The Schizophrenia Care Management Program for Family Caregivers of Chinese Patients With Schizophrenia

Abstract

This is the Pre-Published Version.2 Objectives: This study tested the effectiveness of a schizophrenia care management program for family caregivers of Chinese patients with schizophrenia in Hong Kong.Methods: A multisite controlled trial was conducted with 92 patient-caregiver dyads. They were randomly assigned to either the schizophrenia care management program or to usual care. The patients' symptoms, functioning, and length of rehospitalization and their families' perceived social support, expressed emotion, and functioning were measured at recruitment and at one month and 15 months after the intervention. Other limitations of family intervention studies are the paucity of controlled trials of needsbased interventions with a broad range of outcome measures, poor study power and high attrition rates, and insufficient interdisciplinary collaboration (2,4).A few integrated multidisciplinary and multicomponent educational programs, such as a family psychoeducation group program in Hong Kong (5) and a needs-based psychosocial intervention in the United Kingdom (6), reported significant effects on families' management of patients' problem behaviors and families' general health. These programs 3 consist of multiple supportive strategies, such as schizophrenia care education, stress management, and problem-solving skills. However, only a few family intervention studies have been conducted in Asian populations, where great importance is attached to intimate interpersonal relationships and collective behaviors among family members (1). To address gaps in knowledge about the quality of family interventions, this trial was designed to test the effects of an interdisciplinary, needs-based schizophrenia care management program (SCMP) for family caregivers of Chinese patients with schizophrenia on patients' and families' psychosocial health and functioning. MethodsThe study was a randomized controlled trial that used a repeated-measures design. patient-caregiver dyads agreed to participate. Of these, 92 (46%) were randomly selected to take part. Based on previous studies of family intervention (4,5), this sample size was required to detect any significant difference between the groups at a 5% significance level with a power of 90%, and the size would allow 15% attrition (7).Patient-caregiver dyads were eligible for the study. Caregivers were eligible for the study if they were 18 years or older, if they were the main caregiver for the relative with schizophrenia, and if they lived with the relative with schizophrenia. Patients had to be diagnosed as having schizophrenia according to DSM-IV criteria and be 18 years or older.Caregivers who had mental illness themselves or cared for more than one relative with mental illness were excluded. After written consent of caregivers and patients had been obtained following a full explanation of the study, the participants were randomly assigned to the usual care or the SCMP group. (experience sharing and problem solving), family caregivers were guided to discuss their situations in m...

The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: A randomised controlled trial with 24-month follow-up

“…A few controlled trials (Chien et al, 2008, Glynn et al, 2006, Wiedemann, 2003 have suggested that family-led mutual support groups can improve family functioning and caregiving through two mechanisms: (a) increased social support and, in turn, an enhanced experiential knowledge and sense of control over interpersonal and caregiving skills; and (b) an "all in the same boat" belief, with better sharing and the adoption of effective strategies in patient care among group members. Similar to the findings in this trial, a few studies conducted in Hong Kong (Chien et al, 2006, Chien et al, 2008, Chien and Lee, 2010 suggest that family mutual support groups for Chinese people with severe mental illness are effective in offering practical assistance and advice on caregiving and in improving the willingness of people to share their caregiving experiences openly with other families, particularly when little help is forthcoming from elsewhere.…”

“…They may also find it difficult to build trust and rapport with the family therapist (Fung and Ma, 1997). Chien and Lee (2010) have suggested that although Chinese families are often the ones most in need of intervention, they seldom seek help from health professionals.…”

The Influence of Perceived Social Support on Medication Adherence in First-Episode Psychosis

“…7 Social support has also been linked to outcome in schizophrenia and related disorders, either directly 8 or through the impact of family-related interventions on symptoms, 9 relapse, 10 social functioning, 9 as well as the number and length of hospitalizations. [11][12][13] Further, numerous studies reveal the positive impact of social support and the quality of social networks on remission status, 14 improvement of symptoms, rates of hospitalization, 15 and the degree of adaptive functioning. 16 It is possible that the relation between social support and outcome is, at least partly, mediated through the effect of social-especially family-support on adherence to medication.…”

Support management in schizophrenia: a systematic review of current literature

“…Moreover, family therapy has proven effective in providing knowledge enhancement about mental illness and its treatment and consequently may offer a better ability to cope with the patients and their disease. [29][30][31][32] Thorup et al compared integrated treatment and standard treatment in 547 patients experiencing a first episode of psychosis. 33 The integrated treatment focused on social skills, information about the pharmacological therapy, its side effects, and relapse prevention.…”