Family intervention for schizophrenia
Open accessAbstract
BACKGROUND: People with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families are now widely used. OBJECTIVES: To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared to standard care. SEARCH STRATEGY: We updated previous searches by searching The Cochrane Schizophrenia Group's Register (November 2002 and June 2005), searched references of all new included studies for further trial citations, and contacted authors of trials. SELECTION CRITERIA: We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care. DATA COLLECTION AND ANALYSIS: We independently extracted data and calculated fixed effects relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). MAIN RESULTS: This 2005-6 update adds data of 15 additional trials (1765 participants, 43% of the total 4124). Family intervention may decrease the frequency of relapse (n=857, 16 RCTs, RR 0.71 CI 0.6 to 0.8, NNT 8 CI 6 to 11), although some small but negative studies may not have been identified by the search. Family intervention may also reduce hospital admission (8 RCTs, n=481, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13)--and this finding is a change to the previous equivocal data reported in 2002. Family intervention may also encourage compliance with medication (n=369, 7 RCTs, RR 0.74 CI 0.6 to 0.9, NNT 7 CI 4 to 19) but does not obviously affect the tendency of individuals/families to drop out of care (n=481, 6 RCTs, RR 0.86 CI 0.5 to 1.4). It may improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide. AUTHORS' CONCLUSIONS: Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are applicable to routine care.
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Family work in psychosis improves relationships through problem-solving and reduces service-user relapse.
“Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse.”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [55]
Most improvement from family intervention has been in reducing service-user relapses.
“However, most improvement has been in reducing service user relapses.54,55”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [55]
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Cites
1 retracted
Assertive community treatment for people with severe mental disorders
Marshall, M., & Lockwood, A. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001089 · Cited by 589 · see citing works
RetractedMeasuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
Assessing the quality of reports of randomized clinical trials: Is blinding necessary?
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996) · Controlled Clinical Trials · doi:10.1016/0197-2456(95)00134-4 · Cited by 17,582 · see citing works
Assessing the quality of controlled clinical trials
Jüni, P., Altman, D. G., & Egger, M. (2001) · BMJ · doi:10.1136/bmj.323.7303.42 · Cited by 3,309 · see citing works
Improving the Quality of Reporting of Randomized Controlled Trials: The CONSORT Statement
Begg, C. (1996) · JAMA · doi:10.1001/jama.1996.03540080059030 · Cited by 3,127 · see citing works
The SCL-90 and the MMPI: A Step in the Validation of a New Self-Report Scale
Derogatis, L. R., Rickels, K., & Rock, A. F. (1976) · British Journal of Psychiatry · doi:10.1192/bjp.128.3.280 · Cited by 2,298 · see citing works
Influence of Family Life on the Course of Schizophrenic Disorders: A Replication
Brown, G. W., Birley, J. L. T., & Wing, J. K. (1972) · British Journal of Psychiatry · doi:10.1192/bjp.121.3.241 · Cited by 1,770 · see citing works
Statistics Notes: Detecting skewness from summary information: Table 1
Altman, D. G., & Bland, J. M. (1996) · BMJ · doi:10.1136/bmj.313.7066.1200 · Cited by 1,278 · see citing works
Marshall, M., Lockwood, A., Bradley, C., Adams, C., Joy, C., & Fenton, M. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.176.3.249 · Cited by 870 · see citing works
The unit of analysis error in studies about physicians' patient care behavior
Divine, G. W., Brown, J. T., & Frazier, L. M. (1992) · Journal of General Internal Medicine · doi:10.1007/bf02599201 · Cited by 749 · see citing works
Issues in the meta-analysis of cluster randomized trials
Donner, A., & Klar, N. (2002) · Statistics in Medicine · doi:10.1002/sim.1301 · Cited by 734 · see citing works
The Burden on the Family of a Psychiatric Patient: Development of an Interview Schedule
Pai, S., & Kapur, R. L. (1981) · British Journal of Psychiatry · doi:10.1192/bjp.138.4.332 · Cited by 407 · see citing works
