title: The effectiveness of manual-guided, problem-solving-based self-learning programme for family caregivers of people with recent-onset psychosis: A randomised controlled trial with 6-month follow-up.
abstract: BACKGROUND
  Family intervention for psychotic disorders is an integral part of psychiatric treatment with positive effects on patients' mental state and relapse rate. However, the effect of such family-based intervention on caregivers' psychological distress and well-being, especially in non-Western countries, has received comparatively much less attention.
  
  
  OBJECTIVE
  To test the effects of guided problem-solving-based manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis over a 6-month period of follow-up, when compared with those in usual family support service.
  
  
  METHODS
  A single-centre randomised controlled trial, which was registered at ClinicalTrials.gov (NCT02391649), with a repeated-measures, two-arm (parallel-group) design.
  
  
  METHODS
  One main psychiatric outpatient clinic in the New Territories of Hong Kong.
  
  
  METHODS
  A random sample of 116 family caregiverss of adult outpatients with recent-onset psychosis.
  
  
  METHODS
  Following pre-test measurement, caregivers were assigned randomly to one of two study groups: a 5-month self-help, problem-solving-based manual-guided self-learning (or bibliotherapy) programme (in addition to usual care), or usual family support service only. Varieties of patient and caregiver health outcomes were assessed and compared at baseline and at 1-week and 6-month post-intervention.
  
  
  RESULTS
  One hundred and eleven (96%) caregivers completed the 6-month follow-up (two post-tests); 55 of them (95%) completed ≥4 modules and attended ≥2 review sessions (i.e., 75% of the intervention). The family participants' mean age was about 38 years and over 64% of them were female and patient's parent or spouse. Multivariate analyses of variance indicated that the manual-guided self-learning group reported significantly greater improvements than the usual care group in family burden [F(1,110)=6.21, p=0.006] and caregiving experience [F(1,110)=6.88, p=0.0004], and patients' psychotic symptoms [F(1,110)=6.25, p=0.0003], functioning [F(1,110)=7.01, p=0.0005] and number of hospitalisations [F(1,110)=5.71, p=0.005] over 6-month follow-up.
  
  
  CONCLUSIONS
  Problem-solving-based, manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis can be an effective self-help programme and provide medium-term benefits to patients' and caregivers' mental health and duration of patients' re-hospitalisations.
authors.affiliation: School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region. Electronic address: wai.tong.chien@polyu.edu.hk.
authors.forename: Wai Tong
authors.initials: WT
authors.lastname: Chien
authors.affiliation: School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region. Electronic address: annie.l.k.yip@polyu.edu.hk.
authors.forename: Annie L K
authors.initials: AL
authors.lastname: Yip
authors.affiliation: School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region. Electronic address: justina.liu@polyu.edu.hk.
authors.forename: Justina Y W
authors.initials: JY
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, University of Alberta, Canada. Electronic address: cecilskchu@gmail.com.
authors.forename: Terry W
authors.initials: TW
authors.lastname: McMaster
mesh_terms: D000328:Adult; D017028:Caregivers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D055815:Young Adult
keywords: Bibliotherapy; Family intervention; Problem-solving; Randomised controlled trial; Recent-onset psychosis; Self-learning