Academic Psychology Unit, NorthWestern Mental Health, Epping, Australia.
Department of Psychology and Counselling, La Trobe University, Bundoora, Australia.
Psychol Med. 2020 May;50(7):1099-1109. doi: 10.1017/S0033291719000965. Epub 2019 Apr 29.
Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative.
Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model.
While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication.
This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.
家庭教育计划（FEPs）针对的是被诊断患有严重精神健康状况的亲属/朋友的照顾者与照顾相关的心理困扰。虽然 FEPs 在减轻痛苦方面是有效的，但机制尚不完全清楚。同伴小组支持和更多的心理健康知识被认为可以通过减少污名化态度和自责，以及加强照顾者与他们的亲人的关系，来减轻照顾者的心理困扰。
2009 年至 2016 年期间，参加澳大利亚 Wellways 的 FEPs 的成年照顾者（n=1016）在核心项目开始和结束时、巩固期和 6 个月随访时完成了自我报告问卷。那些提前注册的人在等待名单期间完成了问卷。我们使用线性混合效应模型，采用自然主义等待名单对照纵向设计，评估了该计划的有效性，并使用多变量潜在增长模型测试了一个基于理论的过程变化模型。
虽然在等待名单期间没有显著变化，但心理困扰、自责和污名化态度显著下降，从核心项目开始到结束，沟通和关系质量/感觉增加。这些变化在巩固期和随访期间都得到了维持。同伴小组支持显著预测了痛苦的下降轨迹。同伴小组支持和更多的知识显著预测了自责和污名化态度水平的下降，以及沟通水平的提高。
这是第一项定量验证 FEPs 对照顾者心理困扰影响机制的研究。同伴小组支持是改变照顾者对朋友/亲属病情看法的关键。需要在精神卫生服务系统中继续实施 FEPs。
