexplored in the studies reviewed, as was the use of between-session practice of skills through reading, quiz, and homework tasks.
Most of the studies reviewed were conducted face-to-face, but the researchers acknowledge the increasing use of online delivery formats.
"Given ever-increasing demands on integrating evolving technologies to enhance accessibility and flexibility of evidence-based interventions, further development to optimize online design and delivery of psychoeducational interventions for people with schizophrenia and their families would appear to be a worthwhile endeavor," they write.
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