A Controlled Evaluation of Psychoeducational Family Intervention in a Rural Chinese Community
Xiang, M., Ran, M., & Li, S. (1994) · British Journal of Psychiatry · doi:10.1192/bjp.165.4.544 · Cited by 102 · see citing works
Szmukler, G., Kuipers, E., Joyce, J., Harris, T., Leese, M., Maphosa, W., & Staples, E. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0652-1 · Cited by 88 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Realist review - a new method of systematic review designed for complex policy interventions
Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005) · Journal of Health Services Research & Policy · doi:10.1258/1355819054308530 · Cited by 3,190 · see citing works
Suicide prevention strategies revisited: 10-year systematic review
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30030-x · Cited by 1,765 · see citing works
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry, P., Nielssen, O., & Tran, N. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416641195 · Cited by 877 · see citing works
Early intervention in psychosis: concepts, evidence and future directions
MCGORRY, P. D., KILLACKEY, E., & YUNG, A. (2008) · World Psychiatry · doi:10.1002/j.2051-5545.2008.tb00182.x · Cited by 581 · see citing works
Early intervention for psychosis
Marshall, M., & Rathbone, J. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004718.pub3 · Cited by 531 · see citing works
Self-citationInsel, T. R. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2008.540 · Cited by 459 · see citing works
What contributions do languages other than English make on the results of meta-analyses?
Moher, D., Pham, Klassen, T. P., Schulz, K. F., Berlin, J. A., Jadad, A. R., & Liberati, A. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00188-8 · Cited by 453 · see citing works
Dubreucq, J., Plasse, J., & Franck, N. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa181 · Cited by 358 · see citing works
Psychological interventions for psychosis: A meta-analysis of comparative outcome studies
Turner, D. T., van der Gaag, M., Karyotaki, E., & Cuijpers, P. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13081159 · Cited by 350 · see citing works
Yesufu-Udechuku, A., Harrison, B., Mayo-Wilson, E., Young, N., Woodhams, P., Shiers, D., Kuipers, E., & Kendall, T. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.147561 · Cited by 294 · see citing works
Garety, P. A., Fowler, D. G., Freeman, D., Bebbington, P., Dunn, G., & Kuipers, E. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.043570 · Cited by 296 · see citing works
Ryan, R. E., Santesso, N., Lowe, D., Hill, S., Grimshaw, J. M., Prictor, M., Kaufman, C., Cowie, G., & Taylor, M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007768.pub3 · Cited by 273 · see citing works
Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review
Olivares, J. M., Sermon, J., Hemels, M., & Schreiner, A. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-32 · Cited by 270 · see citing works
Cognitive model of caregiving in psychosis
Kuipers, E., Onwumere, J., & Bebbington, P. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.070466 · Cited by 225 · see citing works
Schizophrenia--Time to Commit to Policy Change
Fleischhacker, W. W., Arango, C., Arteel, P., Barnes, T. R. E., Carpenter, W., Duckworth, K., Galderisi, S., Halpern, L., Knapp, M., Marder, S. R., et al. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbu006 · Cited by 214 · see citing works
Michie, S., Pilling, S., Garety, P., Whitty, P., Eccles, M. P., Johnston, M., & Simmons, J. (2007) · Implementation Science · doi:10.1186/1748-5908-2-8 · Cited by 161 · see citing works
Aripiprazole versus other atypical antipsychotics for schizophrenia
Khanna, P., Suo, T., Komossa, K., Ma, H., Rummel-Kluge, C., El-Sayeh, H. G., Leucht, S., & Xia, J. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006569.pub5 · Cited by 151 · see citing works
Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis
Oud, M., Mayo-Wilson, E., Braidwood, R., Schulte, P., Jones, S. H., Morriss, R., Kupka, R., Cuijpers, P., & Kendall, T. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.157123 · Cited by 144 · see citing works
Shiraishi, N., & Reilly, J. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1617-8 · Cited by 142 · see citing works
Sin, J., & Norman, I. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12r08308 · Cited by 111 · see citing works
Why involve families in acute mental healthcare? A collaborative conceptual review
