Abstract
First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver outcomes. This study aimed to identify pre-treatment characteristics predicting and/or moderating carer outcomes, based on data from a multi-element psychosocial intervention to FEP patients and carers (GET-UP PIANO trial). Carer demography, type of family relationship, patient contact hours, pre-treatment carer burden, patient perceptions of parental caregiving and expressed emotion (EE) were selected, a priori, as potential predictors/moderators of carer burden and emotional distress at 9 months post treatment. Outcomes were analysed separately in mixed-effects random regression models. Analyses were performed on 260 carers. Only patient perceptions of early maternal criticism predicted reports of lower carer burden at follow-up. However, multiple imputation analysis failed to confirm this result. For treatment moderators: higher levels of carer burden at baseline yielded greater reductions in carer emotional distress at follow-up in the experimental group compared with treatment as usual (TAU). Higher levels of perceived EE moderated greater reductions in carer reports of tension in experimental group, compared with TAU, at follow-up. In younger caregivers (<51 years old), there were greater reductions in levels of worry during the baseline to follow-up period, within the experimental group compared with TAU. The study failed to identify significant treatment predictors of FEP carer outcomes. However, our preliminary findings suggest that optimal treatment outcomes for carers at first episode might be moderated by younger carer age, and carers reporting higher baseline levels of burden, and where patients perceive higher levels of negative effect from caregivers.
Highlights
Psychotic disorders affect several million people worldwide (Fleischhacker et al, 2014)
Though many families will take on caregiving responsibilities and in many cases will live with their relative with psychosis (Garety and Rigg, 2001; Cotton et al, 2013; Ran et al, 2016), a large proportion will report experiencing high levels of carer burden, social isolation and a poorer quality of life, as part of their role (Gupta et al, 2015; Poon et al, 2016; Sadath et al, 2017)
16 patients did not have an identified relative; six patients declined consent to contact their relative; seven relatives declined consent to engage in the family intervention (FI); and 13 patients refused to engage with the individual cognitive behavioural therapy (CBT), so the matched relative was excluded
Summary
Psychotic disorders affect several million people worldwide (Fleischhacker et al, 2014). Though many families will take on caregiving responsibilities and in many cases will live with their relative with psychosis (Garety and Rigg, 2001; Cotton et al, 2013; Ran et al, 2016), a large proportion will report experiencing high levels of carer burden, social isolation and a poorer quality of life, as part of their role (Gupta et al, 2015; Poon et al, 2016; Sadath et al, 2017). Psychosis can impact negatively on carer health and wellbeing, and lead to feelings of loss, burnout, worry, shame, self-stigma and psychological distress, which are already firmly established soon after first onset (Addington et al, 2003; Patterson et al, 2005; McCann et al, 2011; Boydell et al, 2014; Onwumere et al, 2017). 30– 40% of carers report clinical depression and other indicators of psychological distress and Downloaded from https://www.cambridge.org/core.
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