Effectiveness of guided self-help in decreasing expressed emotion in family caregivers of people diagnosed with depression in Thailand: a randomised controlled trial.
BACKGROUND
High expressed emotion (EE) can extend the duration of illness and precipitate relapse; however, little evidence-based information is available to assist family caregivers of individuals with depression. In the present exploratory study, we examined the effectiveness of a cognitive behaviour therapy (CBT) based guided self-help (GSH) manual in decreasing EE in caregivers of people with depression, in Thailand.


METHODS
A parallel group randomised controlled trial was conducted, following CONSORT guidelines, with 54 caregivers who were allocated equally to GSH or control group (standard outpatient department support). In addition, both groups were contacted weekly by telephone. EE was assessed, using the Family Questionnaire (FQ), at baseline, post-test (Week 8) and follow-up (Week 12).


RESULTS
FQ scores at baseline indicated that both groups had similar, though moderately high level of EE. However, between baseline and post-test EE scores decreased markedly in the intervention group, but in contrast, they increased slightly in the control group. Between post-test and follow-up, little change took place in the EE scores of either group. Overall, the intervention group recipients of GSH showed a significant decrease in EE whereas the control group recipients of standard outpatient department support reported a slight increase in EE.


CONCLUSIONS
These findings provide preliminary evidence that GSH is beneficial in reducing EE in caregivers, which is advantageous to family members with depression and caregivers. The approach may be used as an adjunct to the limited outpatient department support given to caregivers by mental health professionals and, perhaps, to caregivers who do not attend these departments.


BACKGROUND
Australian and New Zealand Clinical Trials Registry https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366639. Registered 21 July 2014.
Centre for Chronic Disease, College of Health and Biomedicine (Discipline of Nursing), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia. terence.mccann@vu.edu.au.
Terence V
TV
McCann
McCormick Faculty of Nursing, Payap University, Chiang Mai, Thailand. swallapa@yahoo.com.
Wallapa
W
Songprakun
School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, UK. j.stephenson@hud.ac.uk.
John
J
Stephenson
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000704:Analysis of Variance; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology*; D019260:Expressed Emotion; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D013785:Thailand; D055815:Young Adult