Carer-focused strategies may improve caregiving experience for informal carers of people with mental illness

Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, et al. Interventions to improve the experience of caring for people with severe mental illness: Systematic review and meta-analysis Brit J Psychiat. 2015;206:268-274.

Review question

What are the most effective ways to improve the caregiving experience and reduce burden for informal caregivers of individuals with severe mental illness?

Background

Informal caregivers play an important role in providing care for their family members or friends with severe mental health problems. However, their support needs are often disregarded, as most programs and resources provided by social and health care services focus solely on individuals with mental illness, not their caregivers. No systematic reviews or meta-analyses have previously focused on improving caregivers’ experiences or reducing caregiver burden.  

How the review was done

This is a systematic review of 21 randomized controlled trials published between 1987 and 2013 with 1589 participants. A meta-analysis was conducted on 20 of the trials with 1364 participants.

Key features of the studies were: 

• Across studies, average age of caregivers ranged from 36 to 56 years, and the majority of studies included a higher proportion of women than men.
• The studies differed by: sample size (40 to 225 participants); patient diagnosis (schizophrenia spectrum disorder, psychosis, or bipolar disorder); type of support programs (individual psychoeducation, group psychoeducation, support group, combined psychoeducation and support group, bibliotherapy, or self-management); as well as the caregivers’ experience of caregiving, quality of life, and level of psychological distress.
• Researchers measured how the support programs impacted caregivers’ experience of caregiving for individuals with severe mental health problems. Some studies also measured caregivers’ satisfaction with services, quality of life, and psychological distress.
• Impacts of the support programs were measured immediately at the end of the program period, in the short term (up to 6-months later), and long term (more than 6-months later).

What the researchers found

The studies varied greatly from each other and were therefore difficult to compare.

Overall the evidence is of very low or low quality, meaning the results must be interpreted with caution. The findings provide some limited evidence that group psychoeducation decreased caregiver’s psychological distress in the long term, and that this approach may enhance the caregiver experience in the short and long term. Bibliotherapy (self-help manuals) may also decrease psychological distress immediately and in the short-term and quality of life in the short term. Furthermore, a support group may improve the experience of caregivers both immediately and over-time, and reduce distress immediately and in the short term. The impact of self-management and combining psychotherapy with support groups on caregivers is inconclusive at this time.  No interventions were shown to improve caregivers’ satisfaction with services.

Conclusion

Psychoeducation, support groups and bibliotherapy may decrease psychological distress associated with caring for individuals with severe mental illness and may enhance the experience of caregivers, but more high quality research is needed to draw more conclusive recommendations for practice.