Consumer and Family Psychoeducation: Assessing the Evidence
Abstract
Objective
Methods
Results
Conclusions
Description of the service
About the AEB Series
Feature | Description |
---|---|
Service definition | Consumer psychoeducation is a direct service designed to help individuals with mental and substance use disorders manage their own recovery. The service supports development of personal strategies that lead to better understanding of mental and substance use disorders. Individuals then use the acquired information to create personal goals. A combination of motivational, educational, and cognitive-behavioral techniques helps consumers create their own definition of recovery, gain control over their lives, and move forward on their paths to recovery. Educational materials and interventions help consumers learn relapse prevention and recovery strategies, build social support, use medications effectively, cope with stress, and manage their symptoms. |
Service goal | Provide information to help the consumer invest in the treatment and make optimal decisions about his or her own care, thus reducing the likelihood of relapse or rehospitalization |
Populations | Adults with mental disorders, substance use disorders, or co-occurring mental and substance use disorders |
Settings for service delivery | Hospital inpatient and day treatment facilities, outpatient facilities, and consumer and family homes |
Feature | Description |
---|---|
Service definition | Family psychoeducation is a direct service that provides the relatives of adults and children who have (or are at risk of having) mental and substance use disorders with information about prevention, treatment, and recovery strategies for that disorder. The service aims to increase the family’s awareness about related risk factors, symptoms, treatment options, and other resources. The family is encouraged to guide the consumer in making good decisions about his or her own care, such as taking prescribed medications or maintaining engagement in needed services and supports. |
Service goal | Provide families or caregivers of consumers with information about the illness that can help families give appropriate supports for consumer recovery |
Populations | Adults with mental or substance use disorders or co-occurring mental and substance use disorders. Family psychoeducation is also conducted with families of children and adolescents (not reviewed here). |
Settings for service delivery | Hospital inpatient and day treatment facilities, outpatient facilities, consumer and family homes |
Consumer psychoeducation
Family psychoeducation
Methods
Search strategy
Inclusion and exclusion criteria
Strength of the evidence
Effectiveness of the service
Results and discussion
Level of evidence
Service type and study | Focus of review | Studies reviewedb | Outcomes measured | Summary of findings |
---|---|---|---|---|
Consumer | ||||
Fernandez et al., 2006 (5) | Educational interventions related to psychotropic medications for consumers with a mental disorder | 21 RCTs: 10 for patients with schizophrenia, 11 for patients with various mental disorders | Knowledge retention, medication and treatment adherence, relapse, insight into illness | Patients who received the educational intervention demonstrated increased knowledge, but no difference was found in adherence or incidence of relapse. Consumers provided with multiple education sessions had greater knowledge gains in the short term (up to 1 month); however, the effectiveness of multiple sessions in the long term (2 years) was inconclusive. |
Beynon et al., 2008 (19) | Psychosocial interventions for consumers with bipolar disorder | 3 RCTs for individuals with type I (manic episodes) or type II (depressive episodes with hypomania) bipolar disorder or with both types | Overall relapses, manic and depressive relapses, adverse events leading to discontinuation, other treatment-related adverse events, suicide or suicide attempts | Group psychoeducation was significantly associated with fewer relapses overall and with fewer manic and depressive relapses. Compared with usual care, individual psychoeducation was related to fewer manic episodes, but no group differences were found in prevention of overall relapses or depressive relapses. |
Xia et al., 2011 (22) | Psychoeducational interventions compared with standard modes of knowledge provision for people with schizophrenia | 44 studies, mostly of inpatients | Medication adherence, relapse, readmission, length of hospital stay, social and global functioning, satisfaction with treatment | Psychoeducation was related to lower incidence of nonadherence in the short, medium, and long terms; lower rates of relapse and readmission; better social and global functioning; greater clinical improvement; greater satisfaction with mental health services; and improved quality of life. |
