Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
Br J Psychiatry. 2015 Apr;206(4):268-74. doi: 10.1192/bjp.bp.114.147561.
Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met.
To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden.
We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness).
Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference -1.03, 95% CI -1.69 to -0.36) and support groups (SMD = -1.16, 95% CI -1.96 to -0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = -1.79, 95% CI -3.01 to -0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = -0.99, 95% CI -1.48 to -0.49) as did problem-solving bibliotherapy (SMD = -1.57, 95% CI -1.79 to -1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive.
Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.
非正规护理是严重精神疾病患者护理的一个组成部分，但提供这种护理的人的支持需求往往得不到满足。
确定为严重精神疾病患者的护理人员提供的干预措施是否能改善护理体验并减轻护理人员负担。
我们对卫生和社会保健服务为非正式护理人员（即向严重精神疾病患者提供支持的家属或朋友）提供的干预措施进行了系统评价和荟萃分析，这些干预措施均为随机对照试验（RCT）。
共有 21 项 RCT 纳入了 1589 名护理人员，研究结果表明，干预结束时，护理人员的护理体验得到了改善，包括心理教育（标准化均数差-1.03，95%置信区间-1.69 至-0.36）和支持小组（SMD=-1.16，95%置信区间-1.96 至-0.36）。心理教育在干预结束后 6 个月以上对心理困扰有获益（SMD=-1.79，95%置信区间-3.01 至-0.56），但干预后立即没有获益。支持干预措施对干预结束时的心理困扰有有益影响（SMD=-0.99，95%置信区间-1.48 至-0.49），问题解决式自助阅读疗法（SMD=-1.57，95%置信区间-1.79 至-1.35）也有同样效果，且这些效果在随访时仍能保持。证据质量主要为低质量和极低质量。关于联合使用这些干预措施以及自我帮助和自我管理的证据尚不确定。
以护理人员为重点的干预措施似乎能改善护理体验和生活质量，减轻严重精神疾病患者护理人员的心理困扰，并且这些获益可能在首发精神病中获得。应将针对护理人员的干预措施视为严重精神卫生问题患者综合服务的一部分。
