title: Towards a better understanding of caregiver distress in early psychosis: a systematic review of the psychological factors involved.
abstract: OBJECTIVE
  We sought to review empirical studies of psychological factors accounting for distress in caregivers of young people with early psychosis.
  
  
  METHODS
  Following the PRISMA guidelines, we included studies that empirically tested psychological models of caregiver distress in early psychosis by searching the following databases up until March 2014: PsycINFO, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). This was followed by additional manual searches of reference lists and relevant journals.
  
  
  RESULTS
  The search identified 15 papers describing 13 studies together comprising 1056 caregivers of persons with early psychosis. The mean age of caregivers was 47.2years (SD=9.8), of whom 71.5% were female and 74.4% were parents. Nine different psychological variables were examined in the included studies, which were categorised in the following non-mutually exclusive groups: coping, appraisal/attribution and interpersonal response. There was considerable data to support the link between distress and psychological factors such as avoidant coping, appraisal and emotional over-involvement. However, the possibilities of drawing conclusions were limited by a number of methodological issues, including cross-sectional data, small sample sizes, confounding variables not being accounted for, and a wide variation in outcome measures.
  
  
  CONCLUSIONS
  The strengths of the review were the systematic approach, the exclusion of non-empirical papers and the rating of methodological quality by two independent raters. Limitations were that we excluded studies published in languages other than English, that data extraction forms were developed for this study and hence not tested for validity, and that there was a potential publication bias in favour of significant findings.
  
  
  CONCLUSIONS
  A better grasp of the psychological factors accounting for caregiver distress early in the course of illness may help us understand the trajectory of distress. This is an important step in preventing long-term distress in caregivers and supporting recovery in the whole family.
authors.affiliation: Early Psychosis Intervention Center/Psychiatric Research Unit, Region Zealand, Smedegade 10, 4000 Roskilde, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark. Electronic address: jenj@regionsjaelland.dk.
authors.forename: Jens Einar
authors.initials: JE
authors.lastname: Jansen
authors.affiliation: School of Psychology, Australian Catholic University, Locked Bag 4115, Fitzroy MDC, Victoria 3065, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Gleeson
authors.affiliation: Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, 3052, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Cotton
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000451:nursing* / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*
keywords: Burden; Carers; Distress; Family; First-episode psychosis; Systematic review