Caregiver-Directed Psychosocial Interventions in Schizophrenia: Systematic Review and Meta-Analysis
This poster was presented at the 29th Annual U.S. Psychiatric & Mental Health Congress, held October 21-24, 2016, in San Antonio, Texas.
Introduction: The challenges inherent in caring for someone with schizophrenia can be ameliorated with caregiver education and training. Here, we present a systematic review and meta-analysis comparing caregiver-directed psychosocial interventions (CDPIs) versus treatment as usual.
Methods: PubMed/MEDLINE, PsychNet, and the Cochrane Central Register of Controlled Trials were searched with limitations of "2004-2015," "randomized controlled trials," and "English language." Two independent reviewers applied inclusion/exclusion criteria and extracted data; discrepancies were adjudicated by a third. Outcomes were retained as or transformed into binary outcomes and assessed by relative risk (RR). 95% confidence intervals (CIs) were derived from a random-effects model. Outcomes included patient hospitalization, relapse, other key events (death, suicide, suicide attempt, other [patients visiting psychiatric first aid, emergency department visit]), and noncompliance (to medication and clinical activities).
Results: 16 of 693 unduplicated studies were included. CDPIs significantly reduced patient hospitalization (RR [95% CI], 0.71 [0.57-0.89]; p=0.003) and relapse (0.59 [0.45-0.76]; p<0.001). Relationships were strongest at 12-month follow-up for hospitalizations (0.67 [0.49-0.92]; p=0.01) and relapse (0.47 [0.32-0.69]; p<0.001). CDPIs had also significantly reduced noncompliance risk overall (0.38 [0.19-0.74]; p=0.005). Medication compliance alone favored CDPI but was nonsignificant, whereas compliance with clinical activities alone (eg, keeping appointments) alone significantly favored CDPI (0.22 [0.11-0.47]; p<0.00001). The overall effect of CDPIs for other key events favored CDPI, but results were not statistically significant.
Conclusions: Support and skills training for caregivers of persons with schizophrenia can reduce hospitalization and potentially improve other outcomes.