title: Evaluating genetic counseling for family members of individuals with schizophrenia in the molecular age.
abstract: BACKGROUND
  Myths and concerns about the extent and meaning of genetic risk in schizophrenia may contribute to significant stigma and burden for families. Genetic counseling has long been proposed to be a potentially informative and therapeutic intervention for schizophrenia. Surprisingly, however, available data are limited. We evaluated a contemporary genetic counseling protocol for use in a community mental health-care setting by non-genetics professionals.
  
  
  METHODS
  We used a pre-post study design with longitudinal follow-up to assess the impact of genetic counseling on family members of individuals with schizophrenia, where molecular testing had revealed no known clinically relevant genetic risk variant. We assessed the outcome using multiple measures, including standard items and scales used to evaluate genetic counseling for other complex diseases.
  
  
  RESULTS
  Of the 122 family members approached, 78 (63.9%) actively expressed an interest in the study. Participants (n = 52) on average overestimated the risk of familial recurrence at baseline, and demonstrated a significant improvement in this estimate postintervention (P < .0001). This change was associated with an enduring decrease in concern about recurrence (P = .0003). Significant and lasting benefits were observed in other key areas, including increased knowledge (P < .0001) and a decreased sense of stigma (P = .0047). Endorsement of the need for genetic counseling was high (96.1%).
  
  
  CONCLUSIONS
  These results provide initial evidence of the efficacy of schizophrenia genetic counseling for families, even in the absence of individually relevant genetic test results or professional genetics services. The findings support the integration of contemporary genetic counseling for families into the general management of schizophrenia in the community.
authors.affiliation: To whom correspondence should be addressed; Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: +1-416-535-8501 ext. 2731, fax: +1-416-535-7199, e-mail: anne.bassett@utoronto.ca.
authors.forename: Gregory
authors.initials: G
authors.lastname: Costain
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Esplen
authors.forename: Brenda
authors.initials: B
authors.lastname: Toner
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Hodgkinson
authors.forename: Anne S
authors.initials: AS
authors.lastname: Bassett
mesh_terms: D000368:Aged; D002985:Clinical Protocols / Q000592:standards*; D005190:Family / Q000523:psychology*; D005260:Female; D005817:Genetic Counseling / Q000523:psychology / Q000592:standards*; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012559:Schizophrenia / Q000235:genetics*; D057545:Social Stigma; D016896:Treatment Outcome
keywords: copy number variation; genetic counseling; genetic predisposition to disease; genetics; schizophrenia; stigma