Community Mental Health Journal

, Volume 54, Issue 7, pp 983–991 | Cite as

Meta-Analysis of Caregiver-Directed Psychosocial Interventions for Schizophrenia

  • Katie Ashcroft
  • Edward Kim
  • Erica Elefant
  • Carmela Benson
  • John A. Carter
Original Paper


With the recent movement toward a personal-recovery paradigm to treat schizophrenia, the locus of mental health care delivery has shifted toward community-based care. Family caregivers comprise a substantial component of that community, and are often providing care for longer periods, but often have no formal training or support. Caregiver-directed psychosocial interventions (CDPI) have been developed to train and assist caregivers in their efforts to maximize the odds of treatment success for those in their care. This meta-analysis compared CDPI versus treatment as usual (TAU) on outcomes such as hospitalization, relapse, non-compliance, and “other outcomes” (emergency services utilization, suicide attempt, and death). A systematic literature search (2005–2015) was conducted to identify randomized controlled trials of outpatient administered CDPI versus TAU to treat adult patients recovering from schizophrenia. Relative risks (RR) with 95% confidence intervals derived via random effects meta-analysis were calculated to compare CDPI versus TAU on the aforementioned outcomes. Eighteen of the 693 citations were retained for analysis. Overall RR for CDPI versus TAU suggested improved outcomes associated with CDPI: hospitalization [0.62 (0.46, 0.84) p < 0.00001], relapse [0.58 (0.47, 0.73) p < 0.00001] and other outcomes [0.70 (0.19, 2.57) p = 0.59]. CDPI was associated with significantly better compliance with medication and clinical activities combined [0.38 (0.19, 0.74) p = 0.005]. Medication compliance alone favored CDPI but was non-significant. Compliance with clinical activities alone favored CDPI significantly [0.22 (0.11, 0.47) p < 0.00001]. CDPI is associated with reductions in hospitalization, relapse, and treatment non-compliance.


Schizophrenia Caregiver Psychosocial intervention Community-based care 



This study was funded by Janssen Scientific Affairs, LLC, of which EK, CB, and EE are employees. JC is an employee of EPI-Q, Inc., which received consulting fees from Janssen Scientific Affairs, LLC related to the design and implementation of this study. KA, at the time of analysis and manuscript development, was an employee of MyHealios, Inc., which has an ongoing partnership with Janssen Scientific Affairs, LLC to design and adapt a psychosocial intervention employed in Janssen-supported clinical trials. Neither KA nor MyHealios, Inc. received compensation related to the design, implementation, or report of this study.


