title: Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.
abstract: BACKGROUND
  Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met.
  
  
  OBJECTIVE
  To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden.
  
  
  METHODS
  We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness).
  
  
  RESULTS
  Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference -1.03, 95% CI -1.69 to -0.36) and support groups (SMD = -1.16, 95% CI -1.96 to -0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD = -1.79, 95% CI -3.01 to -0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD = -0.99, 95% CI -1.48 to -0.49) as did problem-solving bibliotherapy (SMD = -1.57, 95% CI -1.79 to -1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive.
  
  
  CONCLUSIONS
  Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Amina
authors.initials: A
authors.lastname: Yesufu-Udechuku
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Harrison
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Evan
authors.initials: E
authors.lastname: Mayo-Wilson
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Norman
authors.initials: N
authors.lastname: Young
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Woodhams
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Shiers
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
authors.affiliation: Amina Yesufu-Udechuku, PhD, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London; Bronwyn Harrison, BSc, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Evan Mayo-Wilson, DPhil, Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Norman Young, MSc, Cardiff and Vale UHB and Cardiff University, Whitchurch Hospital, Cardiff; Peter Woodhams, MCIPD, Carer, Alveston, Stratford upon Avon; David Shiers, MBChB, retired GP, National Audit of Schizophrenia, Royal College of Psychiatrists, London; Elizabeth Kuipers, PhD, Department of Clinical Psychology, King's College London, Institute of Psychiatry, and National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit, London; Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Kendall
mesh_terms: D000223:Adaptation, Psychological; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D012657:Self-Help Groups; D013315:Stress, Psychological