Family intervention for schizophrenia.
BACKGROUND
It has been found that people with schizophrenia from families that express high levels of criticism, hostility, or over involvement, have more frequent relapses than people with similar problems from families that tend to be less expressive of their emotions. Psychosocial interventions designed to reduce these levels of expressed emotions within families now exist. These interventions are proposed as adjuncts rather than alternatives to drug treatments and their main purpose is to decrease the stress within the family and also the rate of relapse.


OBJECTIVE
To estimate the effects of family psychosocial interventions in community settings for the care of those with schizophrenia or schizophrenia-like conditions compared to standard care.


METHODS
We updated previous searches of the Cochrane Schizophrenia Group Register (June 1998), MEDLINE (1966-1995), the Cochrane Library (Issue 2 1998), EMBASE (1981-1995) and MEDLINE (1966-1995) by searching Cochrane Schizophrenia Group Register (November 2002). References of all identified studies were searched for further trial citations and authors of trials were contacted.


METHODS
Randomised or quasi-randomised studies were selected if they focused primarily on families of people with schizophrenia or schizoaffective disorder and compared community-orientated family-based psychosocial intervention of more than five sessions with standard care.


METHODS
Data were reliably extracted, and, where appropriate and possible, summated. Relative risk (RR) with 95% confidence intervals (CI) and number needed to treat (NNT) were estimated. The reviewers assume that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption.


RESULTS
Family intervention may decrease the frequency of relapse (n=721, 14 RCTs, RR 0.72 CI 0.6 to 0.9, NNT 7 CI 5 to 16). These data are statistically heterogeneous, the trend over time of this finding is towards the null and some small but negative studies may not have been identified by the search. Family intervention may also encourage compliance with medication (n=369, 7 RCTs, RR 0.74 CI 0.6 to 0.9, NNT 7 CI 4 to 19) but does not obviously affect the tendency of individuals/families to drop out of care (n=327, 4 RCTs, RR attrition at 3 months 0.86 CI 0.3 to 2.1). It may improve general social impairment and the levels of expressed emotion within the family. This review provides no data to suggest that family intervention either prevents or promotes suicide.


CONCLUSIONS
Clinicians, researchers, policy makers and recipients of care cannot be confident of the effects of family intervention from the findings of this review. Further data from already completed trials could greatly inform practice and more trials are justified as long as their participants, interventions and outcomes are applicable to routine care.
Willow House, Littlemore Mental Health Centre, Sandford Rd, Oxford, UK, OX4 4XN. fiona.pharaoh@oxmhc-tr.nhs.uk
F M
FM
Pharoah
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Rathbone
J J
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Mari
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Streiner
D019260:Expressed Emotion; D005196:Family Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D055502:Secondary Prevention; D012944:Social Support