Psychoeducational Family Intervention Research Articles

Supporting patients by family education in psychotic illness: a longitudinal pre–post study protocol

IntroductionA lack of education, resources and support for family carers of young adults with psychotic illnesses leaves them ill-equipped to support their loved one. By equipping families with skills and...

Improvements in Treatment Adherence after Family Psychoeducation in Patients Affected by Psychosis: Preliminary Findings.

(1) Background: Family psychoeducation is a well-recognized intervention which aims to improve the outcomes of illness in patients affected by psychosis. It has benefits in treatment adherence and leads to a reduction in relapses, higher levels of patient insight, and lower levels of stress within the family and among caregivers. (2) Methods: Eight patients and their families were recruited and randomly assigned to a Falloon-based family psychoeducation (FPP) intervention, and nine patients and their families were randomized to a Gestalt-based family intervention (GT). We compared the outcomes of these two treatment groups at a baseline assessment (T0), at the end of the programs (T1), and 6 and 12 months after the end of the programs (T2 and T3). The assessments included examinations of cognition (The Mini-Mental State Examination (MMSE) and The Five Point Test (5 Point)), the psychopathology and severity of illness (The Brief Psychiatric Rating Scale (BPRS), The Positive and Negative Syndrome Scale (PANSS), and The Clinical Global Impression Scale (CGI)), expressed emotion in families (Expressed Emotionality (Family Questionnaire-EE)), patient quality of life (The World Health Organization Quality of Life-BREF (WHOQOL-B)), social functioning (The Personal Social Performance (SPS)), aggression (Modified Overt Aggression Scale (MOAS)), and treatment adherence (The Brief Medication Adherence Report Scale (BMARS)). The primary aim was to test whether the FFP vs. GT program was more effective in improving treatment adherence over time. (3) Results: treatment adherence improved much more in the FFP group over time at any follow-up: +43.1% at T1, +24.0% at T2, and +41.6% at T3. Other characteristics, including psychopathology and the clinical stability of the subject, did not change over time. (4) Discussion: Family psychoeducation based on the Falloon program was effective at improving treatment adherence and contributed to avoiding relapses in the long term. Further studies on larger samples should be conducted to confirm this evidence, and similar psychoeducational programs should be routinely promoted in the clinical setting.

The Efficacy of Psychoeducational Family Intervention for Major Depression: Study Protocol of a Randomized Controlled Trial.

This study aims to assess the efficacy of a psychoeducational family intervention (PFI) to reduce the severity of depressive symptoms and to improve psychosocial functioning and to increase social contacts in a sample of patients with major depressive disorder (MDD). The degree to which PFI will reduce patients' relapses, hospitalizations, and self-stigmatization and will improve their quality of life will also be assessed. Other secondary outcomes include the improvement of relatives' coping strategies, family burden, expressed emotions and quality of life. This non-profit, unfunded, national, multicentric randomized controlled trial with blinded outcome assessments will be carried out in 24 Italian university outpatient units. Families will be assessed at baseline and at 6, 12, and 24 months post-randomization. Our working hypothesis is that the PFIs will reduce the patients' severity of depressive symptoms, their relapses, and their hospitalizations, and that they will improve their psychosocial functioning and quality of life. We expect these results to be maintained after 12 and 24 months, albeit with a reduction in magnitude. The sample will consist of 384 patients randomized at a 1:1 ratio and stratified according to center, age, gender, and educational level.

Family psychoeducation to improve outcome in caregivers and patients with schizophrenia: a randomized clinical trial.

