Szmukler G, Kuipers E, Joyce J, Harris T, Leese M, Maphosa W, Staples E
Health Services Research Dept., Institute of Psychiatry, Kings College London & South London and Maudsley NHS Trust, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2003 Aug;38(8):411-8. doi: 10.1007/s00127-003-0652-1.
Despite an acknowledgement of the impact of serious mental disorders on informal caregivers, we still know little about how to best help them. The aim of the study was to evaluate the effectiveness of a two-phased carers' intervention comprising family sessions followed by relatives' groups. This intervention was designed to be of 'intermediate' intensity, that is,one lying between brief educational programmes and long-term family psychoeducational treatments.
An exploratory randomised controlled trial was conducted comparing the experimental support programme with 'standard' care. All carers of patients with a psychotic disorder from a defined population were approached. Outcome measures were based on a 'stress-appraisal-coping' model of caregiving.
Despite concerted attempts to engage carers, only 42% participated in the study. The carers' programme did not offer any significant advantage on any of the outcome measures: psychological morbidity, negative appraisal, coping or social support. The severity of caregiving difficulties decreased over the study period for the group as a whole.
There is still uncertainty about the most effective interventions for carers. Meeting 'needs' may not improve caregiver distress.
尽管人们已经认识到严重精神障碍对非正式照料者的影响，但我们对如何最好地帮助他们仍知之甚少。本研究的目的是评估一项分两个阶段的照料者干预措施的有效性，该措施包括家庭会议，随后是亲属小组活动。这种干预措施被设计为“中等”强度，即介于简短的教育项目和长期的家庭心理教育治疗之间。
进行了一项探索性随机对照试验，将实验性支持项目与“标准”护理进行比较。研究对象为来自特定人群的所有精神病患者的照料者。结局指标基于照料的“压力评估-应对”模型。
尽管我们齐心协力让照料者参与研究，但只有42%的人参与了。照料者项目在任何结局指标上都没有显示出显著优势：心理发病率、负面评价、应对方式或社会支持。在整个研究期间，整个组的照料困难严重程度有所下降。
对于照料者来说，最有效的干预措施仍然存在不确定性。满足“需求”可能无法减轻照料者的痛苦。
