Ma Chak Fai, Chien Wai Tong, Bressington Daniel Thomas
Kwai Chung Hospital, Kwai Chung, New Territories, Hong Kong.
The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
Early Interv Psychiatry. 2018 Aug;12(4):535-560. doi: 10.1111/eip.12494. Epub 2017 Oct 27.
We aimed to systematically review the evidence of the effectiveness of family interventions for caregivers of people with recent-onset psychosis compared with usual psychiatric care. A secondary objective was to directly compare the effects of different types of family interventions.
MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete and EBSCOhost were searched to identify relevant randomized controlled trials. Trial data were extracted following the procedures described in the Cochrane Handbook of systematic reviews. Random-effects models were used to pool the intervention effects.
Twelve studies including 1644 participants were included in this review. With the exception of a high risk of performance bias inherent to the nature of the psychosocial interventions, the studies had an overall low or unclear risk of bias, suggesting that sources of bias are unlikely to lower confidence in the estimate of intervention effects. Meta-analyses were conducted for 4 different participant outcomes reported in 9 studies. Compared with usual psychiatric care, family intervention was more effective in reducing care burden over all follow-up periods. Family intervention was also superior to usual care with regards to caregiving experience in the short term and improved utilization of formal support and family functioning over longer-term follow up. Mutual support is more effective than psychoeducation in improving family functioning when measured 1 to 2 years after the intervention but had equivalent effects on utilization of formal support services.
This review provides evidence that family intervention is effective for caregivers of recent-onset psychosis, especially for care burden where the positive effects are enhanced over time.
我们旨在系统评价与常规精神科护理相比，针对近期发病精神病患者照料者的家庭干预有效性的证据。次要目标是直接比较不同类型家庭干预的效果。
检索了MEDLINE、EMBASE、PsycINFO、Cochrane对照试验中央注册库（CENTRAL）、CINAHL Complete和EBSCOhost，以识别相关的随机对照试验。按照Cochrane系统评价手册中描述的程序提取试验数据。采用随机效应模型汇总干预效果。
本评价纳入了12项研究，共1644名参与者。除了心理社会干预性质所固有的实施偏倚高风险外，这些研究的总体偏倚风险较低或不明确，这表明偏倚来源不太可能降低对干预效果估计的信心。对9项研究报告的4种不同参与者结局进行了荟萃分析。与常规精神科护理相比，家庭干预在所有随访期内减轻护理负担方面更有效。在短期照料体验方面，家庭干预也优于常规护理，并且在长期随访中，在正式支持的利用和家庭功能改善方面也更优。在干预后1至2年进行测量时，互助在改善家庭功能方面比心理教育更有效，但在正式支持服务的利用方面效果相当。
本评价提供的证据表明，家庭干预对近期发病精神病患者的照料者有效，尤其是在护理负担方面，其积极效果会随着时间的推移而增强。