Lolich et al., 2012 (18) | Psychosocial interventions for consumers with bipolar disorder | 8 RCTs of consumer and family psychoeducation, 11 RCTs of family therapy interventions | Clinical symptoms, hospitalization, medication adherence, time to relapse, duration of illness | Psychoeducation was associated with fewer euphoric, mixed, and depressive episodes; fewer days of hospitalization; fewer recurrences; more time to relapse; and better medication adherence. |
Family | ||||
Lehman and Steinwachs, 1998 (26) | Psychopharmacologic and psychosocial treatments for consumers with schizophrenia | Schizophrenia Patient Outcomes Research Team (PORT) review of family psychosocial interventions | Relapse | In combination with pharmacotherapy, family interventions that provided some combination of illness education, support, problem-solving training, or crisis intervention reduced 1-year relapse rates. |
Dixon et al., 2000 (1) | Family psychoeducation for consumers with schizophrenia | 16 RCTs or other rigorous evaluations | Relapse, clinical symptoms, functional status, mental status, treatment adherence, disruptive behavior, hospitalization, cost | Family psychoeducation was related to improvements in all outcomes. Optimal intervention length and effectiveness may depend on program goals, phase of illness, family and patient life cycle stages, and cultural background. Most interventions did not resemble usual practice, but several studies in clinical environments that were more representative of usual care had positive findings. |
Pitschel-Walz et al., 2001 (14) | Family interventions for consumers with schizophrenia | 25 intervention studies of “sufficient” quality | Relapse | Inclusion of relatives in treatment was related to reduced relapse rates. This effect was stronger when family interventions continued for longer than 3 months. |
McFarlane et al., 2003 (2) | Family psychoeducation for consumers with schizophrenia | >30 RCTs, including 11 studies of “relapse in major outcome trials of family psychoeducation” | Relapse, patient recovery, family well-being, participation in vocational rehabilitation, costs | Compared with standard care or medication alone, family psychoeducation was highly effective; it was reliably associated with decreased relapse and hospitalization rates. |
Murray-Swank and Dixon, 2004 (13) | Family psychoeducation for consumers with schizophrenia and with bipolar disorder | 30 RCTs | Relapse, clinical symptoms, hospitalization | Family psychoeducation was highly effective in reducing relapse rates among consumers with schizophrenia and schizoaffective disorder. Family psychoeducation was also effective in the treatment of bipolar disorder. |
Kreyenbuhl et al., 2010 (27) | Psychopharmacologic and psychosocial treatments for consumers with schizophrenia | Schizophrenia PORT review, number of studies not specified | Relapse, hospitalization, medication adherence, clinical symptoms, stress | Interventions for families of individuals with schizophrenia reliably reduced rates of relapse and rehospitalization and (less consistently) increased medication adherence, reduced psychiatric symptoms, and reduced levels of perceived stress for patients. Key elements of effective family interventions included illness education, crisis intervention, emotional support, and training in how to cope with illness symptoms and related problems. |
Justo et al., 2007 (25) | Family psychosocial interventions for consumers with bipolar disorder | 7 RCTs | Clinical symptoms, relapse | Meta-analyses could not be conducted because of inconsistency in interventions and outcomes across studies. For studies examining family interventions, there were inconsistent effects or no added effects with the family intervention. |
Lincoln et al., 2007 (24) | Psychoeducation for consumers with schizophrenia and other psychotic disorders | 18 RCTs | Relapse, clinical symptoms, knowledge, medication adherence, functioning | Psychoeducation was reliably associated with reduced relapse and increased knowledge, but it was not related to symptoms, functioning, or medication adherence. Compared with psychoeducation for consumers alone, interventions that included families were more effective in reducing symptoms by the end of treatment and in preventing relapse at follow-up. |
Consumer and family | ||||
Zaretsky, 2003 (3) | Psychosocial interventions for consumers with bipolar disorder | General review, number of RCTs not specified | Relapse, medication adherence, clinical symptoms, hospitalization, social and vocational functioning | Consumer psychoeducation was related to better medication adherence, fewer hospitalizations, delayed time to mania, and improved social and vocational functioning. Family educational interventions were related to lower relapse rates and increased time to relapse and to decreased depressive symptoms. |
