Department of Neuropsychiatry, Kochi Medical School, Koch, Japan.
Br J Psychiatry. 2011 May;198(5):385-90. doi: 10.1192/bjp.bp.110.078626. Epub 2011 Feb 22.
The value of family psychoeducation for schizophrenia has been well established, and indications for its use have recently expanded to include bipolar affective disorder. However, no study to date has adequately examined its use in depression.
To examine family psychoeducation in the maintenance treatment of depression and to investigate the influence of the family's expressed emotion (EE) on its effectiveness.
Of 103 patients diagnosed with major depression and their primary family members, 57 pairs provided written informed consent. The pairs were randomly allocated to the intervention (n = 25) or control (n = 32). One family in the intervention group and two in the control group withdrew their consent after randomisation. The intervention group underwent four psychoeducation sessions consisting of didactic lectures about depression and group problem-solving focusing on how to cope in high-EE situations. Patients did not attend these sessions. Patients in both the intervention and control groups received treatment as usual. The families' EE levels were evaluated through Five-Minute Speech Samples. The primary outcome was relapse.
Time to relapse was statistically significantly longer in the psychoeducation group than in the control group (Kaplan-Meier survival analysis, P = 0.002). The relapse rates up to the 9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI 0.04-0.66; number needed to treat 2.4, 95% CI 1.6-4.9). In Cox proportional hazard analysis, baseline EE did not moderate the effectiveness of the intervention.
Family psychoeducation is effective in the prevention of relapse in adult patients with major depression.
家庭心理教育对精神分裂症的价值已得到充分证实，其使用指征最近已扩展到包括双相情感障碍。然而，迄今为止，尚无研究充分检查其在抑郁症中的应用。
研究家庭心理教育在抑郁症维持治疗中的作用，并探讨家庭的表达情感（EE）对其疗效的影响。
在 103 名被诊断患有重度抑郁症的患者及其主要家庭成员中，有 57 对提供了书面知情同意书。将这些对随机分配到干预组（n=25）或对照组（n=32）。干预组中的一个家庭和对照组中的两个家庭在随机分组后撤回了同意。干预组接受了四次心理教育课程，包括关于抑郁症的讲座和小组解决问题，重点是如何应对高 EE 情况。患者未参加这些课程。干预组和对照组的患者均接受常规治疗。通过 5 分钟演讲样本评估家庭的 EE 水平。主要结局是复发。
心理教育组的复发时间明显长于对照组（Kaplan-Meier 生存分析，P=0.002）。截至 9 个月随访时的复发率分别为 8%和 50%（风险比 0.17，95%CI 0.04-0.66；需要治疗的人数 2.4，95%CI 1.6-4.9）。在 Cox 比例风险分析中，基线 EE 并未调节干预的效果。
家庭心理教育可有效预防成年重度抑郁症患者的复发。
