Effectiveness of Internet-based Psychosocial Interventions among Family Caregivers of People with Schizophrenia: A Systematic Review
DOI:
https://doi.org/10.60099/prijnr.2023.262390Keywords:
Caregiver burden, Expressed emotion, Family caregivers, Internet-based intervention, Psychological distress, Psychosocial intervention, Schizophrenia Spectrum Disorders, Systematic reviewAbstract
Internet-based interventions have long been available in mental health care, offering alternative options for caring for patients and caregivers. This review aimed to evaluate the effectiveness of internet-based psychosocial interventions on psychological distress, caregiving burden, expressed emotion, knowledge about psychosis among family caregivers of people with schizophrenia, and hospitalization of the patients. A systematic search was conducted on June 20, 2022, in six databases (MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, and ProQuest) from 2010 onwards in English and Thai. The review was conducted based on the JBI approach and reported following the PRISMA guidelines. The protocol was registered in PROSPERO as CRD42021255318.
Five out of 20 studies were included in the review. Meta-analysis was impossible due to the methodological heterogeneity across the included studies; therefore, narrative synthesis was utilized. Psychological distress was not improved as reported in one study; however, the caregiving burden was improved in another study. Two studies reported expressed emotion; however, they were impossible to combine due to methodological differences, and the results contradicted each other. Knowledge about psychosis was also found to contradict results in two individual studies. Hospitalization was not impacted by the intervention based on one study.
Four studies were randomized control trials, and another was a quasi-experimental research study. One out of four of the former did not mention blinding during randomization, which creates potential performance and detection bias. A robust randomized control trial should be carried out with a similar outcome measurement to decrease the heterogeneity and enhance the possibility for further meta-analysis and the ability to recommend for practice.
References
Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx) [Internet]. 2019 [cited 2023 May 27]. Available from: https://vizhub.healthdata.org/gbd-results/?params=gbd-api-2019-permalink/27a7644e8ad28e739382d31e77589dd7
Charlson FJ, Ferrari AJ, Santomauro DF, Dominic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: findings from the Global Burden of Disease Study 2016. Schizophr Bull. 2018;44(6):1195-203. doi:10.1093/schbul/sby058.
GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137-50. doi:10.1016/ S2215-0366(21)00395-3.
Fleischhacker WW, Arango C, Arteel P, Barnes TR, Carpenter W, Duckworth K, et al. Schizophrenia--time to commit to policy change. Schizophr Bull. 40 Suppl 3(Suppl 3): S165-94. doi:10.1093/schbul/sbu006.
Gowda GS, Das S, Nanjegowda RB. Psychotropic implants can be a new hope in psychiatry. Asian J Psychiatr. 2017;30:214-7. doi:10.1016/j.ajp.2017.03.035.
Kunitoh N. From hospital to the community: the influence of deinstitutionalization on discharged long-stay psychiatric patients. Psychiatry Clin Neurosci. 2013;67(6):384-96. doi:10.1111/pcn.12071.
World Health Organization. Mental health action plan 2013-2020 [Internet]. 2013 [cited 2023 Apr 10]. Available from: https://www.who.int/publications/i/ item/9789241506021
World Health Organization. Schizophrenia [Internet]. 2022 [cited 2023 Feb 24]. Available from: https://www.who. int/news-room/fact-sheets/detail/schizophrenia
Schene AH, van Wijngaarden B, Koeter MW. Family caregiving in schizophrenia: domains and distress. Schizophr Bull. 1998;24(4):609-18. doi:10.1093/oxford journals. schedule.a033352.
Huang XY, Hung BJ, Sun FK, Lin JD, Chen CC. The experiences of carers in Taiwanese culture who have long-term schizophrenia in their families: a phenomenological study. J Psychiatr Ment Health Nurs. 2009;16(10):874- 83. doi:10.1111/j.1365-2850.2009.01468.x.
Tungpunkom P, Srikhachin P, Napa W, Chaniang S. Caregiving experiences of families living with patients with schizophrenia: a systematic review. JBI Libr Syst Rev. 2012;10(28 Suppl):1-8. doi:10.11124/jbisrir-2012-324.
Ranjan L, Gupta P, Kiran M, Singh N. Family care burden and its association with psychological distress among caregivers of chronic patients with schizophrenia. J Public Health Prim Care. 2022;3(3):81-5. doi:10.4103/ jphpc.jphpc_16_22.
Mehmood N, Talib U, Naeem F. The level of depression and anxiety among caregivers of patients with schizophrenia. Br J Med Med Res. 2022;9(2):252-63. doi:10.14738/ jbemi.92.11984.
