Gleeson John F M, Ludwig Kelsey, Stiles Bryan J, Piantella Stefan, McNab Catharine, Cotton Sue, Fraser Madeleine I, Alvarez-Jimenez Mario, Watson Amity, Fraser Elizabeth, Penn David L
Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia.
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America.
Schizophr Res. 2025 Feb;276:57-78. doi: 10.1016/j.schres.2025.01.006. Epub 2025 Jan 23.
Previous reviews have indicated that family interventions in early psychosis are beneficial for patients and family caregivers. Given recent developments in research and service provision an updated review is warranted.
We conducted a systematic review and meta-analysis of family intervention trials in the first 5 years after psychosis onset. We identified randomized controlled trials that reported outcomes for family members and extracted available outcomes in relation to identified patients.
We screened 8737 abstracts and 177 full text papers, resulting in 36 for extraction. We found significant pooled treatment effects for family interventions for carer psychological distress (Hedges g = 0.35), carer burden (Hedges g = -0.68), positive and negative carer appraisals (Hedges g = 0.20, g = -0.21), and components of expressed emotion (critical comments and emotional overinvolement) compared with care as usual (Hedges g = -0.81, -0.92). For patients we found a moderate pooled effect for reduced rates of hospitalization compared with care as usual (Hedges g = -0.52). The effects for carer burden were maintained for studies in China, but not in other settings combined. The effects for hospitalization were maintained for multicomponent interventions but not when psychoeducation was the sole component. There was evidence of significant study heterogeneity. Risk of bias assessment indicated that deviations from intended treatment were most frequently rated as the weakest domain.
Family interventions for early psychosis benefit both family carers and their relatives diagnosed with psychosis when compared with usual care. Future research should further clarify the effective components and investigate innovations in cultural sensitivity, peer support and digital modes.
既往综述表明，针对早期精神病的家庭干预对患者及其家庭照顾者有益。鉴于近期研究和服务提供方面的进展，有必要进行一次更新的综述。
我们对精神病发作后头5年的家庭干预试验进行了系统综述和荟萃分析。我们确定了报告家庭成员结局的随机对照试验，并提取了与已确定患者相关的可用结局。
我们筛选了8737篇摘要和177篇全文论文，最终有36篇可供提取。我们发现，与常规护理相比，家庭干预在照顾者心理困扰（Hedges g = 0.35）、照顾者负担（Hedges g = -0.68）、照顾者的积极和消极评价（Hedges g = 0.20，g = -0.21）以及情感表达的组成部分（批评性评论和过度情感卷入）方面有显著的合并治疗效果（Hedges g = -0.81，-0.92）。对于患者，我们发现与常规护理相比，住院率降低有中等程度的合并效果（Hedges g = -0.52）。在中国进行的研究中，照顾者负担的效果得以维持，但在其他地区合并分析时则不然。多成分干预对住院率的效果得以维持，但以心理教育作为唯一成分时则不然。有证据表明研究存在显著异质性。偏倚风险评估表明，与预期治疗的偏差最常被评为最薄弱的领域。
与常规护理相比，针对早期精神病的家庭干预对家庭照顾者及其被诊断患有精神病的亲属均有益。未来的研究应进一步阐明有效成分，并研究在文化敏感性、同伴支持和数字模式方面的创新。