Schizophrenia is recognized for its severe impact on both patients and caregivers. In a 12-month follow-up randomized clinical trial, we aimed to measure the efficacy of a brief family psychoeducation program in terms of reducing relapse risk and improving medication adherence in patients, as well as reducing caregiver burden, depression and increasing knowledge of the illness. A total of 25 days of patients with schizophrenia (DSM-IV-TR) and family primary caregivers were recruited in a single regional psychiatric outpatient facility located in Bordeaux. In the active group, caregivers received a psychoeducational intervention consisting of six sessions spread over 1.5 months, while the control group was placed on a waiting list. Sociodemographic, symptom severity (PANSS) and medication adherence (MARS) from patients were assessed at baseline and relapse rates was recorded during the 12 months follow-up period. Caregivers' burden (ZBI), depression (CES-D), quality of life (S-CGQoL), knowledge of the disease (KAST) and therapeutic alliance (4PAS-C) were assessed at baseline, three and 6 months. On the 25 patients included, the mean age was 33.3 years (SD = 9.7) with a mean duration of disease of 7.48 years (SD = 7.1). On the 25 caregivers included, the mean age was 50.6 years (SD = 14.0). Twenty-one were female (84.0%), 12 were married (48.0%) and 11 lived alone (44.0%). For patients, the family psychoeducation intervention significantly reduced the risk of relapse with a significant effect found at 12 months follow-up (p = 0.014). No change was observed on medication adherence. For caregivers, the intervention reduced the burden (p = 0.031), decreased the depression (p = 0.019), and increased the knowledge on schizophrenia (p = 0.024). Analyzes for repeated measures showed a statistically significant difference in therapeutic alliance (p = 0.035). As confirmed by previous studies, the brief multifamily program (consisting of six sessions over a period of 1.5 months) was found to be effective in improving outcomes for caregivers (e.g., burden, depression, knowledge) and patients (e.g., preventing relapse) in the context of routine care. Given its short duration, this program is expected to be easily implementable within the community. https://clinicaltrials.gov/, NCT03000985.

Psikoedukasi Menurunkan Beban Keluarga yang Mengalami Stigma sebagai Klien Tuberkulosis dan Riwayat Putus Obat

This study aims to analyze the implementation of family psychoeducation in reducing the burden on families who experience stigma as tuberculosis clients and have a history of drug withdrawal. The research method used was a case report on one family with one caregiver who experienced the burden and anxiety of tuberculosis clients with a history of drug withdrawal. Interviews and observations used the Hamilton Rating Scale (HARS) instrument on caregivers and the Zarit Burden Interview (ZBI) instrument. The results showed that family psychoeducation with six sessions at four meetings could reduce anxiety and burden on caregivers with an initial HARS score of 29 to 16 (mild anxiety) and a ZBI score of 44 to 34 (light-moderate perceived burden). In conclusion, family psychoeducation affects client adherence to treatment; in family psychoeducational interventions, health workers coordinate with caregivers to reduce anxiety and increase caregiver knowledge about the client's illness. Family psychoeducation also plays a role in overcoming social and self-stigma in clients and families. 
 Keywords: Family Psychoeducation, Drug Dropout, Stigma, Pulmonary Tuberculosis

Psychoeducational family intervention for bipolar I disorder: medium and long-term efficacy

IntroductionBipolar disorder (BD) is associated to high personal and social burden, impaired social functioning and high levels of disability. Recent studies have showed that relapse rates are significantly reduced in those patients whose families receive psychoeducational interventions. Even though most of available evidences are related to the short-term efficacy of psychoeducational family interventions (PFI). No evidence is available on medium and long-term efficacy.ObjectivesThis study aims to assess the efficacy after one and five years of PFI in BD in terms of: 1) improvement of patients’ symptoms and global functioning; 2) improvement of relatives’ objective and subjective burden and coping strategies.MethodsA multicenter, controlled, outpatient trial has been conducted in BD patients and their key relatives, recruited in 11 Italian mental health centers. Patient’s clinical status, social and personal functioning, burden of illness, and relative’s burden and coping strategies were assessed with specific instruments at baseline, after 1 year and after 5 years.Results137 families were recruited, 70 allocated to the experimental intervention. After one year, an increasing positive effect on patients’ clinical status, global functioning and objective and subjective burden was found. Moreover, were observed a reduced number of relapses and of hospitalizations after five years, compared to the control group. A reduction in the levels of family burden and an improvement of their coping strategies were also observed.ConclusionsPositive effects of the experimental intervention persist over the mid and long-term period. PFI should be provided in mental health centres to patients with BD and their relatives.DisclosureNo significant relationships.

Calgary Family Intervention Model-Based Family Support and Psychoeducation Related Intervention Experiences of Family Members Caring for Patients with a Chronic Mental Illness: “We Are All in the Same Boat”

In the study, it was aimed to investigate the Calgary Family Intervention Model-based Family Support and Psychoeducation Intervention experiences of family members who cared for patients with a chronic mental illness. The sample of this study consisted of 15 caregivers of chronic psychiatric patients who participated in the Calgary Family Intervention Model-based family support and psychoeducation intervention and met the inclusion criteria. Data were collected through semi-structured questions and individual interviews. The interviews were recorded on a voice recorder. In the analysis of the data, content analysis was used. At the end of the study, the following four main themes were obtained: “we are all in the same boat,” “shared feelings and mutual learning,” “awareness and hope” and “suggestions.” The results obtained from the study indicate that cognitive and emotional support need of those who provide care for family members with a chronic mental illness is an important issue that should not be ignored. Creating environments where individuals with similar experiences can share their experiences and providing the support, they need are an important tool that reinforces their hope and awareness.

