A Randomised Controlled Trial of a Caregiver-Facilitated Problem-Solving Based Self-Learning Program for Family Carers of People with Early Psychosis.

Wai Tong Chien,Dan I Lubman,Daniel Bressington,Thanos Karatzias

doi:10.3390/ijerph17249343

Abstract

Facilitated self-help and problem-solving strategies can empower and support family carers to cope with caregiving for people with severe mental illnesses. This single-blind multi-site randomised controlled trial examined the effects of a five-month family-facilitated problem-solving based self-learning program (PBSP in addition to usual care), versus a family psychoeducation group program and usual psychiatric care only in recent-onset psychosis, with a six-month follow-up. In each of three study sites (integrated community centres for mental wellness), 114 people with early psychosis (≤5 years illness onset) and their family carers were randomly selected and allocated to one of three study groups (n = 38). Caregiving burden (primary outcome) and patients’ and carers’ health conditions were assessed at recruitment, and one-month and six-months post-intervention. Overall, 106 (94.7%) participants completed the assigned intervention and ≥1 post-test. Generalised estimating equations and subsequent contrast tests indicated that the PBSP participants showed significantly greater improvements in carers’ burden, caregiving experiences and problem-solving ability, and patients’ psychotic symptoms, recovery, and duration of re-hospitalisations over the six-month follow-up, compared with the other two groups (moderate to large effect size, η2 = 0.12–0.24). Family-assisted problem-solving based self-learning programs were found to be effective to improve both psychotic patients’ and their carers’ psychosocial health over a medium term, thus reducing patients’ risk of relapse.

Highlights

Psychosis is a major disabling and disruptive mental illness, accounting for over 30% of psychiatric patient populations in Hong Kong and globally [1,2], and often having a high risk of relapse in the first five years of illness [3]
The family psychoeducation group program (FPGP)’s four key components/stages of psychoeducation included: (a) program overview and goal setting for psychosis care; (b) education and information sharing about psychosis and coping, and survival skills in caregiving (4 sessions); (c) stress management, resilience, and life skills training (4 sessions); and (d) review of learning and related challenges and future plans
Chinese self-learning manual utilised in the PBSP, together with the facilitation of a trained family carer, can be effective to assist these carers to learn/practice family caregiving for patients with early-stage psychosis in community care

Summary

Introduction

Psychosis is a major disabling and disruptive mental illness, accounting for over 30% of psychiatric patient populations in Hong Kong and globally [1,2], and often having a high risk of relapse in the first five years of illness [3]. Review of self-care and coping skills learned and practiced in family situations. The carers received education workshops, caregiving skills training, and psychological support by one advanced practice psychiatric nurse, who had >5 years of experience in psychosis care and rehabilitation. The psychiatric nurse attended a two-day training workshop (delivered by the researchers) on the essentials of family care for early-stage psychosis, facilitated sharing and discussion in the groups, and supervised practices for group sessions. The FPGP’s four key components/stages of psychoeducation included: (a) program overview and goal setting for psychosis care (two sessions); (b) education and information sharing about psychosis and coping, and survival skills in caregiving (4 sessions); (c) stress management, resilience, and life skills training (4 sessions); and (d) review of learning and related challenges and future plans (two sessions)

Methods

Results

Discussion

Conclusion