English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Tools annual

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Presents the access of premium content as premium feature

Premium Content

Global: Zendy Plus annual

Global: Zendy Free Plan

Review question/objective The overall objective of this review is to examine the effectiveness of family interventions (i.e. education, psychoeducation, communication and coping skills training, problem‐solving training and cognitive‐behavioral therapy) for family members of persons with first‐episode psychosis. The specific review question to be addressed is: What interventions are the most effective in impacting on family members’ psychological distress and expressed emotion? Background Psychosis is a disorder with a variety of symptoms that include so‐called ‘positive’ and ‘negative’ symptoms.1,2 Positive symptoms include behaviors that reflect higher than usual functioning of sensory perception, such as hallucinations, delusions and disorganized thinking or behavior. Negative symptoms include behaviors that reflect a decrease in, or loss of, normal functioning, for example, in the areas of self‐care and social functioning resulting in poor grooming or hygiene and social withdrawal behaviors.3 First‐episode psychosis (FEP) is used to define a person who has those features for the first time,3,4 and is often accompanied by a diagnosis of schizophrenia spectrum disorder.5 FEP usually occurs during mid‐adolescence to early adulthood (15‐24 years of age) and is called a transitional phase.6‐8 The annual incidence rate of FEP was 30.4 and 16.7 per 100,000 in the UK (in 2000‐2001) and Australia (in 1997‐2000) respectively, with ages ranging between 15‐29 years.9,10 Moreover, the incidence rate of FEP is high in certain immigrant groups. For example, among black ethnic minority groups (ages ranging between 27.5‐29 years) the incidence of FEP was 50.2 per 100,000.11,12 The critical period for initiating treatment is within two years of onset of FEP;13 approximately 60% of FEP patients achieve remission if treatment is initiated during this period.14 However, negative consequences of FEP are still experienced, including decreased occupational performance, social impairment and difficulty making decisions,15‐18 which together, contribute to a lower quality of life.19 In addition, individuals experiencing FEP are considered at higher risk of suicidal ideation;20‐22 violent behaviours;23‐25 homicide;26 and substance misuse, particularly cannabis use.27 Family members of individuals with FEP play an important role in providing support; however, they often experience psychological distress themselves, especially during the critical period as they have no prior involvement in caring for persons with psychosis.28 They worry about the future of, and strange behaviors displayed by, their ill family member,29‐31 and parents feel a sense of loss of their ‘normal’ child after onset of FEP.32 Family members of individuals with FEP also describe their first‐time experience of caring for a person with FEP as burdensome and unpredictable.33 The caregiving tasks required are extensive and intense and can lead to emotional distress.32‐36 Some coping strategies include adjusting expectations,35, 36 and fostering hope in their child while engaging with the new role of being a caregiver.33 Baseline data of 124 carers showed that approximately half used adaptive coping strategies including self‐talk, problem‐solving and reframing.37 The experience of accessing mental health services for the first time can be difficult for many caregivers and they can feel overwhelmed with this activity. For example, some find it difficult to make appointments with specialists and then face the difficult situation of having to take their ill family member to an emergency department to be subsequently hospitalized.38 Some parents have also claimed that their ill family members received inappropriate treatment, especially when the FEP diagnosis was not made around the time of admission.7,39 Moreover, following a diagnosis of psychosis, caregivers report encountering stigma related to mental illness.38,40‐41 Overall, caregivers experience stress at the onset of FEP, comprising emotional distress, difficulties in accessing mental health services and in adjusting to their new role as caregivers. Caregivers need support from mental health providers to enable them to provide care for ill relatives. At the critical period, interventions for families and individuals with FEP assist the latter by shortening treatment duration, achieving full remission and decreasing the risk of relapse.42Interventions, including psychoeducation, communication skills training and problem‐solving skills training are implemented for caregivers.43 Previous studies have shown that family intervention can reduce relapse,1, 44 and decrease the length of hospitalization.45 Recently, family interventions that incorporate a cognitive component have been shown to help reduce the likelihood of individuals with FEP experiencing a second episode of psychosis.44, 46 Participating in psychoeducation about the illness and treatment increases caregivers’ knowledge and psychological well‐being,6, 47‐50 and reduces their depressive symptoms and negative views toward ill relatives.51 However, psychoeducation can have a variable effect on caregivers’ expressed emotion,52 burden and coping skills.50, 53 It is important to note that these interventions produce multiple outcomes, which can be positive and/or neutral, and contain a variety of components and modules, such as delivering information, communication skills training and problem‐solving training. Therefore, it may be beneficial to investigate which kind of family intervention is effective and which specific outcome is achieved. To date, family interventions place emphasis on specific components during the critical period. Studies indicate that medical treatment information increases caregivers’ knowledge and positive attitude towards patients,2 and communication skills training improves individuals’ psychotic symptoms and social functioning.54,55 These findings confirm that specific components of family interventions may be crucial and lead to good outcomes of care. Recently, studies have shown that incorporation of a cognitive component, such as cognitive behavioural therapy (CBT), within family interventions significantly improves caregivers’ stress appraisal.44 Moreover, caregivers’ negative experience of caregiving, including burden, anxiety and depression, are reduced after participating in such interventions.56 A randomized controlled study found that carers who participated in bibliotherapy had positive experiences of caring for a child with FEP and their psychological distress decreased.57 Although previous studies have evaluated family interventions, only one systematic review has been undertaken. This review focused on persons with psychosis, early intervention services, CBT and family interventions at the critical period (the first three to five years following onset of psychosis).58 Three studies were included in the review and family interventions were varied in terms of their mode of delivery. Results demonstrated that patients who received such interventions were less likely to relapse and be readmitted to hospital. The effectiveness of family interventions covering the onset of psychosis up to two years following diagnosis is still under investigation. No Cochrane Library or Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports have been undertaken on this topic. Therefore, the objective of this systematic review is to examine the effectiveness of family interventions for family members of individuals diagnosed with FEP, ranging from the onset of illness up to two years. The review can provide the most up‐to‐date evidence to inform practice. In so doing, it will contribute to better outcomes in enhancing caregivers’ psychological well‐being while providing care to family members with FEP during the critical period.

jbi database of systematic reviews and implementation reports

The effectiveness of family interventions on psychological distress and expressed emotion in family members of individuals diagnosed with first-episode psychosis: a systematic review protocol