Telehealth-Based Psychoeducation for Caregivers: The Family Intervention in Recent-Onset Schizophrenia Treatment Study.

BackgroundSchizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes.ObjectiveThe Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The impact of study-provided psychoeducation on caregiver burden is also investigated.MethodsEligible patients and their designated caregivers were randomly assigned to either the study-provided psychoeducation (≤16 sessions of telehealth-based psychoeducation over 6 months) or UC group, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey.ResultsA total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number of sessions in the study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in patient outcomes (rates of TF: 70% vs 67%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with enrollment, and caregiver–treatment team coordination may have affected the outcomes of the FIRST study.ConclusionsKey insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment team.Trial RegistrationClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741

Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial

SummaryBackgroundContact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China.MethodsWe conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133.FindingsIn April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively).InterpretationThis first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory.FundingGeneral Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).

Medium and long-term efficacy of psychoeducational family intervention for bipolar I disorder: Results from a real-world, multicentric study.

This study aims to explore the long-term efficacy of a psychoeducational family intervention (PFI) in bipolar I disorder at one and five years post-intervention in terms of improvement of: (1) patients' symptoms and global functioning and (2) relatives' objective and subjective burden and coping strategies. This is a multicentre, real-world, controlled, outpatient trial. Recruited patients and key-relatives were consecutively allocated to the experimental intervention or treatment as usual. Patients were assessed at baseline, and after one and five years. One hundred and thirty-seventh number families have been recruited; 70have been allocated to the experimental intervention, and 67have been allocated to the control group. We observed an increasing positive effect of the PFI on patients' clinical status, global functioning and objective and subjective burden after one year. We also found a reduction in the levels of relatives' objective and subjective burden and a significant improvement in the levels of perceived professional support and of coping strategies. The efficacy of PFI on patients' clinical status was maintained at five years from the end of the intervention, in terms of relapses, hospitalizations and suicide attempts. The study showed that the provision of PFI in real-world settings is associated with a significant improvement of patients' and relatives' mental health and psychosocial functioning in the long term. We found that the clinical efficacy of the intervention, in terms of reduction of patients' relapses, hospitalization and suicide attempts, persists after 5years. It is advisable that PFI is provided to patients with BD I in routine practice.

CORRELATION OF KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING MANAGEMENT OF SCHIZOPHRENIA AMONG PRIMARYCAREGIVERS IN SELECTED PSYCHIATRIC HOSPITAL, CHENNAI

Schizophrenia is a constant dysfunctional behavior which makes the individual hard to separate the genuine and incredible, and the individual can't think legitimately to have mental enthusiastic reactions, and to act typically in friendly circumstances. Schizophrenia has changed symptoms that for the most part start in early adulthood and as a rule go on all through life. Most patients have a background marked by conduct brokenness basically friendly and learning hardships. Demonstrative elements of schizophrenia incorporate hearable fantasies (an encounter including the obvious view of something not present) and dream (the activity of misdirecting or the condition misled). Setting and Design: This is a pre-experimental study evaluating the effectiveness of family psycho educational intervention conducted in selected psychiatric hospitals at Chennai, Tamil Nadu

Cultural competence in multi-family psychoeducation groups: The experiences of Russian-speaking immigrant mothers of adults with severe mental illness.

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes-linguistic, cognitive, emotional, socio-cultural and relational-improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed.

Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019).

This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n=6), depression for families (n=13), and bipolar for families (n=5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.

Psychosocial Interventions for Adults With Schizophrenia: An Overview and Update of Systematic Reviews.

The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia. MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality. Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse. Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.