Dirik, A., Sandhu, S., Giacco, D., Barrett, K., Bennison, G., Collinson, S., & Priebe, S. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017680 · Cited by 95 · see citing works
Couple and family involvement in adult mental health treatment: a systematic review
Meis, L. A., Griffin, J. M., Greer, N., Jensen, A. C., MacDonald, R., Carlyle, M., Rutks, I., & Wilt, T. J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.12.003 · Cited by 92 · see citing works
The role of family therapy in the management of schizophrenia: challenges and solutions
Rus-Calafell, M., Caqueo-Urízar, A., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s51331 · Cited by 89 · see citing works
“Only a few studies have reported that family interventions improve experience of care and the commitment to the caregiving role.(25,57) Although all these studies on family intervention have shown a series of outcome measures, both intervention programs and studies’ goals usually focus mainly on patients rather than c…”
Packages of Care for Schizophrenia in Low- and Middle-Income Countries
Mari, J. D. J., Razzouk, D., Thara, R., Eaton, J., & Thornicroft, G. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000165 · Cited by 91 · see citing works
Self-citationInternet-Based Interventions for Psychosis
Álvarez-Jiménez, M., Gleeson, J. F., Bendall, S., Lederman, R., Wadley, G., Killackey, E., & McGorry, P. D. (2012) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2012.06.011 · Cited by 67 · see citing works
Sin, J., Henderson, C., Woodham, L. A., Sesé Hernández, A., & Gillard, S. (2019) · Journal of Medical Internet Research · doi:10.2196/14374 · Cited by 52 · see citing works
Family psychoeducation for people living with schizophrenia and their families
Harvey, C. (2018) · BJPsych Advances · doi:10.1192/bja.2017.4 · Cited by 52 · see citing works
Taylor, M., & Jauhar, S. (2019) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125319870033 · Cited by 51 · see citing works
Shimodera, S., Furukawa, T. A., Mino, Y., Shimazu, K., Nishida, A., & Inoue, S. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-40 · Cited by 43 · see citing works
Al-Sawafi, A., Lovell, K., Renwick, L., & Husain, N. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02816-5 · Cited by 42 · see citing works
Honary, M., Fisher, N. R., McNaney, R., & Lobban, F. (2018) · JMIR Mental Health · doi:10.2196/11473 · Cited by 28 · see citing works
Delivering cognitive-behavioural family interventions for schizophrenia
Onwumere, J., Grice, S., & Kuipers, E. (2016) · Australian Psychologist · doi:10.1111/ap.12179 · Cited by 33 · see citing works
Chan, S. K. W., Tse, S., Sin, H. L. T., Hui, C. L. M., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.02006 · Cited by 32 · see citing works
Family therapy for persons with schizophrenia: neglected yet important
Hahlweg, K., & Baucom, D. H. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01393-w · Cited by 27 · see citing works
Carers' attributions about positive events in psychosis relate to expressed emotion
Grice, S. J., Kuipers, E., Bebbington, P., Dunn, G., Fowler, D., Freeman, D., & Garety, P. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.06.004 · Cited by 14 · see citing works
- Authors
- Pharoah, F., Mari, J., Rathbone, J., & Wong, W.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- Universidade Federal de São Paulo (BR)
- University of Sheffield (GB)
- Huddersfield Royal Infirmary (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2006-10-18
- Issue
- 12
- Pages
- CD000088-CD000088
- ISSN
- 1361-6137 (ISSN-L)
- PMC
- PMC4204509
- OpenAlex
- W1801862032
- Cited by
- 737
- References
- 15
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 18 · 2023: 21 · 2022: 30 · 2021: 50 · 2020: 31 · 2019: 29 · 2018: 30 · 2017: 30 · 2016: 45 · 2015: 42 · 2014: 55 · 2013: 46 · 2012: 52
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2010-12-08)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- family intervention, schizophrenia, expressed emotion, relapse prevention, hospitalization, medication adherence, social dysfunction, community-based care, schizoaffective disorder, family involvement in treatment, treatment discontinuation, family involvement in care planning, family involvement in decision-making
- MeSH terms
- Family Relations, Family Therapy, Humans, Schizophrenia, Social Support, Randomized Controlled Trials as Topic, Expressed Emotion, Secondary Prevention
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