King's College London, London, UK.
London School of Hygiene and Tropical Medicine, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2022 Sep;57(9):1749-1769. doi: 10.1007/s00127-022-02309-8. Epub 2022 Jun 14.
Of the 80% people with psychosis living in low- and middle-income countries (LMICs), up to 90% are left to the care of families. The World Health Organization has recommended the inclusion of families in community-based rehabilitation and while there is evidence of its implementation in LMICs, this has not been reviewed yet. This study aims to describe the key features and implementation strategies of family-based interventions in LMICs, and appraise their effectiveness.
Included are people with psychosis in LMICs who receive any form of family-based intervention, compared to their usual or absence of treatment, with patient outcome measures. We searched (August 2021) through Embase, MEDLINE, Global Health, PsycInfo, Social Policy and Practice, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as from grey literature and hand-searched records. Risk of bias was assessed through the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS), then analyzed narratively.
27 studies were included from the 5254 records. Psychotherapeutic features, systems approach and task-sharing were key intervention elements. Delivery strategies included preliminary research, sustained family engagement, and cultural adaptation. There were positive health impacts across four outcome domains.
All studies recommended family-based interventions, with limitations in heterogeneity and 70% of them rated high risk of bias.
Review was registered in PROSPERO (CRD42021256856). The authors did not receive funding for this research.
在低中等收入国家（LMICs）中，有 80%的精神病患者生活在这些国家，其中高达 90%的患者由其家庭照顾。世界卫生组织（WHO）建议将家庭纳入社区康复中，虽然已经有证据表明在 LMICs 中实施了这种方法，但尚未对其进行审查。本研究旨在描述 LMICs 中基于家庭的干预措施的主要特征和实施策略，并评估其效果。
纳入研究对象为在 LMICs 中接受任何形式的基于家庭的干预措施的精神病患者，与他们的常规治疗或不治疗相比，以患者的结果作为衡量指标。我们通过 Embase、MEDLINE、全球健康、PsycInfo、社会政策与实践以及护理学和联合健康文献累积索引（CINAHL）进行了搜索（2021 年 8 月），同时还从灰色文献和手工检索的记录中进行了搜索。通过综合多研究设计质量标准（ICROMS）和健康经济评估报告标准（CHEERS）评估偏倚风险，然后进行叙述性分析。
从 5254 条记录中纳入了 27 项研究。心理治疗特征、系统方法和任务分担是关键的干预要素。实施策略包括初步研究、持续的家庭参与和文化适应。四个结果领域都有积极的健康影响。
所有研究都推荐了基于家庭的干预措施，但存在异质性限制，其中 70%的研究被评为高偏倚风险。
该研究已在 PROSPERO（CRD42021256856）上注册。作者没有为这项研究提供资金。
