title: Family intervention for schizophrenia.
abstract: BACKGROUND
  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 emotions. Forms of psychosocial intervention, designed to reduce these levels of expressed emotions within families, are now widely used.
  
  
  OBJECTIVE
  To estimate the effects of family psychosocial interventions in community settings for people with schizophrenia or schizophrenia-like conditions compared with standard care.
  
  
  METHODS
  We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register (September 2008).
  
  
  METHODS
  We selected randomised or quasi-randomised studies focusing primarily on families of people with schizophrenia or schizoaffective disorder that compared community-orientated family-based psychosocial intervention with standard care.
  
  
  METHODS
  We independently extracted data and calculated fixed-effect relative risk (RR), the 95% confidence intervals (CI) for binary data, and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD).
  
  
  RESULTS
  This 2009-10 update adds 21 additional studies, with a total of 53 randomised controlled trials included. Family intervention may decrease the frequency of relapse (n = 2981, 32 RCTs, RR 0.55 CI 0.5 to 0.6, NNT 7 CI 6 to 8), although some small but negative studies might not have been identified by the search. Family intervention may also reduce hospital admission (n = 481, 8 RCTs, RR 0.78 CI 0.6 to 1.0, NNT 8 CI 6 to 13) and encourage compliance with medication (n = 695, 10 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 6 CI 5 to 9) but it does not obviously affect the tendency of individuals/families to leave care (n = 733, 10 RCTs, RR 0.74 CI 0.5 to 1.0). Family intervention also seems to improve general social impairment and the levels of expressed emotion within the family. We did not find data to suggest that family intervention either prevents or promotes suicide.
  
  
  CONCLUSIONS
  Family intervention may reduce the number of relapse events and hospitalisations and would therefore be of interest to people with schizophrenia, clinicians and policy makers. However, the treatment effects of these trials may be overestimated due to the poor methodological quality. Further data from trials that describe the methods of randomisation, test the blindness of the study evaluators, and implement the CONSORT guidelines would enable greater confidence in these findings.
authors.affiliation: South West Community Mental Health Team, Oxford and Buckinghamshire Mental Health NHS Foundation Trust, Apex 550 (Unit 5), The Valley Centre, Gordon Road, High Wycombe, Buckinghamshire, UK, HP13 6EQ.
authors.forename: Fiona
authors.initials: F
authors.lastname: Pharoah
authors.forename: Jair
authors.initials: J
authors.lastname: Mari
authors.forename: John
authors.initials: J
authors.lastname: Rathbone
authors.forename: Winson
authors.initials: W
authors.lastname: Wong
mesh_terms: D019260:Expressed Emotion; D005195:Family Relations; D005196:Family Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D055502:Secondary Prevention; D012944:Social Support