  1. Awad, A. G., & Voruganti, L. N. P. (2008). The burden of schizophrenia on caregivers. Pharmacoeconomics, 26(2), 149–162. Scholar
  2. Berglund, N., Vahlne, J. O., & Edman, A. (2003). Family intervention in schizophrenia—impact on family burden and attitude. Social Psychiatry and Psychiatric Epidemiology, 38(3), 116–121. Scholar
  3. Bradley, G. M., Couchman, G. M., Perlesz, A., Nguyen, A. T., Singh, B., & Riess, C. (2006). Multiple-family group treatment for English- and Vietnamese-speaking families living with schizophrenia. Psychiatric Services, 57(4), 521–530. Scholar
  4. Bressi, C., Manenti, S., Frongia, P., Porcellana, M., & Invernizzi, G. (2008). Systemic family therapy in schizophrenia: A randomized clinical trial of effectiveness. Psychotherapy and Psychosomatics, 77(1), 43–49. Scholar
  5. Brundtland, G. H. (2001). From the World Health Organization. Mental health: New understanding, new hope. JAMA, 286(19), 2391.CrossRefPubMedGoogle Scholar
  6. Carra, G., Montomoli, C., Clerici, M., & Cazzullo, C. L. (2007). Family interventions for schizophrenia in Italy: Randomized controlled trial. European Archives of Psychiatry and Clinical Neuroscience, 257(1), 23–30. Scholar
  7. Chatterjee, S., Naik, S., John, S., et al. (2014). Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): A randomised controlled trial. Lancet, 383(9926), 1385–1394. Scholar
  8. Dai, M. (2007). A study on influence of early comprehensive intervention on prognosis of incipient schizophrenia patients. Chinese Nursing Research, 21(9), 3293–3294.Google Scholar
  9. Dosman, D., & Keating, N. (2005). Cheaper for whom? Costs experienced by formal caregivers in adult family living programs. Journal of Aging & Social Policy, 17(2), 67–83. Scholar
  10. Eassom, E., Giacco, D., Dirik, A., & Priebe, S. (2014). Implementing family involvement in the treatment of patients with psychosis: A systematic review of facilitating and hindering factors. British Medical Journal Open, 4(10), e006108. Scholar
  11. Giron, M., Fernandez-Yanez, A., Mana-Alvarenga, S., Molina-Habas, A., Nolasco, A., & Gomez-Beneyto, M. (2010). Efficacy and effectiveness of individual family intervention on social and clinical functioning and family burden in severe schizophrenia: A 2-year randomized controlled study. Psychological Medicine, 40(1), 73–84. Scholar
  12. Glick, I. D., Stekoll, A. H., & Hays, S. (2011). The role of the family and improvement in treatment maintenance, adherence, and outcome for schizophrenia. Journal of Clinical Psychopharmacology, 31(1), 82–85. Scholar
  13. Grawe, R. W., Falloon, I. R. H., Widen, J. H., & Skogvoll, E. (2006). Two years of continued early treatment for recent-onset schizophrenia: A randomised controlled study. Acta Psychiatrica Scandinavica, 114(5), 328–336. Scholar
  14. Guo, X., Zhai, J., Liu, Z., et al. (2010). Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Archives of General Psychiatry, 67(9), 895–904. Scholar
  15. Hasan, A. A., Callaghan, P., & Lymn, J. S. (2015). Evaluation of the impact of a psycho-educational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: A randomized controlled trial. BMC Psychiatry, 15, 72. Scholar
  16. Hesse, K., Kriston, L., Mehl, S., et al. (2015). The vicious cycle of family atmosphere, interpersonal self-concepts, and paranoia in schizophrenia—a longitudinal study. Schizophrenia Bulletin, 41(6), 1403–1412. Scholar
  17. Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35(4), 696–703. Scholar
  18. Kulhara, P., Chakrabarti, S., Avasthi, A., Sharma, A., & Sharma, S. (2009). Psychoeducational intervention for caregivers of Indian patients with schizophrenia: A randomised-controlled trial. Acta Psychiatrica Scandinavica, 119(6), 472–483. Scholar
  19. McDonell, M. G., Short, R. A., Hazel, N. A., Berry, C. M., & Dyck, D. G. (2006). Multiple-family group treatment of outpatients with schizophrenia: Impact on service utilization. Family Process, 45(3), 359–373.CrossRefPubMedGoogle Scholar
  20. Nasr, T., & Kausar, R. (2009). Psychoeducation and the family burden in schizophrenia: A randomized controlled trial. Annals of General Psychiatry, 8, 17. Scholar
  21. Okpokoro, U., Adams, C. E., & Sampson, S. (2014). Family intervention (brief) for schizophrenia. The Cochrane Database of Systematic Reviews. Scholar
  22. Palma-Sevillano, C., Cañete-Crespillo, J., Farriols-Hernando, et al. (2011). Randomised controlled trial of cognitive-motivational therapy program for the initial phase of schizophrenia: A 6-month assessment. The European Journal of Psychiatry, 25, 68–80.Google Scholar
  23. Pharoah, F., Mari, J., Rathbone, J., & Wong, W. (2010). Family intervention for schizophrenia. The Cochrane Database of Systematic Reviews. Scholar
  24. Secher, R. G., Hjorthoj, C. R., Austin, S. F., et al. (2015). Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophrenia Bulletin, 41(3), 617–626. Scholar
  25. Sellwood, W., Wittkowski, A., Tarrier, N., & Barrowclough, C. (2007). Needs-based cognitive-behavioural family intervention for patients suffering from schizophrenia: 5-Year follow-up of a randomized controlled effectiveness trial. Acta Psychiatrica Scandinavica, 116(6), 447–452. Scholar
  26. Sungur, M., Soygur, H., Guner, P., Ustun, B., Cetin, I., & Falloon, I. R. (2011). Identifying an optimal treatment for schizophrenia: A 2-year randomized controlled trial comparing integrated care to a high-quality routine treatment. International Journal of Psychiatry in Clinical Practice, 15(2), 118–127. Scholar
  27. Valencia, M., Fresan, A., Juarez, F., Escamilla, R., & Saracco, R. (2013). The beneficial effects of combining pharmacological and psychosocial treatment on remission and functional outcome in outpatients with schizophrenia. Journal of Psychiatric Research, 47(12), 1886–1892. Scholar
  28. Valenstein, M., Ganoczy, D., McCarthy, J. F., Myra Kim, H., Lee, T. A., & Blow, F. C. (2006). Antipsychotic adherence over time among patients receiving treatment for schizophrenia: A retrospective review. The Journal of Clinical Psychiatry, 67(10), 1542–1550.CrossRefPubMedGoogle Scholar
  29. Viana, M. C., Gruber, M. J., Shahly, V., et al. (2013). Family burden related to mental and physical disorders in the world: Results from the WHO World Mental Health (WMH) surveys. Revista Brasileira De Psiquiatria, 35(2), 115–125.CrossRefPubMedGoogle Scholar
  30. Zhao, S., Sampson, S., Xia, J., & Jayaram, M. B. (2015). Psychoeducation (brief) for people with serious mental illness. The Cochrane Database of Systematic Reviews. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Katie Ashcroft
    • 1
  • Edward Kim
    • 2
  • Erica Elefant
    • 2
  • Carmela Benson
    • 2
  • John A. Carter
    • 3
  1. 1.Dr. Katie Ashcroft, LTDLancashireUK
  2. 2.Janssen Scientific Affairs, LLCTitusvilleUSA
  3. 3.EPI-Q, Inc.Oak BrookUSA

Personalised recommendations