Effectiveness of family psychoeducation interventions regarding caregivers burden among primary caregivers of psychiatric clients admitted at selected tertiary care hospital, Coimbatore

Effectiveness of family psychoeducation interventions regarding caregivers burden among primary caregivers of psychiatric clients admitted at selected tertiary care hospital, Coimbatore

Development and efficacy of a psychoeducational family intervention for perinatal depression

Abstract BodyThe perinatal period represents an at-risk period for mental health consequences, which has been overlooked for long time. Perinatal mental health problems constitute a relevant threat for long-term mental health, not only for the direct impact on the affected women, but also for the considerable foetal/infant morbidity and mortality. Perinatal mental disorders are associated with negative outcomes in the newborn, including an increased risk of premature delivery and infant mortality, as well as a higher prevalence of mental disorders in the offspring (e.g., attention deficit or anxiety disorders). Depressive disorders represent the most common disorder during the perinatal period. For the adequate, appropriate and complete management of women with perinatal depression, there is the need for integrated interventions, following a comprehensive global assessment of women’s mental health. In particular, the management of depression during perinatal period requires special attention, even considering the problems and limitations in prescribing pharmacological drugs. In this context, psychoeducational interventions are effective in reducing affective symptoms and the levels of stress, with low costs for the mental health department.DisclosureNo significant relationships.

O9.7. TECHNOLOGY ASSISTED RELAPSE PREVENTION PROGRAM REDUCES HOSPITALIZATION IN SCHIZOPHRENIA PATIENTS AT HIGH RISK FOR RELAPSE

BackgroundPsychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. During the first six months after a hospitalization, patients are at increased risk for return to the hospital. Targeting treatment during this period may be especially valuable. Mobilizing a range of treatment enhancements using both smart phones and computers to support patients by individualizing treatment to specific needs may be especially beneficial. The Improving Care Reducing Cost (ICRC) program sought to determine whether a novel, multicomponent, and technology-enhanced approach to relapse prevention in outpatients following a psychiatric hospitalization could reduce days spent in a hospital after discharge.MethodsThe ICRC study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between February 2013 and April 2015 at 10 sites in the US that provide both in and outpatient. Data were obtained from 89 participants who received usual relapse prevention services, followed by a second cohort of 349 participants who received technology-enhanced relapse prevention program. Both groups were followed for 6 months. Patients were between 18 and 60 years old; had a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified; and were currently hospitalized or had been hospitalized within the past 30 days at consent. The first cohort received usual care; the second cohort received the Health Technology Program (HTP) a technology-enhanced relapse prevention program. HTP included medication treatment guided by a computer decision support system for the prescriber, a smartphone application for patients that supported medication adherence and other coping strategies, a web-based patient and family psycho-educational intervention, and web-accessed cognitive behavioral therapy for paranoia and hallucinations. A mental health technology coach provided technical support, and developed a personalized, structured, relapse prevention plan with each participant that identified individual relapse precipitants and determined which HTP components should be employed to address them. All patients received computers and Android smartphones to insure access to the interventions. Days spent in a psychiatric hospital during 6 months after discharge was assessed. The Heinrichs Carpenter Quality of Life Scale was completed at baseline and six months.ResultsThe study included 438 patients. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention, and followed by 349 participants (128 females) who received the HTP. Days of hospitalization were reduced by 4 days (Mean days: b = -4.25, 95% CI: -8.29; -0.21, P = 0.039) during follow-up in the intervention condition compared to control. Finally, using Heinrichs Carpenter Quality of Life total score at month 6 as an outcome, we found no significant effect of HTP (β = 0.02, t (345) = 0.43, P = 0.668).DiscussionRecently hospitalized patients with schizophrenia who received an integrated technology informed relapse prevention program (HTP) experienced fewer days in the hospital compared to those who received usual care in the six months following their discharge. Given the high patient burden and costs of even a single day spent in a psychiatric hospital, estimated at $1358 per day based on inflation adjusted results from a recent study, our findings imply total savings in psychiatric inpatient expenditures of $5772 during the first 6 months after discharge on average. However, reduction in hospitalization days did not result in a parallel improvement in functioning as assessed by the Quality of Life Scale.Although the control and experimental cohorts were comparable in many characteristics, the quasi–experimental design represented by sequential cohorts rather than a true concurrent randomized controlled trial represents a limitation. The results of the study suggest that technology enhanced treatments that are tailored to patient needs can be implemented in a range of clinical settings in the US to patients at high risk of hospitalization and that the intervention can reduce subsequent hospitalization days. Future research should address limitations in the current study design and will benefit from the development of technology applications that can be available on a single flexible platform.

Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting.

