Psychosocial family interventions for relatives of people living with psychotic disorders in the Arab world: systematic review

Abstract

Background: Family interventions in schizophrenia are evidence based and have been adapted to different cultural settings to improve their effectiveness and acceptability. The Arab world has a unique set of socio-cultural norms and values that cannot be ignored when developing or implementing such interventions. There is a lack of research on the feasibility of delivering family interventions for schizophrenia in the Arab region. The aim of this review is to synthesise the available evidence about culturally-adapted psychosocial family interventions in the Arab world. The review identifies the content and characteristics of these interventions, determines the strategies used to adapt them to Arab culture successfully, assesses the feasibility and acceptability of the interventions, and evaluates the effectiveness of these interventions for service users and their families. Method: Five electronic databases were searched including MEDLINE, CINAHL, Cochrane Library, PsycINFO and EMBASE for articles written in Arabic and English from inception to August 2019. Data were extracted and synthesised narratively. Results: Six studies were retrieved from the search: three randomised control studies, two non-randomised studies and one qualitative study. There is limited evidence about culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. The methodological quality of the included studies was generally poor, so there is a risk of underestimating the effect size of the interventions due to lack of rigour and the presence of bias. Conclusion: The present review provides the foundation for future work regarding family interventions in the Arab world, and confirms the feasibility of implementing such interventions with some modifications. Furthermore, the data suggests that any family-oriented intervention for schizophrenia is likely to be better than standard care in improving the outcome for patients and their families.

Exploring views of relatives and mental health professionals to inform the cultural adaptation of a family intervention for schizophrenia in Oman: A qualitative study

“…Families living with individuals diagnosed with schizophrenia in Oman emphasised the role of religious and spiritual causes, which also confirms our previous findings in the systematic review (Al-Sawafi et al, 2020). Nearly all nurses and psychiatrists highlighted the importance of incorporating spiritual and cultural beliefs because these influence caregivers’ understanding of illness causes, health-seeking behaviours and attitude towards treatment.…”

The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data

“…In some Middle Eastern communities, caregivers thought that mental illness manifested due to lack of faith or disconnection from religion [ 19 ]. Other communities within the Middle East thought mental illness was attributed to supernatural forces and treatment required spiritual healers [ 44 ]. According to Al-Darmaki, Thomas, & Yaaqeib (2016), it is common in most Middle Eastern cultures to believe in supernatural causes of mental disorder such as “jinn (demons) and seher (magic) or evil eye or that it is caused by Allah as a test of faith or punishment for sins” (p. 237) [ 45 ].…”

Exploring the experience of relatives living with individuals diagnosed with schizophrenia in Oman: A qualitative study

“…Family interventions have been found effective in treating individuals diagnosed with schizophrenia and reducing families' burden ([NICE]., 2014;Pharoah et al, 2010). However, the evidence to support their effectiveness in the Arab world is still emerging (Al-Sawafi et al, 2020). Family interventions were developed in the west, and cultural adaptation is recommended for application in non-western cultures (Degnan et al, 2018;Hall et al, 2016;Maura & Weisman de Mamani, 2017).…”

“…Research on mental illness from GCC countries suggests that socio-cultural factors influence people's experience of mental illness in the region (Hickey et al, 2016). The Arab world has distinct sociocultural beliefs that shape the perceptions and management of mental illness (Al-Sawafi et al, 2020;Fakhr El-Islam, 2008). For example, Al-Alawi et al, (2017) found that social stigma is stronger in such collective societies, and most Omanis tend towards secretiveness because of the deep shame of mental illness.…”