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

Abstract

Background: Positive effects on the relapse from illness and compliance with medication by patients have been observed from family intervention for schizophrenia. However, little attention has been paid to the effects on family members, particularly those in non-Western countries. Inconsistent and inconclusive findings were found on the family-related outcomes and longer-term effects of family intervention. Objective: This study tested the effects of a nine-month family-led mutual support group for Chinese people with schizophrenia, compared with a psycho-education group and standard psychiatric care over a 24-month follow-up. Design: A randomised controlled trial [registered with ClinicalTrials.gov (NCT00940394)] with repeated-measures, three-group design. Settings: Two regional psychiatric outpatient clinics in Hong Kong. Participants: One hundred and thirty-five Chinese family caregivers and their patients with schizophrenia were randomly recruited, of whom 45 family dyads received family-led mutual support group, a psycho-education group, or standard care. Methods: After completing the pre-test questionnaire, the participants were randomly assigned into one of the three study groups. The mutual support and psycho-education groups comprised 14 two-hour group sessions, with patients participating in at least 5 sessions. Those in standard care (and two treatment groups) received routine psychiatric care. Multiple patient and family-related psychosocial outcomes were compared at recruitment and at one week, 12 months, and 24 months following interventions. Results: One hundred and twenty-six of 135 family dyads completed the three post-tests and 43 (95.6%) attended at least nine group sessions (60%) of the mutual support group programme. Mean ages of the family caregivers in the study ranged from 41.2 (SD = 7.0) to 42.7 (SD = 7.6) years. About two-thirds of the caregivers were male and patients' parent or spouse. The results of multivariate analysis of variance followed by Helmert contrasts tests indicated that the participants in the mutual support group indicated significantly greater improvement in family and patient functioning [F(2, 132) = 5.40, p = 0.005 and F(2, 132) = 6.88, p = 0.001, respectively] and social support for families [F(2, 131) = 5.01, p = 0.005], and in reducing patients' symptom severity [F(2, 132) = 4.65, p = 0.01] and length of re-hospitalisations [F(2, 132) = 4.78, p = 0.01] at 12- and 24-month follow-ups. Conclusions: Family-led mutual support group for schizophrenia produces longer-term benefits to both the patients' and families' functioning and relapse prevention for patients, compared with psycho-education and standard care. This group programme can be an effective family intervention for Chinese people with schizophrenia.