Miklowitz, 2006 (28) | Psychosocial interventions for consumers with bipolar disorder | Not specified | Relapse, clinical symptoms, hospitalization, medication adherence, social functioning | Family involvement in treatment provided benefits over a similarly intensive individual therapy (for example, fewer hospitalizations and relapses and better medication adherence). Consumer psychoeducation (individual and group) was effective in lessening symptoms of mania (but not of depression) and in reducing relapses. |
Miklowitz and Scott, 2009 (7) | Adjunctive psychotherapy for consumers with bipolar disorder | 19 RCTs of individual family and group therapies | Relapse, time to recovery, symptom severity, medication adherence, psychosocial functioning, hospitalization | Consumer psychoeducation was related to fewer relapses, greater medication adherence, improved symptoms and functioning, less time in the hospital, higher levels of social and work functioning, greater likelihood of attending outpatient appointments, and lower likelihood of emergency consultation (group psychoeducation). There was no effect on depressive relapse. |
Välimäki et al., 2012 (29) | Psychoeducational interventions using information and communication technology for consumers with schizophrenia or related psychosis | 6 studies | Patient treatment adherence, global state, mental state, level of knowledge and insight, behavior, quality of life, satisfaction with treatment, health and social needs, service utilization, health economic outcomes, death | Psychoeducation using information and communication technology as a supplement to standard care did not improve general mental state, negative or positive symptoms, global state, level of knowledge, or quality of life. However, findings regarding level of knowledge and satisfaction with treatment were inconsistent. The authors concluded that this approach has potential. |
Addington et al., 2013 (23) | Evidence-based components of services for consumers with a first episode of psychosis | 280 peer-reviewed articles; number of studies of consumer and family psychoeducation not specified | Not identified | Using the Delphi technique, reviewers rated the evidence for the effectiveness of multifamily group psychoeducation as strong and evidence for individual consumer psychoeducation as moderate. |
Service type and study | Population | Intervention | Comparison group | Outcomes measured | Summary of findings |
---|---|---|---|---|---|
Consumer | |||||
Chien et al., 2012 (21) | Individuals in outpatient treatment for first-onset mental illness (N=79) | Usual care plus 6-session, nurse-led psychoeducation program (N=39) | Usual care (N=40) | Mental state, insights into illness and treatment, self-efficacy in managing difficult life situations, overall health | Compared with the control group, 2 weeks after intervention the psychoeducation group had greater improvements in mental and overall health status, perceived self-efficacy, insights into their treatment and illness, and hospitalization duration. |
Rabovsky et al., 2012 (20) | Individuals in inpatient treatment, mixed diagnosis (N=82) | Psychoeducation for a group with mixed diagnoses (N=43) | Nonspecific intervention control (N=44) | Readmission, treatment adherence, clinical variables (e.g., global functioning) | Psychoeducation was associated with better treatment adherence after 3 months and a lower suicide rate. For most other outcomes, there were no differences between psychoeducation and control groups. |
Family | |||||
Shimazu et al., 2011 (30) | Consumers with major depression and their primary family members (N=57) | Usual care for patients plus family psychoeducation without patients (N=25) | Usual care (N=32) | Depressive symptoms, levels of expressed emotion of family members | Patients who received psychoeducation had significantly longer times to relapse and lower rates of relapse at 9-month follow-up than those in the control group. |
Kopelowicz et al., 2012 (31) | Mexican-American adults with schizophrenia spectrum disorder and their key relatives (N=174) | Adapted (N=64) or standard (N=53) multifamily group therapy | Usual care (N=57) | Medication adherence, hospitalization | A multifamily group intervention adapted specifically to improve medication adherence for a specific group of consumers was more effective (resulted in higher adherence) than standard multifamily group therapy or usual care. |
Consumer psychoeducation.
Family psychoeducation.
Effectiveness of the service
Consumer psychoeducation.
Family psychoeducation.
Duration of treatment.
Special populations.
Conclusions
Evidence for the effectiveness of consumer psychoeducation for adults: high
Evidence for the effectiveness of family psychoeducation for adults: high
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