National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. [Internet]. 2014 Mar [cited 2022 Mar 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555203/
Zhou Z, Wang Y, Feng P, Li T, Tebes JK, Luan R, et al. Associations of caregiving knowledge and skills with caregiver burden, psychological well-being, and coping styles among primary family caregivers of people living with schizophrenia in China. Front Psychiatry. 2021;12:631420. doi:10. 3389/fpsyt.2021.631420.
Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophr Bull. 2010;36(1):94-103. doi:10.1093/ schbul/sbp130.
Norman R, Lecomte T, Addington D, Anderson E. Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults. Can J Psychiatry. 2017;62(9):617-23. doi:10. 1177/0706743717719894.
Ince P, Haddock G, Tai S. A systematic review of the implementation of recommended psychological interventions for Schizophrenia: rates, barriers, and improvement strategies. Psychol Psychother. 2016;89(3):324-50. doi:10.1111/papt.12084.
Caqueo-Urízar A, Urzúa A, Ponce-Correa F, Ferrer R. Psychosocial effects of the COVID-19 pandemic on patients with schizophrenia and their caregivers. Front Psychol. 2021;12:729793. doi:10.3389/fpsyg.2021.729793.
The Bellagio eHealth Evaluation Group. Call to action on global eHealth evaluation [Internet]. 2011 [cited 2023 May 27]. Available from: https://www.who.int/publications/m/ item/call-to-action-on-global-ehealth-evaluation.
Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014;13(1):4-11. doi:10.1002wps.20083.
Ozkan B, Erdem E, Demirel Ozsoy S, Zararsiz G. Effect of psychoeducation and telepsychiatric follow up given to the caregiver of the schizophrenic patient on family burden, depression and expression of emotion. Pak J Med Sci. 2013; 29(5): 1122-7. doi:10.12669/pjms.295.2613.
Haley C, O’Callaghan E, Hill S, Mannion N, Donnelly B, Kinsella A, et al. Telepsychiatry and carer education for schizophrenia. Eur Psychiatry. 2011;26(5):302-4. doi:10.1016/j.eurpsy.2009.12.021.
Glynn SM, Randolph ET, Garrick T, Lui A. A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia. Psychiatr Rehabil J. 2010;33(4):278-87. doi:10.2975/ 33.4.2010.278.287.
Onwumere J, Amaral F, Valmaggia LR. Digital technology for caregivers of people with psychosis: systematic review. JMIR Ment Health. 2018;5(3):e55. doi:10.2196/mental.9857.
Barbeito S, Sánchez-Gutiérrez T, Becerra-García JA, González Pinto A, Caletti E, Calvo A. A systematic review of online interventions for families of patients with severe mental disorders. J Affect Disord. 2020;263:147-54. doi:10.1016/j.jad.2019.11.106.
Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis [Internet]. 2020 [cited 2022 Jun 19]. Available from: https://synthesismanual.jbi.global
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. doi:10.1186/s13643-021-01626-4.
Kaewwanna W, Bhatarasakoon P, Kitsumban V. Effectiveness of Internet-based psychosocial interventions on psychological distress, expressed emotion, and knowledge about psychosis among family caregivers of people with schizophrenia: a systematic review protocol. JBI Evid Synth. 2023;21(4): 789-95. doi:10.11124/JBIES-22-00132.
Munn Z, Aromataris E, Tufanaru C, Stern C, Porritt K, Farrow J, et al. The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Int J Evid Based Healthc. 2019;17(1):36-43. doi:10.1097/XEB.00000000 00000152.
Munn Z, Tufanaru C, Aromataris E. JBI’s systematic reviews: data extraction and synthesis. Am J Nurs. 2014;114(7):49-54. doi:10.1097/01.NAJ.0000451 683.66447.89.
Rotondi AJ, Anderson CM, Haas GL, Eack SM, Spring MB, Ganguli R, et al. Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes. Psychiatr Serv. 2010; 61(11):1099-105. doi:10.1176/ps.2010.61.11.1099.
Chien WT, Bressington D, Lubman DI, Karatzias T. A randomised controlled trial of a caregiver-facilitated problem-solving based self-learning program for family carers of people with early psychosis. Int J Environ Res Public Health. 2020;17(24):9343. doi:10.3390/ ijerph17249343.
Budiono W, Kantono K, Kristianto FC, Avanti C, Herawati F. Psychoeducation improved illness perception and expressed emotion of family caregivers of patients with schizophrenia. Int J Environ Res Public Health. 2021; 18(14):7522. doi:10.3390/ijerph18147522.
Sin J, Henderson C, Elkes J, et al. Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial. Lancet Digit Health. 2022;4(5):e320-9. doi:10.1016/ S2589-7500(22)00031-0.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Pacific Rim International Journal of Nursing Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