WHAT IS KNOWN ON THE SUBJECT?: Internalized stigma in people diagnosed with mental illness has several negative outcomes; however, it remains unclear in an Indonesian context. The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of the existing stigma against mental illness and deficiencies in the country's mental healthcare services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best of our knowledge, this is the first study to examine the level of internalized stigma and related factors among Indonesians diagnosed with schizophrenia. Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Specifically, younger and unemployed people with more psychotic symptoms had higher levels of internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of adequate pharmacological and psychosocial treatments to help people manage their psychotic symptoms is extremely important to ameliorate stigma. Vocational rehabilitation and employment support for unemployed people may potentially reduce their internalized stigma and promote recovery. ABSTRACT: Introduction The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of societal stigma associated with mental illness and deficiencies in the country's mental healthcare services. Knowledge about internalized stigma among people diagnosed with schizophrenia in lower middle-income Muslim countries is also scarce. Aim To identify the level of internalized stigma and related factors among people diagnosed with schizophrenia in Indonesia. Method A cross-sectional survey was conducted with a purposive sample of 300 people diagnosed with schizophrenia from an urban Indonesian psychiatric hospital. Results Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Younger age, unemployment status and having psychotic symptoms significantly increased the risk of internalized stigma when analysed in a multivariable ordinal logistic regression. Discussion The present study firstly identified the high levels of internalized stigma among Indonesian individuals diagnosed with schizophrenia. Implications for practice Mental health nurses are suggested to provide early anti-stigma illness management and family psychoeducation interventions to people diagnosed with schizophrenia and their family caregivers, helping them to develop an optimistic understanding about the concept of schizophrenia and mitigating the negative consequences of public and internalized stigma.

Impact of Family Psychoeducation Intervention on Relapse Prevention in Hospitalized Psychiatric Patients

Background: Family psychoeducation is considered as an intervention focused on individual rehabilitation of mental disorders through improving the caregiver’s awareness about their family member’s illness, risk factors, and treatment component and relapse prevention strategies. Objectives: The aim of this study was to determine the impact of family psychoeducation on patients’ relapse and length of stay in hospital. Methods: In this retrospective study, registered data in the health information management unit, including demographic data, acute symptoms and signs and medical history, was used and sample selection was done through a purposive sampling procedure. Participants consisted of 2192 patients with severe mental disorders admitted to Ibn Sina Psychiatric Hospital in Bandar Abbas, Iran since 2009 to 2014. The recipients of psychoeducation comprised all immediate family members of the patients in psychiatric hospital who were available at time of discharge. Subjects were receiving standard pharmacologic treatment and one session of individual family psychoeducation interventions. The psychoeducation was presented by a psychologist and a nurse upon patient discharge day from hospital between 2011 and 2014. The findings including recurrence rate and admission durations were compared with data collected during the three years leading to the intervention (2009 to 2011). Data was assessed through Paired-sample t-test. Results: The results revealed that receiving psychoeducation by family can positively affect the rate of readmission (t = 41.30, P &lt; 0.001) and the length of stay in hospital (t = 39.10, P &lt; 0.001). Conclusions: Since psychoeducation of caregivers can be significantly influential in reducing the recurrence rate and duration of hospitalization, it is advisable after discharge for patients suffering from chronic mental disorders.

The Optimalization of Family Coping n Caring for Mental Retardation Children through Family Psychoeducation in Jombang

Background:Children with Mental retardation have intellectual limitations which cause dependency. The limitation of mentally retarded children becomes a stressor for the family which can affect the family’s ability to provide care. So that adaptive coping is needed, so families can provide optimal care. Family psychoeducation is a way that can optimize family coping.&#x0D; Objective: This study aims to determine the effect of family psychoeducation on coping in treating children with mental retardation.&#x0D; Methods: The design of this study was quasi experimental pre-post test with control group of family psychoeducation intervention. The family population who had mental retardation children in Jombang was 277. While the sample was taken using a simple random sampling technique as many as 140 families with a distribution of 70 families as the control group and 70 families as the treatment group. The independent variable was family psychoeducation and the dependent variable was family coping in treating children with mental retardation. This study used the Wilcoxon statistical test in the treatmentgroup0.001whichfollowedbyaMannWhitneydifferencetestwhichshowed the results of ρ value (0.000)&lt;α (0.05).&#x0D; Result: The results showed that there was an effect of family psychoeducation on family coping in treating children with mental retardation. Family psychoeducation provided information through a psychological approach to the care of children.&#x0D; Conclusion/implication: Families are expected not only understand the care of children with mental retardation but also improve family coping mechanisms so that psychosocial problems in the family are resolved properly.