The effectiveness and active ingredients of mutual support groups for family caregivers of people with psychotic disorders: A literature review

Abstract

Objectives: To explore the literature through a systematic search to assess the effectiveness of mutual support groups for family caregivers of people with schizophrenia and other psychotic disorders.Methods: This review of the research literature was based on the procedures suggested by the National Health Service Centre for Reviews and Dissemination (2001) Report Number 4 in the UK. A combined free-text and thesaurus approach was used to search relevant research studies within electronic databases, including Medline, Embase, CINAHL, OVID full-text, PsycINFO, the Cochrane Library, the British Nursing Index, the NHS National Research register, and System for Info on Grey literature for the period 1980-2007. Reference lists of all retrieved literature were also searched to identify studies that may have been missed. Twenty-five research studies were selected for inclusion in the analysis on the basis that they were either family-led or professional-facilitated support group programmes for family caregivers of people with schizophrenia or other psychotic disorders.Results: The review identified that most studies on this group programme used qualitative, exploratory cross-sectional surveys and quasi-experimental study designs (n= 19); six were experimental studies or randomised controlled trials. There were only a few small-scale, singlecentre controlled trials with the findings supporting the significant positive effects of mutual support groups on families' and patients' psychosocial well-being. A number of nonexperimental studies conducted in Western countries reported benefits of group participation up to one year, such as increased knowledge about the illness, reduced burden and distress, and enhanced coping ability and social support. However, many of these studies lacked rigorous control and did not use standardised and valid instruments as outcome measures or schedule follow-up to examine the long-term effects of support groups on families and/or patients. This is the Pre-Published Version.2 Conclusions: With increasing recognition of benefits from mutual support, this review highlights the dearth of evidence for the effects and active ingredients of mutual support groups.Mutual support may have significant impacts on long-term psychosocial and nursing interventions for both patients with severe mental illness and their families in community mental health care. Further research is recommended to investigate the therapeutic components and effects of mutual support groups for family caregivers of people with schizophrenia and psychotic disorders across cultures.

The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: A randomised controlled trial with 24-month follow-up

“…In spite of an increasing number of descriptive and prospective studies endorsing the use of mutual support groups for people with schizophrenia and other mental health problems such as substance abuse and eating disorders, as well as for their families, few controlled trials have been undertaken on the effectiveness of this intervention in community mental health services Chan, 2004, Chien andNorman, 2009). The findings of this trial lend support for the forming of 9-month family-led mutual support groups for schizophrenia patients, as they demonstrate that re-hospitalisations of patients are reduced and their psychosocial functioning improved.…”

“…Moreover, there is increasing research evidence (e.g., Dixon et al, 2001, Lehman et al, 2004 indicating that the common therapeutic components in the approaches to family intervention, including the sharing of information, psychological support, and practical assistance between peer participants, are associated with greater improvements in the ability of family members to cope with the stress and demands of taking care of a relative with schizophrenia and other severe mental illnesses (Chien and Norman, 2009). Therefore, there is a need to investigate whether any alternative models of family intervention can be effective in improving the psychosocial functioning and well-being of both families and patients.…”

“…The literature reviews by Asen (2002) and Chien and Norman (2009) on family intervention in schizophrenia suggest that mental health professionals may be hesitant to implement such a highly structured and intensive form of family therapy due to inadequate resources and a lack of trained therapists. In addition, traditional models of family intervention may not be readily accepted by Chinese families because of their reluctance to openly disclose their thoughts and feelings in the presence of the therapist or other people perceived to be unfamiliar with their family situations and needs.…”

“…As with many Asian families, however, they may be more willing to accept other family caregivers who are "all in the same boat", and to discuss their problems openly with them, sharing effective strategies and social learning about patient care among group members (Chien et al, 2008, Wiedemann, 2003 One of a few clinical trials of mutual support groups for Chinese family caregivers of people with schizophrenia has indicated that these familyled mutual support groups could provide significantly greater improvements in family burden and functioning and in reducing the relapse rates of patients at the one-year follow-up, when compared with routine psychiatric care (Chien et al, 2008). Otherwise, most mutual support group intervention studies employ a cross-sectional survey and a qualitative exploratory or quasi-experimental single-group design, to explore or evaluate the perceived benefits to group participants in terms of individual and family psychological and social well-being (Chien & Norman, 2009 (Bae and Kung, 2000). With positive effects found in Caucasian populations, it is important to design and test a client-directed approach to family intervention for Chinese families of people with mental illness.…”

Updated meta-review of evidence on support for carers

“…The most commonly featured carers in reviews were those looking after people with dementia, [48][49][50][51][52][53][54][55][56][57] followed by those caring for people with cancer. [58][59][60][61][62][63] Reviews also featured carers of people with stroke, 64,65 carers of people with mental health problems 66,67 and carers of people with various conditions. [68][69][70][71][72] In reviews that included primary studies of carers of people with different conditions, carers of patients at the end of life were represented, 69,71,72 as were carers of people with conditions including cancer, stroke, dementia and cardiovascular disease.…”